Cognitive Behavioral Therapy vs Zopiclone for Treatment of Chronic Primary Insomnia in Older Adults: A Randomized Controlled Trial
Abstract
CONTEXT: Insomnia is a common condition in older adults and is associated with a number of adverse medical, social, and psychological consequences. Previous research has suggested beneficial outcomes of both psychological and pharmacological treatments, but blinded placebo-controlled trials comparing the effects of these treatments are lacking. OBJECTIVE: To examine short- and long-term clinical efficacy of cognitive behavioral therapy (CBT) and pharmacological treatment in older adults experiencing chronic primary insomnia. DESIGN, SETTING, AND PARTICIPANTS: A randomized, double-blinded, placebo-controlled trial of 46 adults (mean age, 60.8 y; 22 women) with chronic primary insomnia conducted between January 2004 and December 2005 in a single Norwegian university-based outpatient clinic for adults and elderly patients. INTERVENTION: CBT (sleep hygiene, sleep restriction, stimulus control, cognitive therapy, and relaxation; n = 18), sleep medication (7.5-mg zopiclone each night; n = 16), or placebo medication (n = 12). All treatment duration was 6 weeks, and the 2 active treatments were followed up at 6 months. MAIN OUTCOME MEASURES: Ambulant clinical polysomnographic data and sleep diaries were used to determine total wake time, total sleep time, sleep efficiency, and slow-wave sleep (only assessed using polysomnography) on all 3 assessment points. RESULTS: CBT resulted in improved short- and long-term outcomes compared with zopiclone on 3 out of 4 outcome measures. For most outcomes, zopiclone did not differ from placebo. Participants receiving CBT improved their sleep efficiency from 81.4% at pretreatment to 90.1% at 6-month follow-up compared with a decrease from 82.3% to 81.9% in the zopiclone group. Participants in the CBT group spent much more time in slow-wave sleep (stages 3 and 4) compared with those in other groups, and spent less time awake during the night. Total sleep time was similar in all 3 groups; at 6 months, patients receiving CBT had better sleep efficiency using polysomnography than those taking zopiclone. CONCLUSION: These results suggest that interventions based on CBT are superior to zopiclone treatment both in short- and long-term management of insomnia in older adults. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00295386.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Three RCTs comparing CBT-I, benzodiazepine and placebo for chronic insomnia all show that CBT-I was the most effective sleep intervention.
“Three RCTs [99,100,101] which compared CBT-I, BZD and placebo for chronic insomnia all show that CBT-I was the most effective sleep intervention.”
From Cognitive behavioral therapy and acceptance and commitment therapy for the discontinuation of long-term benzodiazepine use in insomnia and anxiety disorders (2021) · cites this paper as [100]
Pharmacotherapy produced only moderate improvements that were limited to the duration of drug administration.
“Notably, pharmacotherapy produced only moderate improvements that were limited to the duration of drug administration.”
From Cognitive behavioral therapy and acceptance and commitment therapy for the discontinuation of long-term benzodiazepine use in insomnia and anxiety disorders (2021) · cites this paper as [100]
One study found that the interplay between inflammatory and stress markers at the cell level, as assessed in vitro by the sensitivity of monocytes to the counter-inflammatory cortisol signal, was dysregulated following prolonged sleep restriction in humans.
“one study found that the interplay between inflammatory and stress markers at the cell level, as assessed in vitro by the sensitivity of monocytes to the counter-inflammatory cortisol signal, was dysregulated following prolonged sleep restriction in humans”
From The Sleep-Immune Crosstalk in Health and Disease (2019) · cites this paper as [512]
Cognitive Behavioral Therapy for Insomnia does not carry the risks of prescription hypnotic medications and is therefore preferable for reasons beyond demonstrated efficacy, efficacy relative to medications, and effectiveness.
“The recommended first-line treatment, Cognitive Behavioral Therapy for Insomnia (CBTI) does not carry these risks and is therefore preferable for reasons beyond demonstrated efficacy(244-248), efficacy relative to medications(249-253), and effectiveness(254).”
From Sleep: important considerations for the prevention of cardiovascular disease (2016) · cites this paper as [253]
The trials compared CBT-I to zopiclone, zolpidem, temazepam, and triazolam.
“The trials compared CBT-I to zopiclone [29], zolpidem [30], temazepam [31,32], and triazolam [33].”
From Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic review (2012) · cites this paper as [29]
Three included studies had a treatment arm combining CBT-I and medication.
“Of note, three of the studies [29,31,32] included a treatment arm that was a combination of CBT-I and medication.”
From Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic review (2012) · cites this paper as [29]
Cites
Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975) · Journal of Psychiatric Research · doi:10.1016/0022-3956(75)90026-6 · Cited by 88,282 · see citing works
Statistical power analysis for the behavioral sciences
Cohen, J. (1990) · Computers Environment and Urban Systems · doi:10.1016/0198-9715(90)90050-4 · Cited by 65,406 · see citing works
Statistical Power Analysis for the Behavioral Sciences (2nd ed.).
Lachenbruch, P. A., & Cohen, J. (1989) · Journal of the American Statistical Association · doi:10.2307/2290095 · Cited by 37,385 · see citing works
Rechtschaffen, A. (1968) · Medical Entomology and Zoology · Cited by 11,772 · see citing works
(1975) · Medical Entomology and Zoology · Cited by 7,245 · see citing works
Epidemiologic study of sleep disturbances and psychiatric disorders. An opportunity for prevention?
Ford, D. E. (1989) · JAMA · doi:10.1001/jama.262.11.1479 · Cited by 2,440 · see citing works
(1993) · Medical Entomology and Zoology · Cited by 2,324 · see citing works
Epidemiologic Study of Sleep Disturbances and Psychiatric Disorders: An Opportunity for Prevention?
