Psych, med therapies improved daytime insomnia symptoms, functionality

Key takeaways:

• The study included 211 adults with insomnia who received 6 weeks of treatment.
• Posttreatment benefits were consistent during 12-month follow-up, with additional benefit for those given behavioral therapy.

Combination behavioral and pharmaceutical therapy improved functionality and daytime symptoms of insomnia, while addition of a second treatment provided further benefits for the condition, according to research from JAMA Network Open.

“Insomnia is a 24-hour disorder that consists not only of nocturnal symptoms but also daytime symptoms,” Charles M. Morin, PhD, a professor in the department of psychology at the Brain Research Center at the University of Laval in Canada, and colleagues wrote. “As one of the key components for insomnia diagnosis, daytime functional impairments such as fatigue and mood disturbances are often the primary reasons for patients with insomnia to seek treatment.

Morin and colleagues aimed to compare effectiveness of behavioral therapy (BT) and zolpidem as initial methods for improving daytime functions among those with insomnia, as well as to evaluate the value of additional treatment without insomnia recurrence.

Their randomized clinical trial was conducted at institutions in Quebec City and Denver between May 2012 and December 2015. A total of 211 adults (mean age 45.6 years; 63% women) with chronic insomnia disorder were assigned 1:1 to receive either BT or zolpidem as first-stage therapy, while those for whom insomnia had not remitted received second-stage psychological therapy (BT or cognitive therapy) or medication (zolpidem or trazodone), for 6 weeks. Initial randomization was stratified by age, sex and presence of a comorbid psychiatric issue. After the initial treatment period, those who met insomnia remission criteria received 12 months of follow up with maintenance therapy.

Primary outcomes for analysis were daytime symptoms of insomnia including mood disturbances, fatigue, functional impairments of insomnia and scores on the 36-item Short-Form Health Survey (SF-36) physical and mental health components.

According to results, first-stage treatment with BT or zolpidem yielded significant and equivalent benefits for daytime outcomes, including depressive symptoms (Beck Depression Inventory-II mean score change, 3.5 [95% CI, 4.7 to 2.3] vs 4.3 [95% CI, 5.7 to 2.9]), fatigue (Multidimensional Fatigue Inventory mean score change, 4.7 [95% CI, 7.3 to 2.2] vs 5.2 [95% CI, 7.9 to 2.5]), functional impairments (Work and Social Adjustment Scale mean score change, 5.0 [95% CI, 6.7 to 3.3] vs 5.1 [95% CI, 7.2 to 2.9]) and mental health (SF-36 mental health subscale mean score change, 3.5 [95% CI, 1.9-5.1] vs 2.5 [95% CI, 0.4-4.5]).

Data further showed second-stage therapy resulted in similar improvements for both conditions, while posttreatment benefits were solid across the 12-month follow-up and additional improvements were noted for patients receiving BT.

“Future developments of insomnia treatment strategies should take into account the daytime consequences of insomnia,” Morin and colleagues wrote.