Can we mix behavioral therapy with hypnotics when treating insomniacs?

Area of Science:

• Behavioral sleep medicine
• Clinical psychology
• Sleep science

Background:

• Insomnia is a prevalent sleep disorder affecting millions globally.
• Behavioral therapies are first-line treatments for chronic insomnia.
• The role of concomitant hypnotic use during behavioral therapy for insomnia is not fully understood.

Purpose of the Study:

• To investigate whether abstaining from hypnotics is necessary for effective behavioral therapy in insomniacs.
• To compare the long-term efficacy of behavioral therapy with and without occasional hypnotic use.

Main Methods:

• Twenty-six insomniacs received six sessions of sleep hygiene and relaxation training.
• Subjects were randomized to either abstain from hypnotics or use them occasionally.
• Sleep was monitored in-lab and at home, with follow-up immediately post-treatment and 10 months later.

Main Results:

• Behavioral therapy significantly improved sleep latency and efficiency compared to a waiting list, regardless of hypnotic use.
• Immediate post-treatment improvements were similar between groups receiving behavioral therapy alone or combined with occasional hypnotics.
• At 10-month follow-up, subjects who abstained from hypnotics showed greater improvements in sleep duration and efficiency.

Conclusions:

• Behavioral therapy is effective for insomnia, even with occasional hypnotic use.
• Discontinuing hypnotics during behavioral therapy may lead to superior long-term sleep outcomes.
• Clinicians should consider advising insomniacs to abstain from hypnotics during behavioral treatment for sustained benefits.