Ford, D. E. (1989) · JAMA · doi:10.1001/jama.1989.03430110069030 · Cited by 2,252 · see citing works
Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits
Glass, J., Lanctôt, K. L., Herrmann, N., Sproule, B. A., & Busto, U. E. (2005) · BMJ · doi:10.1136/bmj.38623.768588.47 · Cited by 1,161 · see citing works
Nonpharmacological interventions for insomnia: a meta-analysis of treatment efficacy
(1994) · American Journal of Psychiatry · doi:10.1176/ajp.151.8.1172 · Cited by 1,098 · see citing works
Behavioral and Pharmacological Therapies for Late-Life Insomnia: A Randomized Controlled Trial
Morin, C. M., Colecchi, C., Stone, J., Sood, R., & Brink, D. (1999) · JAMA · doi:10.1001/jama.281.11.991 · Cited by 1,095 · see citing works
Insomnia and Its Treatment: Prevalence and Correlates
Mellinger, G. D. (1985) · Archives of General Psychiatry · doi:10.1001/archpsyc.1985.01790260019002 · Cited by 1,071 · see citing works
Treatment of Chronic Insomnia by Restriction of Time in Bed
(1987) · Sleep · doi:10.1093/sleep/10.1.45 · Cited by 948 · see citing works
Comparative Meta-Analysis of Pharmacotherapy and Behavior Therapy for Persistent Insomnia
Smith, M. T., Perlis, M. L., Park, A., Smith, M. S., Pennington, J., Giles, D. E., & Buysse, D. J. (2002) · American Journal of Psychiatry · doi:10.1176/appi.ajp.159.1.5 · Cited by 863 · cited 1× · see citing works
“9 on most sleep variables.(48) Hence, expecting a difference between multicomponent CBT and pharmacotherapy at posttreatment and follow-up equivalent to an effect size of approximately 1.”
BackgroundPrevalence, burden, and treatment of insomnia in primary care
(1997) · American Journal of Psychiatry · doi:10.1176/ajp.154.10.1417 · Cited by 694 · see citing works
Identifying effective psychological treatments for insomnia: A meta-analysis.
Murtagh, D. R. R., & Greenwood, K. M. (1995) · Journal of Consulting and Clinical Psychology · doi:10.1037//0022-006x.63.1.79 · Cited by 664 · see citing works
Jacobs, G. D., Pace-Schott, E. F., Stickgold, R., & Otto, M. W. (2004) · Archives of Internal Medicine · doi:10.1001/archinte.164.17.1888 · Cited by 579 · see citing works
Irwin, M. R., Cole, J. C., & Nicassio, P. M. (2006) · Health Psychology · doi:10.1037/0278-6133.25.1.3 · Cited by 537 · see citing works
Identifying effective psychological treatments for insomnia: A meta-analysis.
Murtagh, D. R. R., & Greenwood, K. M. (1995) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.63.1.79 · Cited by 535 · see citing works
Quality of life in people with insomnia.
Zammit, G. K., Weiner, J., Damato, N., Sillup, G. P., & McMillan, C. A. (1999) · PubMed · Cited by 467 · see citing works
Evaluation of Chronic Insomnia
Sateia, M. J., Doghramji, K., Hauri, P. J., & Morin, C. M. (2000) · Sleep · doi:10.1093/sleep/23.2.1l · Cited by 466 · see citing works
Benzodiazepines and Zolpidem for Chronic Insomnia: A Meta-analysis of Treatment Efficacy
Nowell, P. D. (1997) · JAMA · doi:10.1001/jama.1997.03550240060035 · Cited by 451 · see citing works
Ohayon, M. M. (1997) · Journal of Psychiatric Research · doi:10.1016/s0022-3956(97)00002-2 · Cited by 423 · see citing works
Moldofsky, H. (2001) · Sleep Medicine Reviews · doi:10.1053/smrv.2001.0179 · Cited by 407 · see citing works
Insomnia: Epidemiology, characteristics, and consequences
Roth, T. G., & Roehrs, T. (2003) · Clinical cornerstone · doi:10.1016/s1098-3597(03)90031-7 · Cited by 358 · see citing works
Cognitive-behavioral therapy for primary insomnia
Edinger, J. D., & Means, M. K. (2005) · Clinical Psychology Review · doi:10.1016/j.cpr.2005.04.003 · Cited by 344 · see citing works
Internet-Based Treatment for Insomnia: A Controlled Evaluation.
Ström, L., Pettersson, R., & Andersson, G. (2004) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.72.1.113 · Cited by 311 · see citing works
A systematic review of non-pharmacological therapies for sleep problems in later life
Montgomery, P. (2004) · Sleep Medicine Reviews · doi:10.1016/s1087-0792(03)00026-1 · Cited by 260 · see citing works
Noble, S., Langtry, H. D., & Lamb, H. M. (1998) · Drugs · doi:10.2165/00003495-199855020-00015 · Cited by 254 · see citing works
Bastien, C. H., Morin, C. M., Ouellet, M.-C., Blais, F. C., & Bouchard, S. (2004) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.72.4.653 · Cited by 243 · see citing works
Cognitive behavioural interventions for sleep problems in adults aged 60+
Montgomery, P., & Dennis, J. A. (2003) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003161 · Cited by 234 · see citing works
The direct economic costs of insomnia in the United States for 1995.
