A Cochrane review [Abstract] 1 included 6 studies with a total of 282 subjects. The final total of participants included in the meta-analysis was 224. The data suggest a mild effect of CBT for sleep problems in older adults, best demonstrated for sleep maintenance insomnia.
A systematic review 2 including 66 studies with a total of 1 538 subjects in experimental and 369 subjects in no-treatment groups was abstracted in DARE. The interventions included progressive muscular relaxation-based approaches, other relaxation techniques, paradoxical intention approaches, sleep restriction approaches, and combination treatments. The results for all treatments investigated were as follows (weighted mean effect):
Comment: The review has many methodological problems. Controlled and uncontrolled studies were analysed together.
In a subsequent RCT 3 adults (mean age 60.8 y; 22 women) with chronic primary insomnia were assigned to 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) for 6 weeks. CBT resulted in improved short- and long-term outcomes compared with zopiclone. 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.
Comment: The quality of evidence is downgraded by imprecise results (limited study size for each comparison) and by indirectness (differences in studied interventions and outcomes).
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