Sivertsen B et al. (2006) Cognitive behavioral therapy vs zopiclone for treatment of chronic primary insomnia in older adults: a randomized controlled trial. JAMA 295: 2851–2858

Insomnia is common in older adults (i.e. those aged ≥55 years), but most cases go untreated. Pharmacological treatments have shown good short-term efficacy, but long-term use can lead to dependency or tolerance. Cognitive behavioral therapy (CBT) is effective in patients aged <55 years, but is believed to be less beneficial in older patients. A recent randomized, controlled trial compared CBT with the non-benzodiazepine treatment zopiclone in adults ≥55 years of age.

In total, 46 individuals (mean age 60.8 years) with chronic primary insomnia received CBT weekly (n = 18), 7.5 mg zoplicone daily (n = 16) or placebo daily (n = 12) for 6 weeks. Polysomnography was used to assess sleep variables at three time points: pretreatment, at 6 weeks, and 6 months after treatment completion.

At 6 weeks, wake time decreased significantly more in CBT-treated patients than in those treated with zopiclone or placebo: CBT-treated patients spent 52% less time awake than at pretreatment, compared with 4% less time awake for zoplicone-treated patients and 16% less time awake for placebo-treated patients (P <0.001). The amount of slow-wave sleep increased considerably in patients who received CBT, but decreased in patients treated with zopiclone or placebo. Changes in total sleep time were similar between interventions, but sleep efficiency was higher in CBT-treated patients than in placebo-treated patients (P = 0.004). At 6 months, total wake time, sleep efficiency and slow-wave sleep showed greater improvement in CBT-treated patients than in those who received zopiclone (P <0.008 for all).

The authors conclude that CBT seems to be more effective than zopiclone in both the short term and longer term in older adults with insomnia.