Speed and trajectory of changes of insomnia symptoms during acute treatment with cognitive-behavioral therapy, singly and combined with medication.
OBJECTIVE
To examine the speed and trajectory of changes in sleep/wake parameters during short-term treatment of insomnia with cognitive-behavioral therapy (CBT) alone versus CBT combined with medication; and to explore the relationship between early treatment response and post-treatment recovery status.


METHODS
Participants were 160 adults with insomnia (mean age, 50.3 years; 97 women, 63 men) who underwent a six-week course of CBT, singly or combined with 10 mg zolpidem nightly. The main dependent variables were sleep onset latency, wake after sleep onset, total sleep time, sleep efficiency, and sleep quality, derived from sleep diaries completed daily by patients throughout the course of treatment.


RESULTS
Participants treated with CBT plus medication exhibited faster sleep improvements as evidenced by the first week of treatment compared to those receiving CBT alone. Optimal sleep improvement was reached on average after only one week for the combined treatment compared to two to three weeks for CBT alone. Early treatment response did not reliably predict post-treatment recovery status.


CONCLUSIONS
Adding medication to CBT produces faster sleep improvement than CBT alone. However, the magnitude of early treatment response is not predictive of final response after the six-week therapy. Additional research is needed to examine mechanisms involved in this early treatment augmentation effect and its impact on long-term outcome.
École de psychologie, Université Laval, Québec, QC, Canada; Centre de recherche de l'Institut universitaire en santé mentale de Québec, Québec, QC, Canada. Electronic address: cmorin@psy.ulaval.ca.
Charles M
CM
Morin
École de psychologie, Université Laval, Québec, QC, Canada; Centre de recherche de l'Institut universitaire en santé mentale de Québec, Québec, QC, Canada.
Simon
S
Beaulieu-Bonneau
École de psychologie, Université Laval, Québec, QC, Canada; Centre de recherche de l'Institut universitaire en santé mentale de Québec, Québec, QC, Canada; Centre de recherche du CHU de Québec, Québec, QC, Canada.
Hans
H
Ivers
École de psychologie, Université Laval, Québec, QC, Canada; Centre de recherche de l'Institut universitaire en santé mentale de Québec, Québec, QC, Canada; Centre de recherche du CHU de Québec, Québec, QC, Canada.
Annie
A
Vallières
Centre de recherche de l'Institut universitaire en santé mentale de Québec, Québec, QC, Canada.
Bernard
B
Guay
École de psychologie, Université Laval, Québec, QC, Canada; Centre de recherche du CHU de Québec, Québec, QC, Canada.
Josée
J
Savard
Centre de recherche de l'Institut universitaire en santé mentale de Québec, Québec, QC, Canada; Faculté de médicine, Université Laval, Québec, QC, Canada.
Chantal
C
Mérette
D000328:Adult; D000368:Aged; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011725:Pyridines / Q000627:therapeutic use; D012720:Severity of Illness Index; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D000077334:Zolpidem
D006993:Hypnotics and Sedatives; D011725:Pyridines; D000077334:Zolpidem
Cognitive–behavioral therapy; Combined therapy; Insomnia; Medication; Sleep; Treatment response