Walsh, J. K., & Engelhardt, C. L. (1999) · PubMed · Cited by 229 · see citing works
The distribution and clinical significance of sleep time misperceptions among insomniacs
Edinger, J. D., & Fins, A. I. (1995) · SLEEP · doi:10.1093/sleep/18.4.232 · Cited by 226 · see citing works
A Comparative Assessment of the Risks and Benefits of Zopiclone
Hajak, G. (1999) · Drug Safety · doi:10.2165/00002018-199921060-00003 · Cited by 213 · see citing works
Prevalence of Insomnia in the Adult Norwegian Population
Pallesen, S., Nordhus, I. H., Nielsen, G. H., Havik, O. E., Kvale, G., Johnsen, B. H., & Skjøtskift, S. (2001) · SLEEP · doi:10.1093/sleep/24.7.771 · Cited by 194 · see citing works
Self-citationBehavioral Treatments for Insomnia
Bootzin, R. R., & Nicassio, P. M. (1978) · Progress in behavior modification · doi:10.1016/b978-0-12-535606-0.50007-9 · Cited by 192 · see citing works
Prevalence of insomnia in elderly general practice attenders and the current treatment modalities
Hohagen, F., Käppler, C. D. O., Schramm, E., Rink, K., Weyerer, S. B., Riemann, D. W., & Berger, T. (1994) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.1994.tb01563.x · Cited by 140 · see citing works
Pallesen, S., Nordhus, I. H., & Kvale, G. (1998) · Psychotherapy · doi:10.1037/h0087829 · Cited by 116 · see citing works
Self-citationSelf-Help Treatment for Insomnia: a Randomized Controlled Trial
Morin, C. M., Beaulieu‐Bonneau, S., LeBlanc, M., & Savard, J. (2005) · SLEEP · doi:10.1093/sleep/28.10.1319 · Cited by 109 · see citing works
Behavioral assessment and treatment of insomnia: A review with an emphasis on clinical application
Lichstein, K. L., & Riedel, B. W. (1994) · Behavior Therapy · doi:10.1016/s0005-7894(05)80203-5 · Cited by 103 · see citing works
Lorenzo, J., & Barbanoj, M. (2002) · Psychophysiology · doi:10.1111/1469-8986.3940409 · Cited by 103 · see citing works
Strategies for evaluating adherence to sleep restriction treatment for insomnia
Riedel, B. W., & Lichstein, K. L. (2001) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(00)00002-4 · Cited by 99 · see citing works
Morgan, K., Thompson, J., Dixon, S., Tomeny, M., & Mathers, N. (2003) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(02)00569-x · Cited by 62 · see citing works
Holbrook, A., Crowther, R., Lotter, A., & Endeshaw, Y. (2001) · Journal of the American Geriatrics Society · doi:10.1046/j.1532-5415.2001.49161.x · Cited by 61 · see citing works
Insomnia in the geriatric patient
Avidan, A. Y. (2003) · Clinical cornerstone · doi:10.1016/s1098-3597(03)90035-4 · Cited by 34 · see citing works
Jenkins, J. G., & Jacobson, E. (1939) · The American Journal of Psychology · doi:10.2307/1416499 · Cited by 18 · see citing works
Jacobson, E. (1940) · The Journal of Nervous and Mental Disease · doi:10.1097/00005053-194004000-00044 · Cited by 2 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Qaseem, A., Kansagara, D., Forciea, M. A., Cooke, M., Denberg, T. D., & for the Clinical Guidelines Committee of the American College of Physicians* (2016) · Annals of Internal Medicine · doi:10.7326/m15-2175 · Cited by 1,965 · see citing works
The Sleep-Immune Crosstalk in Health and Disease
Besedovsky, L., Lange, T., & Haack, M. (2019) · Physiological Reviews · doi:10.1152/physrev.00010.2018 · Cited by 1,479 · see citing works
Depression in sleep disturbance: A review on a bidirectional relationship, mechanisms and treatment
Fang, H., Tu, S., Sheng, J., & Shao, A. (2019) · Journal of Cellular and Molecular Medicine · doi:10.1111/jcmm.14170 · Cited by 1,152 · see citing works
Cognitive Behavioral Therapy for Chronic Insomnia: A Systematic Review and Meta-analysis
Trauer, J. M., Qian, M. Y., Doyle, J. S., Rajaratnam, S. M. W., & Cunnington, D. (2015) · Annals of Internal Medicine · doi:10.7326/m14-2841 · Cited by 1,053 · see citing works
“In a direct comparison, CBT-i has been found to be superior to hypnotics for the management of chronic insomnia, with effects sustained over 6 months of follow-up (51).”
BackgroundInfluentialMorin, C. M., & Benca, R. (2012) · The Lancet · doi:10.1016/s0140-6736(11)60750-2 · Cited by 976 · see citing works
Morin, C., Vallières, A., Guay, B., Ivers, H., Savard, J., Mérette, C., Bastien, C., & Baillargeon, L. (2009) · Journal of the American Medical Association (JAMA) · doi:10.1001/jama.2009.682 · Cited by 766 · see citing works
“Thus, this sequential regimen would seem preferable to a combined approach in which both therapies are initiated and discontinued at the same time, which was a common practice in most of the previous studies.(14,15,17) The present study evaluated only 3 maintenance strategies and it is plausible that other treatment s…”
BackgroundResultDepression and coronary heart disease
Carney, R. M., & Freedland, K. E. (2017) · Nature Reviews Cardiology · doi:10.1038/nrcardio.2016.181 · Cited by 705 · see citing works
Morin, C. M., Drake, C. L., Harvey, A. G., Krystal, A. D., Manber, R., Riemann, D., & Spiegelhalder, K. (2015) · Nature Reviews Disease Primers · doi:10.1038/nrdp.2015.26 · Cited by 746 · see citing works
Cognitive and behavioral therapies in the treatment of insomnia: A meta-analysis
van Straten, A., van der Zweerde, T., Kleiboer, A., Cuijpers, P., Morin, C. M., & Lancee, J. (2018) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2017.02.001 · Cited by 676 · see citing works
Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic review
Mitchell, M. D., Gehrman, P., Perlis, M., & Umscheid, C. A. (2012) · BMC Family Practice · doi:10.1186/1471-2296-13-40 · Cited by 617 · see citing works
“Of note, three of the studies [29,31,32] included a treatment arm that was a combination of CBT-I and medication.”
