title: Long-Term Maintenance of Therapeutic Gains Associated With Cognitive-Behavioral Therapy for Insomnia Delivered Alone or Combined With Zolpidem.
abstract: To document the long-term sleep outcomes at 12 and 24 months after patients with chronic insomnia were treated with cognitive-behavioral therapy (CBT), either singly or combined with zolpidem medication.
  
  
  
  Participants were 160 adults with chronic insomnia. They were first randomized for a six-week acute treatment phase involving CBT alone or CBT combined with nightly zolpidem, and randomized for a six-month extended treatment phase involving CBT, no additional treatment, CBT combined with zolpidem as needed, or CBT with zolpidem tapered. This paper reports results of the 12- and 24-month follow-ups on the main outcome measures derived from the Insomnia Severity Index and sleep diaries.
  
  
  
  Clinical improvements achieved 6 months following the end of treatment were well-maintained in all four conditions, with insomnia remission rates ranging from 48% to 74% at the 12-month follow-up, and from 44% to 63% at the 24-month follow-up. Participants receiving CBT with zolpidem taper in the extended treatment phase had significantly better results than those receiving CBT with continued zolpidem as needed. The magnitude of improvements on sleep diary parameters was similar between conditions, with a slight advantage for the CBT with zolpidem taper condition. The addition of extended CBT did not alter the long-term outcome over improvements obtained during the initial 6-week CBT.
  
  
  
  The results suggest that CBT for insomnia, when delivered alone or in combination with medication, produce durable sleep improvements up to two years after completion of treatment. These long-term results indicate that even if a combined CBT plus medication approach provide an added benefit immediately after treatment, extending CBT while tapering medication produce better sustained improvements compared to continued use of medication as needed.
authors.affiliation: École de psychologie, Université Laval, Pavillon Félix-Antoine Savard, 2325, des Bibliothèques, Québec G1V 0A6, Canada.
authors.forename: Simon
authors.initials: S
authors.lastname: Beaulieu-Bonneau
authors.affiliation: École de psychologie, Université Laval, Pavillon Félix-Antoine Savard, 2325, des Bibliothèques, Québec G1V 0A6, Canada.
authors.forename: Hans
authors.initials: H
authors.lastname: Ivers
authors.affiliation: Centre de recherche de l'Institut universitaire en santé mentale de Québec, 2601, de la Canardière, Québec G1J 2G3, Canada.
authors.forename: Bernard
authors.initials: B
authors.lastname: Guay
authors.affiliation: École de psychologie, Université Laval, Pavillon Félix-Antoine Savard, 2325, des Bibliothèques, Québec G1V 0A6, Canada.|Centre de recherche de l'Institut universitaire en santé mentale de Québec, 2601, de la Canardière, Québec G1J 2G3, Canada.
authors.forename: Charles M
authors.initials: CM
authors.lastname: Morin
mesh_terms: D000328:Adult; D003071:Cognition; D015928:Cognitive Behavioral Therapy / Q000379:methods; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011725:Pyridines / Q000008:administration & dosage*; D012890:Sleep; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy / Q000628:therapy*; D016896:Treatment Outcome; D000077334:Zolpidem
chemical_list: D006993:Hypnotics and Sedatives; D011725:Pyridines; D000077334:Zolpidem
keywords: CBT; Insomnia; behavioral; medication.; nonpharmacological; sleep; treatment