title: Psychological treatment of hypnotic-dependent insomnia in a primarily older adult sample.
abstract: OBJECTIVE
  This study tested cognitive behavior therapy (CBT) in hypnotic-dependent, late middle-age and older adults with insomnia.
  
  
  METHODS
  Seventy volunteers age 50 and older were randomized to CBT plus drug withdrawal, placebo biofeedback (PL) plus drug withdrawal, or drug withdrawal (MED) only. The CBT and PL groups received eight, 45 min weekly treatment sessions. The drug withdrawal protocol comprised slow tapering monitored with about six biweekly, 30 min sessions. Assessment including polysomnography (PSG), sleep diaries, hypnotic consumption, daytime functioning questionnaires, and drug screens collected at baseline, posttreatment, and 1-year follow-up.
  
  
  RESULTS
  Only the CBT group showed significant sleep diary improvement, sleep onset latency significantly decreased at posttreatment. For all sleep diary measures for all groups, including MED, sleep trended to improvement from baseline to follow-up. Most PSG sleep variables did not significantly change. There were no significant between group differences in medication reduction. Compared to baseline, the three groups decreased hypnotic use at posttreatment, down 84%, and follow-up, down 66%. There was no evidence of withdrawal side-effects. Daytime functioning, including anxiety and depression, improved by posttreatment. Rigorous methodological features, including documentation of strong treatment implementation and the presence of a credible placebo, elevated the confidence due these findings.
  
  
  CONCLUSIONS
  Gradual drug withdrawal was associated with substantial hypnotic reduction at posttreatment and follow-up, and withdrawal side-effects were absent. When supplemented with CBT, participants accrued incremental self-reported, but not PSG, sleep benefits.
authors.affiliation: The University of Alabama, United States. Electronic address: lichstein@ua.edu.
authors.forename: Kenneth L
authors.initials: KL
authors.lastname: Lichstein
authors.forename: Sidney D
authors.initials: SD
authors.lastname: Nau
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Wilson
authors.forename: R Neal
authors.initials: RN
authors.lastname: Aguillard
authors.forename: Kristin W
authors.initials: KW
authors.lastname: Lester
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Bush
authors.forename: Christina S
authors.initials: CS
authors.lastname: McCrae
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000704:Analysis of Variance; D001676:Biofeedback, Psychology; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D017286:Polysomnography; D012064:Relaxation Therapy / Q000379:methods; D007319:Sleep Initiation and Maintenance Disorders / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D006993:Hypnotics and Sedatives
keywords: Cognitive behavior therapy; Drug withdrawal; Hypnotic dependence; Insomnia