title: Cognitive behavioral therapy vs zopiclone for treatment of chronic primary insomnia in older adults: a randomized controlled trial.
abstract: BACKGROUND
  Insomnia is a common condition in older adults and is associated with a number of adverse medical, social, and psychological consequences. Previous research has suggested beneficial outcomes of both psychological and pharmacological treatments, but blinded placebo-controlled trials comparing the effects of these treatments are lacking.
  
  
  OBJECTIVE
  To examine short- and long-term clinical efficacy of cognitive behavioral therapy (CBT) and pharmacological treatment in older adults experiencing chronic primary insomnia.
  
  
  METHODS
  A randomized, double-blinded, placebo-controlled trial of 46 adults (mean age, 60.8 y; 22 women) with chronic primary insomnia conducted between January 2004 and December 2005 in a single Norwegian university-based outpatient clinic for adults and elderly patients.
  
  
  METHODS
  CBT (sleep hygiene, sleep restriction, stimulus control, cognitive therapy, and relaxation; n = 18), sleep medication (7.5-mg zopiclone each night; n = 16), or placebo medication (n = 12). All treatment duration was 6 weeks, and the 2 active treatments were followed up at 6 months.
  
  
  METHODS
  Ambulant clinical polysomnographic data and sleep diaries were used to determine total wake time, total sleep time, sleep efficiency, and slow-wave sleep (only assessed using polysomnography) on all 3 assessment points.
  
  
  RESULTS
  CBT resulted in improved short- and long-term outcomes compared with zopiclone on 3 out of 4 outcome measures. For most outcomes, zopiclone did not differ from placebo. Participants receiving CBT improved their sleep efficiency from 81.4% at pretreatment to 90.1% at 6-month follow-up compared with a decrease from 82.3% to 81.9% in the zopiclone group. Participants in the CBT group spent much more time in slow-wave sleep (stages 3 and 4) compared with those in other groups, and spent less time awake during the night. Total sleep time was similar in all 3 groups; at 6 months, patients receiving CBT had better sleep efficiency using polysomnography than those taking zopiclone.
  
  
  CONCLUSIONS
  These results suggest that interventions based on CBT are superior to zopiclone treatment both in short- and long-term management of insomnia in older adults.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00295386.
authors.affiliation: Department of Clinical Psychology, University of Bergen, Bergen, Norway. borge.sivertsen@psykp.uib.no
authors.forename: Børge
authors.initials: B
authors.lastname: Sivertsen
authors.forename: Siri
authors.initials: S
authors.lastname: Omvik
authors.forename: Ståle
authors.initials: S
authors.lastname: Pallesen
authors.forename: Bjørn
authors.initials: B
authors.lastname: Bjorvatn
authors.forename: Odd E
authors.initials: OE
authors.lastname: Havik
authors.forename: Gerd
authors.initials: G
authors.lastname: Kvale
authors.forename: Geir Høstmark
authors.initials: GH
authors.lastname: Nielsen
authors.forename: Inger Hilde
authors.initials: IH
authors.lastname: Nordhus
mesh_terms: D000368:Aged; D053961:Azabicyclo Compounds; D002908:Chronic Disease; D015928:Cognitive Behavioral Therapy; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010879:Piperazines / Q000627:therapeutic use*; D017286:Polysomnography; D007319:Sleep Initiation and Maintenance Disorders / Q000628:therapy*
chemical_list: D053961:Azabicyclo Compounds; D006993:Hypnotics and Sedatives; D010879:Piperazines; C515050:zopiclone