BackgroundInfluentialInsomnia and health-related quality of life
Kyle, S. D., Morgan, K., & Espie, C. A. (2010) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2009.07.004 · Cited by 520 · see citing works
Efficacy of an Internet-based behavioral intervention for adults with insomnia
Ritterband, L. M., Thorndike, F. P., Gonder-Frederick, L. A., Magee, J. C., Bailey, E. T., Saylor, D. K., & Morin, C. M. (2009) · Archives of General Psychiatry · doi:10.1001/archgenpsychiatry.2009.66 · Cited by 482 · see citing works
Riemann, D., & Perlis, M. L. (2009) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2008.06.001 · Cited by 477 · see citing works
Blake, M. J., Trinder, J. A., & Allen, N. B. (2018) · Clinical Psychology Review · doi:10.1016/j.cpr.2018.05.006 · Cited by 452 · see citing works
Espie, C. A. (2009) · SLEEP · doi:10.1093/sleep/32.12.1549 · Cited by 422 · see citing works
Perlis, M. L., Posner, D. A., Riemann, D. W., Bastien, C., Teel, J., & Thase, M. (2022) · The Lancet · doi:10.1016/s0140-6736(22)00879-0 · Cited by 398 · see citing works
Pavlova, M. K., & Latreille, V. (2018) · The American Journal of Medicine · doi:10.1016/j.amjmed.2018.09.021 · Cited by 381 · see citing works
A Randomized Controlled Trial of Mindfulness Meditation for Chronic Insomnia
Ong, J. C., Manber, R., Segal, Z., Xia, Y., Shapiro, S., & Wyatt, J. K. (2014) · Sleep · doi:10.5665/sleep.4010 · Cited by 332 · see citing works
Sleep Disturbance and Depression Recurrence in Community-Dwelling Older Adults: A Prospective Study
Cho, H. J., Lavretsky, H., Olmstead, R., Levin, M. J., Oxman, M. N., & Irwin, M. R. (2008) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2008.07121882 · Cited by 318 · see citing works
Edinger, J. D., Arnedt, J. T., Bertisch, S. M., Carney, C. E., Harrington, J. J., Lichstein, K. L., Sateia, M. J., Troxel, W. M., Zhou, E. S., Kazmi, U., et al. (2021) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.8988 · Cited by 309 · see citing works
OKAJIMA, I., KOMADA, Y., & INOUE, Y. (2011) · Sleep and Biological Rhythms · doi:10.1111/j.1479-8425.2010.00481.x · Cited by 306 · see citing works
Sleep and Sleep Disorders in the Menopausal Transition
Baker, F. C., Lampio, L., Saaresranta, T., & Polo‐Kantola, P. (2018) · Sleep Medicine Clinics · doi:10.1016/j.jsmc.2018.04.011 · Cited by 321 · see citing works
Sleep problems during the menopausal transition: prevalence, impact, and management challenges
Baker, F. C., de Zambotti, M., Colrain, I. M., & Bei, B. (2018) · Nature and Science of Sleep · doi:10.2147/nss.s125807 · Cited by 305 · see citing works
“Compared to sleep medication alone, effects of CBT-I are comparable in the short term and superior in the long term.(154) However, CBT-I has only recently been evaluated specifically for insomnia during the menopausal transition.”
Health economics of insomnia treatments: The return on investment for a good night's sleep
Wickwire, E. M., Shaya, F. T., & Scharf, S. M. (2015) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2015.11.004 · Cited by 290 · see citing works
Ong, J. C., Shapiro, S. L., & Manber, R. (2008) · Behavior Therapy · doi:10.1016/j.beth.2007.07.002 · Cited by 268 · see citing works
“Total wake time (TWT) was used as the primary outcome measure for sleep given the heterogeneous complaints of both sleep onset and sleep maintenance difficulties in this sample as well as the increasing use of TWT as a primary outcome measure in recent studies on CBT-I (Sivertsen et al., 2006; Khalsa, 2004; Strom, Pet…”
BackgroundMethodResultInfluentialIrwin, M. R., Olmstead, R. E., & Motivala, S. J. (2008) · SLEEP · doi:10.5665/sleep/31.7.1001 · Cited by 255 · see citing works
Edinger, J. D., Olsen, M. K., Stechuchak, K. M., Means, M. K., Lineberger, M. D., Kirby, A. C., & Carney, C. E. (2009) · SLEEP · doi:10.1093/sleep/32.4.499 · Cited by 259 · see citing works
Campbell, T., Garland, S., Johnson, J., Savard, J., Gehrman, P., Perlis, M., & Carlson, L. (2014) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s47790 · Cited by 250 · see citing works
Systematic Review and Meta-analysis of Adolescent Cognitive–Behavioral Sleep Interventions
Blake, M. J., Sheeber, L. B., Youssef, G. J., Raniti, M. B., & Allen, N. B. (2017) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-017-0234-5 · Cited by 242 · see citing works
“However, different to hypnotics, CBT-I effects are likely to continue after treatment cessation (Sivertsen et al. 2006) and to have fewer side effects, such as adverse effects and rebound insomnia after discontinuation (Buscemi et al. 2007; Kales et al. 1991).”
BackgroundSleep and circadian functioning: critical mechanisms in the mood disorders?
Harvey, A. G. (2011) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-032210-104550 · Cited by 237 · see citing works
“F or p er so na l u se o nl y. therapy for insomnia (CBT-I), produces more durable effects, relative to hypnotic medications ( Jacobs et al. 2004, Morin et al. 1999, Sivertsen et al. 2006).”
