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BERGEN, NORWAY | A unique and much-needed phase III study comparing the outcomes of psychological and pharmacological treatments for older adults with insomnia has found that cognitive behavioural therapy (CBT) is superior to treatment with the drug zopiclone in these patients-both in the short and long term.

According to the researchers, the finding has important clinical implications because at present CBT-based interventions for insomnia are not widely available in practice.

In the June 28 issue of the Journal of the American Medical Association, Dr. Bjørn Bjorvatn and colleagues from the University of Bergen used poly-somnography to compare these interventions in a randomized, double-blinded, placebo-controlled trial of 48 adults with a mean age of of 61 years who suffered from chronic primary insomnia. These treatments were received for six weeks, with the two active arms followed up at six months...

The original article can found in the Media Doctor archives.

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The key drawback to this report of an innovative study comparing cognitive behavioural therapy against the commonly prescribed sleep aid, zopiclone is that it quotes the evidence only in relative numbers and sometimes presents the evidence in a confusing and unenlightening manner.

For example the author notes that "CBT and zopiclone were compared in their ability to improve slow-wave sleep, which is believed responsible for much of the next-day sleepiness experienced by insomniacs that can lead to car accidents. Other measures assessed in the study were total wake time, total sleep time and sleep efficiency."

It is unclear if the author is saying that slow-wave sleep is a good thing or a bad thing? Nor is it clear what is meant by "sleep efficiency." And what would be most important to patients and clinicians is whether these parameters are clinically significant or known to improve quality of life.

While the treatment seems promising, more detail could be provided about the CBT interventions. How many sessions? How long do they take? Are they difficult to teach to elderly patients? And who pays for them? In BC, at least, MSP would not fund these techniques when taught by GPs.

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