Discontinuation of hypnotics during cognitive behavioural therapy for insomnia
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BACKGROUND: In practical sleep medicine, therapists face the question of whether or not to discontinue the ongoing use of hypnotics in patients, as well as the possible effects of discontinuation. The aim of this study was to evaluate the effects of discontinuing third-generation hypnotics on the results of cognitive-behavioural therapy (CBT) for primary insomnia in patients after long-term abuse. METHODS: Twenty-eight outpatients were treated by CBT for 8 weeks. The treatment outcome was estimated by means of differences among subjective clinical scales and polysomnography variables assessed before and after the treatment period. The therapeutic effect in a subgroup of 15 patients who had previously received hypnotics and were successively withdrawn during weeks 2-6 was compared to the effect achieved in patients who had not used hypnotics before CBT. RESULTS: There were no significant differences in baseline subjective and objective sleep characteristics between the hypnotic abusers and non-abusers. According to clinical scales and most polysomnographic measures, CBT was highly effective in both groups of subjects; it produced the greatest changes in total sleep time, REM sleep and sleep efficiency. Unexpectedly, discontinuation of hypnotics, as a factor in the analysis, was followed by an additional improvement of sleep efficiency and wake after sleep onset parameters. CONCLUSION: Our study confirmed the efficacy of CBT in both hypnotic-abusing and non-abusing patients with chronic insomnia. The results of this study suggest that tapered withdrawal of third-generation hypnotics during CBT therapy for chronic insomnia could be associated with improvement rather than worsening of sleep continuity.
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Individual, face-to-face CBT-I appears to be the most effective modality to support the deprescription of hypnotic agents, including BZDs and Z-drugs.
“Individual, face-to-face CBT-I appears to be the most effective modality to support the deprescription of hypnotic agents, including BZDs 75 and Z-drugs. 73 74”
From Z-drug abuse and dependence: Clinical guideline of the Brazilian Academy of Neurology for diagnosis and management (2025) · cites this paper as [73]
The Abstract Conclusion reports that tapering third-generation hypnotics during CBT could improve sleep continuity. But Methods > Psychotherapy describes group CBT, with five patients per group; the paper does not compare delivery modalities or establish individual, face-to-face CBT-I as the most effective for deprescribing. (LLM, conf=0.88)
Experimental — accuracy not yet measuredA review on the feasibility of BZD/Z-drug deprescribing highlighted the potential benefits of gradual tapering combined with non-pharmacological interventions; however, the overall quality of the supporting evidence was low.
“a review on the feasibility of BZD/Z-drug deprescribing highlighted the potential benefits of gradual tapering combined with non-pharmacological interventions; however, the overall quality of the supporting evidence was low. 30 73 80”
From Z-drug abuse and dependence: Clinical guideline of the Brazilian Academy of Neurology for diagnosis and management (2025) · cites this paper as [73]
The Methods (Study design) describe gradual withdrawal of third-generation hypnotics during CBT, and the Results (Effects of hypnotic discontinuation on sleep variables) report improved sleep efficiency and wakefulness after sleep onset. But this paper is a clinical study, not a review of BZD/Z-drug deprescribing, and it does not rate the overall quality of supporting evidence as low. The Discussion limits its findings to third-generation hypnotics and notes that a larger study is needed. (LLM, conf=0.88)
Experimental — accuracy not yet measuredCBT-I has been investigated as a therapeutic strategy to support hypnotic deprescription, including Z-drugs.
“CBT-I has also been investigated 72 73 74 75 76 77 78 79 as a therapeutic strategy to support hypnotic deprescription, including Z-drugs.”
From Z-drug abuse and dependence: Clinical guideline of the Brazilian Academy of Neurology for diagnosis and management (2025) · cites this paper as [73]
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Chapter 4. Case Formulation and Treatment Planning
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Chapter 11. Modifying Delusions
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Chapter 3. Enhancing the Impact of Brief Sessions
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Chapter 7. Targeting Maladaptive Thinking
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Chapter 16. Relapse Prevention
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Chapter 5. Promoting Adherence
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Chapter 15. CBT in Medical Patients
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Chapter 12. Coping With Hallucinations
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Chapter 14. Lifestyle Change: Building Healthy Habits
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Chapter 13. CBT for Substance Misuse and Abuse
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Chapter 10. CBT Methods for Insomnia
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Chapter 2. Indications and Formats for Brief CBT Sessions
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Chapter 9. Behavioral Methods for Anxiety
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- Authors
- Zavesicka, L., Brunovsky, M., Matousek, M., & Sos, P.
- Venue
- BMC Psychiatry
- Published
- 2008-09-18
- Volume
- 8
- Issue
- 1
- Pages
- 80-80
- ISSN
- 1471-244X (ISSN-L)
- PMC
- PMC2562375
- OpenAlex
- W2062020267
- Cited by
- 43
- References
- 28
- Citations by year
- 2025: 2 · 2022: 2 · 2020: 4 · 2018: 2 · 2014: 3 · 2013: 2 · 2012: 4
- FWCI
- 10.43
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Psychiatry (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- Ministerstvo Školství, Mládeže a Tělovýchovy (0021620816, VZ 0021620816)
- 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
- cognitive behavioral therapy for insomnia, primary insomnia, hypnotic abuse, sleep efficiency, wake after sleep onset, REM sleep, total sleep time, polysomnography
- MeSH terms
- Adult, Aged, Drug Therapy, Female, Humans, Hypnotics and Sedatives, Sleep Initiation and Maintenance Disorders, Male, Middle Aged, Sleep, REM, Cognitive Behavioral Therapy, Polysomnography, Withholding Treatment
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