BackgroundWhere are the Behavioral Sleep Medicine Providers and Where are They Needed? A Geographic Assessment
Thomas, A., Grandner, M. A., Nowakowski, S., Nesom, G., Corbitt, C. B., & Perlis, M. L. (2016) · Behavioral Sleep Medicine · doi:10.1080/15402002.2016.1173551 · Cited by 223 · see citing works
“…Stickgold, & Otto, 2004; Jungquist et al., 2010; McClusky, Milby, Switzer, Williams, & Wooten, 1991; Morin, Colecchi, Stone, Sood, & Brink, 1999; Sivertsen et al., 2006; Smith et al., 2002), and effectiveness in a number of clinical populations with comorbid insomnia (Currie, Wilson,…”
Skin deep: enhanced sleep depth by cutaneous temperature manipulation
Raymann, R. J. E. M., Swaab, D. F., & Van Someren, E. J. W. (2008) · Brain · doi:10.1093/brain/awm315 · Cited by 218 · see citing works
“Non-pharmacological interventions are of value in the management of age-related sleep complaints, since they may be at least as effective as hypnotics and lack the adverse effects that occur with chronic use (Sivertsen et al., 2006).”
BackgroundInsomnia: prevalence, consequences and effective treatment
Cunnington, D., Junge, M. F., & Fernando, A. T. (2013) · The Medical Journal of Australia · doi:10.5694/mja13.10718 · Cited by 212 · see citing works
Kyle, S. D., Miller, C. B., Rogers, Z., Siriwardena, A. N., Macmahon, K., & Espie, C. A. (2014) · SLEEP · doi:10.5665/sleep.3386 · Cited by 205 · see citing works
Rodrı́guez, J. C., Dzierzewski, J. M., & Alessi, C. (2014) · Medical Clinics of North America · doi:10.1016/j.mcna.2014.11.013 · Cited by 201 · see citing works
A Comparison of Actigraphy and Polysomnography in Older Adults Treated for Chronic Primary Insomnia
Sivertsen, B., Omvik, S., Havik, O. E., Pallesen, S., Bjorvatn, B., Nielsen, G. H., Straume, S., & Nordhus, I. H. (2006) · SLEEP · doi:10.1093/sleep/29.10.1353 · Cited by 201 · see citing works
Self-citationAdherence to cognitive behavioral therapy for insomnia: a systematic review
Matthews, E. E., Arnedt, J. T., McCarthy, M. S., Cuddihy, L. J., & Aloia, M. S. (2013) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2013.01.001 · Cited by 199 · see citing works
Evaluation and management of sleep disturbance during the menopause transition
Joffe, H., Massler, A., & Sharkey, K. (2010) · Seminars in Reproductive Medicine · doi:10.1055/s-0030-1262900 · Cited by 195 · see citing works
Integrated behavioral health in primary care: Step-by-step guidance for assessment and intervention.
Hunter, C. L., Goodie, J. L., Oordt, M. S., & Dobmeyer, A. C. (2016) · American Psychological Association eBooks · doi:10.1037/0000017-000 · Cited by 191 · see citing works
Workgroup, A. C. W. (2013) · Journal of the American Geriatrics Society · doi:10.1111/jgs.12226 · Cited by 191 · see citing works
“Studies have found that cognitive behavioral therapy (CBT) can alleviate chronic insomnia.(53) In one randomized, double-blind, placebo-controlled trial enrolling 46 older adults with chronic primary insomnia, for example, CBT was more effective—immediately and over the long term—than zopiclone.”
Dissemination of CBTI to the Non-Sleep Specialist: Protocol Development and Training Issues
Manber, R., Carney, C., Edinger, J., Epstein, D., Friedman, L., Haynes, P. L., Karlin, B. E., Pigeon, W., Siebern, A. T., & Trockel, M. (2012) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.1786 · Cited by 178 · see citing works
Self-help therapy for insomnia: a meta-analysis
van Straten, A., & Cuijpers, P. (2009) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2008.04.006 · Cited by 185 · see citing works
Insomnia in Elderly Patients: Recommendations for Pharmacological Management
Abad, V. C., & Guilleminault, C. (2018) · Drugs & Aging · doi:10.1007/s40266-018-0569-8 · Cited by 174 · see citing works
Who is at risk for dropout from group cognitive-behavior therapy for insomnia?
Ong, J. C., Kuo, T. F., & Manber, R. (2008) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2007.10.009 · Cited by 168 · see citing works
Sleep: important considerations for the prevention of cardiovascular disease
Grandner, M. A., Alfonso-Miller, P., Fernandez-Mendoza, J., Shetty, S., Shenoy, S., & Combs, D. (2016) · Current Opinion in Cardiology · doi:10.1097/hco.0000000000000324 · Cited by 166 · see citing works
Parasomnias: An Updated Review
Howell, M. J. (2012) · Neurotherapeutics · doi:10.1007/s13311-012-0143-8 · Cited by 165 · see citing works
“Patients with insomnia can also be successfully treated with cognitive behavioral therapy [213].”
BackgroundSleep problems in midlife and beyond
Polo‐Kantola, P. (2011) · Maturitas · doi:10.1016/j.maturitas.2010.12.009 · Cited by 164 · see citing works
Advances in the management of chronic insomnia
Kay-Stacey, M., & Attarian, H. P. (2016) · BMJ · doi:10.1136/bmj.i2123 · Cited by 163 · see citing works
Nutt, D. J., & Stahl, S. M. (2010) · Journal of Psychopharmacology · doi:10.1177/0269881109106927 · Cited by 163 · see citing works
“Racemic zopiclone reduces sleep latency and increases total sleep time (TST) (Ngen and Hassan, 1990; Ponciano et al., 1990; Noble et al., 1998; Sivertsen et al., 2006) (Table 6).”
