Psychological treatment for insomnia in the management of long-term hypnotic drug use: A pragmatic randomised controlled trial

Abstract

Objective: To evaluate the clinical and cost impact of providing cognitive behaviour therapy (CBT) for insomnia (comprising sleep hygiene, stimulus control, relaxation and cognitive therapy components) to long-term hypnotic drug users in general practice. Design: A pragmatic randomised controlled trial with two treatment arms (a CBT treated 'sleep clinic' group, and a 'no additional treatment' control group), with post-treatment assessments commencing at 3 and 6 months. Setting. Twenty-three general practices in Sheffield, UK Participants. Two hundred and nine serially referred patients aged 31-92years with chronic sleep problems who had been using hypnotic drugs for at least I month (mean duration 13.4 years). Results. At 3- and 6-month follow-ups patients treated with CBT reported significant reductions in sleep latency, significant improvements in sleep efficiency, and significant reductions in the frequency of hypnotic drug use (all P<0.01). Among CBT treated patients SF-36 scores showed significant improvements in vitality at 3 months (P<0.01). older age presented no barrier to successful treatment outcomes. The total cost of service provision was pound154.40 per patient, with a mean incremental cost per quality-adjusted life-year of pound3416 (at 6 months). However there was evidence of longer term cost offsets owing to reductions in sleeping tablet use and reduced utilisation of primary care services. Conclusions: In routine general practice settings, psychological treatments for insomnia can improve sleep quality and reduce hypnotic consumption at a favourable cost among long-term hypnotic users with chronic sleep difficulties.