Sleep restriction therapy and hypnotic withdrawal versus sleep hygiene education in hypnotic using patients with insomnia.
OBJECTIVE
Insomnia is a common problem that affects 9% to 15% of the population chronically. The primary objective of this study was to demonstrate that 8 weekly sessions of sleep restriction therapy of insomnia combined with hypnotic reduction instructions following a single session of sleep hygiene education would result in greater improvements in sleep and hypnotic use than sleep hygiene education alone.


METHODS
Forty-six men and women were recruited from a sleep medicine practice and randomly assigned to sleep hygiene education plus 8 weeks of sleep restriction and hypnotic withdrawal (SR+HW; n = 24), or a sleep hygiene education alone (SHE; n = 22) condition. Pre-randomization, all patients received a single session of instruction in good sleep habits (sleep hygiene education).


RESULTS
The SR+HW condition had greater improvements in hypnotic medication usage, sleep onset latency, morning wake time, sleep efficiency, and wake time after sleep onset (trend), than the SHE condition. Continued improvement was seen in TST in the SR+HW group at 6-month follow-up, and gains on all other variables were maintained at 6- and 12-month follow-up.


CONCLUSIONS
These results provide evidence that more intensive treatment of insomnia (i.e., 8 sessions of SR+HW plus hypnotic withdrawal instructions) results in better outcomes than SHE alone.
Taylor
Daniel J
DJ
University of North Texas, Denton, TX 762031280, USA. djtaylor@unt.edu
Schmidt-Nowara
Wolfgang
W
Jessop
Carol A
CA
Ahearn
John
J
D001521:Behavior Therapy / Q000379:methods*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006266:Health Education / Q000379:methods; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods*; D017286:Polysomnography / Q000379:methods; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy / Q000628:therapy*; D016896:Treatment Outcome; D014851:Wakefulness
D006993:Hypnotics and Sedatives
Sleep Med Rev. 2002 Apr;6(2):97-111
12531146
Sleep. 2003 Mar 15;26(2):177-82
12683477
J Geriatr Psychiatry Neurol. 2000 Spring;13(1):17-27
10753003
Br J Gen Pract. 2003 Dec;53(497):923-8
14960215
Behav Modif. 1999 Jul;23(3):379-402
10467890
Sleep. 1999 May 1;22 Suppl 2:S386-93
10394612
Behav Res Ther. 2001 Jan;39(1):45-60
11125723
Sleep. 1987 Feb;10(1):45-56
3563247
Sleep. 2006 Nov;29(11):1398-414
17162986
Am J Psychiatry. 2002 Jan;159(1):5-11
11772681
J Gerontol. 1991 Jan;46(1):P1-8
1986039
Sleep. 2006 Nov;29(11):1415-9
17162987
Behav Modif. 1998 Jan;22(1):3-28
9567734
Sleep Med. 2008 Jan;9(2):165-71
17644419
Arch Intern Med. 2004 Sep 27;164(17):1888-96
15451764
Am J Psychiatry. 2004 Feb;161(2):332-42
14754783
Sleep. 2007 May;30(5):574-84
17552372
JAMA. 2006 Jun 28;295(24):2851-8
16804151
JAMA. 1999 Mar 17;281(11):991-9
10086433
Eur Arch Psychiatry Clin Neurosci. 1993;242(6):329-36
8323982
Psychol Med. 2003 Oct;33(7):1223-37
14580077
Proc (Bayl Univ Med Cent). 2008 Jul;21(3):264-5
18628925