Comparative study of effectiveness of cognitive behavioral self-help therapy and zolpidem on patients with chronic insomnia / 中华神经医学杂志

ABSTRACT

Objective To test the efficacy of cognitive behavioral self-help therapy (CBTI-SH) on patients with chronic insomnia vs.a zolpidem control condition.Methods A total of 60 adults with chronic insomnia and common comorbidities were recruited from our hospital from July 2011 to October 2012.Participants were randomly assigned to either intervention group (n=30),consisting of sleep hygiene plus four-week CBTI-SH with printed material and 2 telephone instruction-calls,or control group (n=30),consisting of sleep hygiene plus a four-week supervised zolpidem tapering therapy.The CBTI-SH included cognitive restruction,stimulus control therapy,sleep restriction therapy and relaxation therapy.The primary outcome was self-report symptom,based on sleep diaries (including Sleep Latency-SL,Total Sleep Time-TST,Time In Bed-TIB,Sleep Efficiency-SE,Wake after Sleep Onset-WASO),Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleeping Scale (ESS) which were evaluated at baseline and at the end of the 2th,4th,6th week treatment.Continuous variables were evaluated by repeated-measures multivariate analyses of variance (MANOVA).At the end of every two weeks,each participant was asked to assess treatment adherence to the six core recommendations of CBTI-SH or sleep hygiene.Results The multivariate analysis of variance showed a significant treatment group plus time interaction,and time main effects for PSQI,ESS,SL,SE,TST,TIB and WASO in the two groups (P＜0.05).The patients in the intervention group had significantly better outcomes than those in control group.Effect sizes (Cohen d)were 1.93,0.04,1.00,0.98,0.11,0.57 and 0.43,respectively.The intervention group reported higher average adherence scores in "use of the bed only for sleeping,not worrying in bed",and lower average scores in "adherence to TIB prescription,getting out of bed when unable to sleep",compared with those in the control group.Conclusion CBTI-SH is effective for treating chronic insomnia and daytime sleepiness as compared with supervised zolpidem tapering therapy,but the treatment adherence needs to be improved.