Comparison of cognitive-behavioral therapy and clonazepam for treating periodic limb movement disorder

Many patients with periodic limb movement disorder (PLMD) display inadequate sleep hygiene, and others decline conventional pharmacologic intervention for their form of sleep disturbance. Nonetheless, the use of nonpharmacologic therapies with PLMD remains unexplored. The current study was designed to compare the short-term treatment effects of a cognitive-behavioral therapy (CBT) and conventional pharmacotherapy (clonazepam) among a group of insomniacs with PLMD. The 16 subjects participating in this study first underwent baseline assessment procedures, including completion of a sleep log for 2 weeks, an ambulatory polysomnogram (APSG) and an Insomnia Symptom Questionnaire (ISQ). They then were randomized either to CBT (n = 8) or standard clonazepam therapy (n = 8). Subjects maintained sleep logs throughout a 4-week treatment and then completed a second APSG and ISQ. Comparison of pre- and post-treatment data suggested that the two treatments led to equal improvements in sleep log measures of sleep-wake times and ISQ measures of subjective sleep concerns. Patients treated with CBT showed a decrease in daytime napping, whereas the clonazepam group reported increased napping. Conversely, those treated with clonazepam showed larger declines in periodic limb movement-arousals per hour of sleep than did the CBT group. Post-treatment interviews suggested that both CBT and clonazepam therapies were generally well tolerated by study participants. It is concluded that both treatments may be useful for PLMD but that the two treatments may have contrasting effects across selected measures of improvement. Additional research is needed to examine the long-term efficacy of CBT as a primary or adjunctive treatment for varying levels of PLMD severity.