BackgroundWickwire, E. M., Williams, S. G., Roth, T. G., Capaldi, V. F., Jaffe, M., Moline, M. L., Motamedi, G. K., Morgan, G. W., Mysliwiec, V., Germain, A., et al. (2016) · Neurotherapeutics · doi:10.1007/s13311-016-0429-3 · Cited by 162 · see citing works
Insomnia and Depressive Symptoms in Late Pregnancy: A Population-Based Study
D⊘rheim, S. K., Bjorvatn, B., & Eberhard‐Gran, M. (2012) · Behavioral Sleep Medicine · doi:10.1080/15402002.2012.660588 · Cited by 159 · see citing works
Self-citationMargolies, S. O., Rybarczyk, B. D., Vrana, S. R., Leszczyszyn, D. J., & Lynch, J. (2013) · Journal of Clinical Psychology · doi:10.1002/jclp.21970 · Cited by 155 · see citing works
Hypnosedative-Induced Complex Behaviours
Dolder, C. R., & Nelson, M. H. (2008) · CNS Drugs · doi:10.2165/0023210-200822120-00005 · Cited by 155 · see citing works
Nowakowski, S., Meers, J. M., & Heimbach, E. (2013) · Sleep Medicine Research · doi:10.17241/smr.2013.4.1.1 · Cited by 157 · see citing works
Brasure, M., Fuchs, E. L., MacDonald, R. H., Nelson, V. A., Koffel, E., Olson, C. M., Khawaja, I. S., Diem, S. J., Carlyle, M. H., Wilt, T. J., et al. (2016) · Annals of Internal Medicine · doi:10.7326/m15-1782 · Cited by 148 · see citing works
“Six trials compared CBT-I with inactive control in older adults (64, 69, 70, 73, 82, 83).”
BackgroundSchwartz, D. R., & Carney, C. E. (2012) · Clinical Psychology Review · doi:10.1016/j.cpr.2012.06.006 · Cited by 137 · see citing works
Ong, J. C., Shapiro, S. L., & Manber, R. (2008) · EXPLORE · doi:10.1016/j.explore.2008.10.004 · Cited by 148 · see citing works
“Finally, CBT-I was more effective in improving sleep efficiency when compared with zopiclone at posttreatment and at six-month follow-up.(5) Although these findings are impressive, these studies only evaluated sleep measures at each follow-up time point and did not provide information about patients’ sleep between fol…”
ResultAssessing and Managing Sleep Disturbance in Patients with Chronic Pain
Cheatle, M. D., Foster, S. L., Pinkett, A., Lesneski, M., Qu, D., & Dhingra, L. K. (2016) · Anesthesiology Clinics · doi:10.1016/j.anclin.2016.01.007 · Cited by 144 · see citing works
Brewster, G. S., Riegel, B. J., & Gehrman, P. (2017) · Sleep Medicine Clinics · doi:10.1016/j.jsmc.2017.09.002 · Cited by 151 · see citing works
Sleep Medicine: Insomnia and Sleep.
Bollu, P. C., & Kaur, H. (2019) · Europe PMC (PubMed Central) · Cited by 144 · see citing works
Chen, H.-Y., Cheng, I.-C., Pan, Y.-J., Chiu, Y.-L., Hsu, S.-P., Pai, M.-F., Yang, J.-Y., Peng, Y.-S., Tsai, T.-J., & Wu, K.-D. (2011) · Kidney International · doi:10.1038/ki.2011.151 · Cited by 140 · see citing works
The Complex Role of Sleep in Adolescent Depression
Clarke, G. N., & Harvey, A. G. (2012) · Child and Adolescent Psychiatric Clinics of North America · doi:10.1016/j.chc.2012.01.006 · Cited by 139 · see citing works
The medicalization of sleeplessness: a public health concern
Moloney, M. E., Konrad, T. R., & Zimmer, C. R. (2011) · American Journal of Public Health · doi:10.2105/ajph.2010.300014 · Cited by 136 · see citing works
Drug Treatment of Primary Insomnia: A Meta-Analysis of Polysomnographic Randomized Controlled Trials
Winkler, A., Auer, C. J., Doering, B. K., & Rief, W. (2014) · CNS Drugs · doi:10.1007/s40263-014-0198-7 · Cited by 139 · see citing works
Carroll, J., Seeman, T. E., Olmstead, R. E., Melendez, G., Sadakane, R., Bootzin, R. R., Nicassio, P. M., & Irwin, M. R. (2015) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2015.02.010 · Cited by 136 · see citing works
Lancee, J., van den Bout, J., van Straten, A., & Spoormaker, V. I. (2012) · Behaviour Research and Therapy · doi:10.1016/j.brat.2011.09.012 · Cited by 131 · see citing works
“…similar to those of several face-to-face intervention studies (e.g., Edinger, Wohlgemuth, Radtke, Marsh, & Quillian, 2001; Jacobs et al., 2004; Sivertsen et al., 2006), slightly smaller than the effect sizes found in metaanalyses (Murtagh & Greenwood, 1995; Smith et al., 2002), but higher…”
BackgroundResultInfluentialMorin, C. M., & Buysse, D. J. (2024) · New England Journal of Medicine · doi:10.1056/nejmcp2305655 · Cited by 169 · see citing works
Hanlon, J. T., Semla, T. P., & Schmader, K. E. (2015) · Journal of the American Geriatrics Society · doi:10.1111/jgs.13807 · Cited by 128 · see citing works
Cognitive behavioral treatment of insomnia
