Changes in use of sleep aids following digital cognitive behavioral therapy for insomnia
Drake CL, Cheng P, Tallent G, Atkinson R, Cuamatzi AS, and Bazan L. Changes in use of sleep aids following digital cognitive behavioral therapy for insomnia. Sleep 2019; 42(Suppl 1):A149.
Introduction: Cognitive behavioral therapy for insomnia is now recommended as first-line treatment for chronic insomnia, and can be delivered digitally (dCBT-I) for increased access. Furthermore, dCBT-I confers an advantage of reduced adverse events relative to pharmacologic interventions (e.g., hypnotics and other sleep aids). This study examined if treatment with dCBT-I can also reduce use of sleep aids compared to an online sleep education control. Methods: 1232 individuals with insomnia (DSM-5 diagnostic criteria) were randomized into two conditions: dCBT-I (N=639), or an online sleep education control (N=593). Use of medications for sleep (prescription and non-prescription) were assessed pre-treatment and post-treatment. Responses were categorized into general classes of medications (i.e. benzodiazepine, hypnotic, antihistamine, etc.), and compared across time points between the two conditions. Results: Results from a repeated-measures mixed-effects logistic regression indicated that the odds of prescription medication was significantly lower following dCBT-I compared to control (OR=0.09, 95%CI[0.02, 0.34]). Specifically, whereas prescription medication use in the control group increased from 16.5% to 18.0% at post-treatment, prescription medication use in the dCBT-I group decreased from 17.8% to 14.6%. Change in prescription medication use was more pronounced for antidepressants, followed by hypnotics. No differences were found in use of non-prescription medications. Conclusion: This study provides preliminary evidence that use of prescription sleep aids may decrease following completion of dCBT-I. Together, this suggests that a minimally resource intensive intervention may have a small effect in reducing reliance on prescription sleep aids.