Williams, J., Roth, A., Vatthauer, K., & McCrae, C. S. (2013) · Chest · doi:10.1378/chest.12-0731 · Cited by 123 · see citing works
Evidence-Based Psychological Treatments: An Update and a Way Forward
Barlow, D. H., Bullis, J. R., Comer, J. S., & Ametaj, A. A. (2013) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-050212-185629 · Cited by 120 · see citing works
Berger, A. M., Kuhn, B. R., Farr, L., Essen, S. G. V., Chamberlain, J., Lynch, J. C., & Agrawal, S. (2009) · Journal of Clinical Oncology · doi:10.1200/jco.2008.20.8306 · Cited by 118 · see citing works
Panossian, L. A., & Avidan, A. Y. (2009) · Medical Clinics of North America · doi:10.1016/j.mcna.2008.09.001 · Cited by 116 · see citing works
Dombrovski, A. Y., Cyranowski, J. M., Mulsant, B. H., Houck, P. R., Buysse, D. J., Andreescu, C., Thase, M. E., Mallinger, A. G., & Frank, E. (2008) · Depression and Anxiety · doi:10.1002/da.20467 · Cited by 116 · see citing works
“Finally, cognitive behavioral therapy for insomnia (CBT-I), which combines behavioral approaches (relaxation training, stimulus control, sleep restriction) with a cognitive intervention targeting negative beliefs about sleep, is effective and may be superior to hypnotics in primary insomnia.([53,54]) There is accumula…”
BackgroundBehavioral Treatment of Insomnia in Bipolar Disorder
Kaplan, K. A., & Harvey, A. G. (2013) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2013.12050708 · Cited by 115 · see citing works
Cognitive Training Improves Sleep Quality and Cognitive Function among Older Adults with Insomnia
Haimov, I., & Shatil, E. (2013) · PLoS ONE · doi:10.1371/journal.pone.0061390 · Cited by 116 · see citing works
Recent Advancements in Treating Sleep Disorders in Co-Occurring PTSD
Colvonen, P. J., Straus, L. D., Stepnowsky, C. J., McCarthy, M. J., Goldstein, L. A., & Norman, S. B. (2018) · Current Psychiatry Reports · doi:10.1007/s11920-018-0916-9 · Cited by 112 · see citing works
Chen, H.-Y., Chiang, C.-K., Wang, H.-H., Hung, K.-Y., Lee, Y.-J., Peng, Y.-S., Wu, K.-D., & Tsai, T.-J. (2008) · American Journal of Kidney Diseases · doi:10.1053/j.ajkd.2008.03.012 · Cited by 111 · see citing works
Sleep/wake measurement using a non-contact biomotion sensor
de Chazal, P., Fox, N. A., O’Hare, E., Heneghan, C., Zaffaroni, A., BOYLE, P., SMITH, S., O’CONNELL, C., & McNicholas, W. T. (2010) · Journal of Sleep Research · doi:10.1111/j.1365-2869.2010.00876.x · Cited by 110 · see citing works
“Researchers have tried to overcome these limitations of laboratory PSG by approaches such as reduced PSG systems suitable for home use (Sivertsen et al., 2006a), specialized systems for sleep staging (Jacobs et al., 2004) and actigraphy (Gruber et al., 2000; Lötjönen et al., 2003; Pollak et al.,…”
MethodEmerging anti-insomnia drugs: tackling sleeplessness and the quality of wake time
Wafford, K. A., & Ebert, B. (2008) · Nature Reviews Drug Discovery · doi:10.1038/nrd2464 · Cited by 109 · see citing works
“In clinical trials, CBT can be as effective, if not better, than pharmacotherapy, with fewer concerns regarding relapse and tolerance effect”
BackgroundArnedt, J. T., Conroy, D. A., Mooney, A., Furgal, A. K. C., Sen, A., & Eisenberg, D. (2020) · SLEEP · doi:10.1093/sleep/zsaa136 · Cited by 109 · see citing works
Non-pharmacological Approaches for Management of Insomnia
Chan, N. Y., Chan, J. W. Y., Li, S. X., & Wing, Y. K. (2021) · Neurotherapeutics · doi:10.1007/s13311-021-01029-2 · Cited by 117 · see citing works
Insomnia and Sleep-Related Breathing Disorders
Wickwire, E. M., & Collop, N. A. (2010) · CHEST Journal · doi:10.1378/chest.09-1485 · Cited by 108 · see citing works
Wickwire, E. M., Schnyer, D. M., Germain, A., Smith, M. T., Williams, S. G., Lettieri, C. J., McKeon, A. B., Scharf, S. M., Stocker, R., Albrecht, J. S., et al. (2018) · Journal of Neurotrauma · doi:10.1089/neu.2017.5243 · Cited by 106 · see citing works
Alessi, C., Martin, J. L., Fiorentino, L., Fung, C. H., Dzierzewski, J. M., Tapia, J. C. R., Song, Y., Josephson, K. R., Jouldjian, S., & Mitchell, M. N. (2016) · Journal of the American Geriatrics Society · doi:10.1111/jgs.14304 · Cited by 106 · see citing works
“Improvements in sleep with CBT-I are equal or greater in magnitude and more durable than improvements seen with sedative–hypnotics.(18) Treatment guidelines universally recommend behavioral therapies as first-line treatment for insomnia in older adults,(3,19) but these treatments have not been widely implemented.”
BackgroundAssessing the Risk of Bias in Randomized Clinical Trials With Large Language Models
Lai, H., Ge, L., Sun, M., Pan, B., Huang, J., Hou, L., Yang, Q., Liu, J., Liu, J., Ye, Z., et al. (2024) · JAMA Network Open · doi:10.1001/jamanetworkopen.2024.12687 · Cited by 103 · see citing works
Treatment Options for Sleep Disturbances During Alcohol Recovery
Arnedt, J. T., Conroy, D. A., & Brower, K. J. (2007) · Journal of Addictive Diseases · doi:10.1300/j069v26n04_06 · Cited by 102 · see citing works
Prospective randomized study of patients with insomnia and mild sleep disordered breathing
Guilleminault, C., Davis, K., & Huynh, N. T. (2008) · SLEEP · doi:10.1093/sleep/31.11.1527 · Cited by 100 · see citing works
Effectiveness of Sequential Psychological and Medication Therapies for Insomnia Disorder
Morin, C. M., Edinger, J. D., Beaulieu‐Bonneau, S., Ivers, H., Krystal, A. D., Guay, B., Bélanger, L., Cartwright, A., Simmons, B., Lamy, M., et al. (2020) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2020.1767 · Cited by 98 · see citing works
Randomized Controlled Trial of Telephone-Delivered Cognitive Behavioral Therapy for Chronic Insomnia
Arnedt, J. T., Cuddihy, L. J., Swanson, L. M., Pickett, S. M., Aikens, J. E., & Chervin, R. D. (2013) · SLEEP · doi:10.5665/sleep.2448 · Cited by 98 · see citing works
Greater incidence of depression with hypnotic use than with placebo
Kripke, D. F. (2007) · BMC Psychiatry · doi:10.1186/1471-244x-7-42 · Cited by 95 · see citing works
Piantino, J. A., Lim, M. M., Newgard, C. D., & Iliff, J. J. (2019) · Current Pain and Headache Reports · doi:10.1007/s11916-019-0799-4 · Cited by 94 · see citing works
Patient characteristics and predictors of sleep medication use
Omvik, S., Pallesen, S., Bjorvatn, B., Sivertsen, B., Havik, O. E., & Nordhus, I. H. (2010) · International Clinical Psychopharmacology · doi:10.1097/yic.0b013e328334e5e6 · Cited by 95 · see citing works
“For instance, comparative studies have shown that cognitive behavioural therapy has an advantage over sleep medications (Morin et al., 1999; Sivertsen et al., 2006).”
BackgroundSelf-citationOne- vs. five-session treatment of dental phobia: A randomized controlled study
Haukebø, K., Skaret, E., Öst, L., Raadal, M., Berg, E., Sundberg, H., & Kvale, G. (2007) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2007.09.006 · Cited by 96 · see citing works
Self-citationPhotic Resetting in Night-Shift Work: Impact on Nurses' Sleep
Boivin, D. B., Boudreau, P., James, F. O., & Kin, N. M. K. N. Y. (2012) · Chronobiology International · doi:10.3109/07420528.2012.675257 · Cited by 95 · see citing works
“Although the extension of TST was of a comparable magnitude to the efficacy of other known sleep-promoting interventions, such as behavioral therapy for insomnia treatment (Sivertsen et al., 2006), the shorter daytime sleep duration in workers of the control group was relatively long compared to the daytime sleep epis…”
ResultNew developments in cognitive behavioral therapy as the first-line treatment of insomnia
Siebern, A. T., & Manber (2011) · Psychology Research and Behavior Management · doi:10.2147/prbm.s10041 · Cited by 91 · see citing works
Raymann, R., & Someren, E. J. W. V. (2008) · SLEEP · doi:10.5665/sleep/31.9.1301 · Cited by 90 · see citing works
Zolpidem: Efficacy and Side Effects for Insomnia
Edinoff, A. N., Wu, N. W., Ghaffar, Y. T., Prejean, R., Gremillion, R., Cogburn, M., Chami, A. A., Kaye, A. M., & Kaye, A. D. (2021) · Health Psychology Research · doi:10.52965/001c.24927 · Cited by 89 · see citing works
Non-Pharmacological Treatment of Insomnia
Siebern, A. T., Suh, S., & Nowakowski, S. (2012) · Neurotherapeutics · doi:10.1007/s13311-012-0142-9 · Cited by 88 · see citing works
Aging, circadian rhythms and depressive disorders: a review.
Costa, I. C., Carvalho, H. N., & Fernandes, L. P. N. S. (2013) · Europe PMC (PubMed Central) · Cited by 90 · see citing works
Sleep to Lower Elevated Blood Pressure: A Randomized Controlled Trial (SLEPT)
McGrath, E. R., Espie, C. A., Power, A., Murphy, A. W., Newell, J., Kelly, C., Duffy, N., Gunning, P., Gibson, I., Bostock, S., et al. (2016) · American Journal of Hypertension · doi:10.1093/ajh/hpw132 · Cited by 88 · see citing works
- Authors
- Sivertsen, B., Omvik, S., Pallesen, S., Bjorvatn, B., Havik, O. E., Kvale, G., Nielsen, G. H., & Nordhus, I. H.
- Affiliations
- University of Bergen (NO)
- Corresponding author
- Sivertsen, Børge
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2006-06-28
- Volume
- 295
- Issue
- 24
- Pages
- 2851
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W2160984931
- Cited by
- 589
- References
- 46
- Citations by year
- 2026: 9 · 2025: 25 · 2024: 18 · 2023: 17 · 2022: 24 · 2021: 24 · 2020: 29 · 2019: 35 · 2018: 16 · 2017: 39 · 2016: 45 · 2015: 36 · 2014: 39 · 2013: 29 · 2012: 34
- FWCI
- 42.39
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- chronic primary insomnia, older adults, cognitive behavioral therapy, zopiclone, hypnotics, sleep efficiency, slow-wave sleep, sleep restriction, stimulus control, cognitive therapy, relaxation, polysomnography, sleep diary, long-term treatment outcomes
- MeSH terms
- Aged, Chronic Disease, Double-Blind Method, Female, Humans, Hypnotics and Sedatives, Sleep Initiation and Maintenance Disorders, Male, Middle Aged, Piperazines, Cognitive Behavioral Therapy, Polysomnography, Azabicyclo Compounds
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
