Cognitive behavioral treatments such as relaxation therapy are more beneficial than the non-benzodiazepine medication zopiclone, according to an article in the June 28issue of the Journal of the American Medical Association.
Prior to the current study, none had compared the newer non-benzodiazepine sleep medications with non-pharmacological treatments.

Borge Sivertsen, PsyD, of the University of Bergen, Norway, and colleagues conducted a randomized controlled trial between January 2004 and December 2005 to compare the short- and long-term clinical efficacy of cognitive behavioral therapy and the non-benzodiazepine medication zopiclone.

The trial included 46 adults (average age 60.8 years; 22 women) with chronic primary insomnia. The participants received either the cognitive behavioral therapy intervention (information on sleep hygiene, sleep restriction, stimulus control, cognitive therapy, and progressive relaxation technique; n = 18), sleep medication (7.5 mg zopiclone each night; n = 16), or placebo medication (n = 12).

All treatments were given for 6 weeks, and the two active treatments were followed for 6 months. Clinical polysomnographic data and sleep diaries were used to determine total wake time, total sleep time, sleep efficiency, and slow-wave sleep.

Using polysomnographic testing, the total time spent awake during the night for the nonpharmacological group improved significantly more than both the placebo group at 6 weeks and the zopiclone group at both 6 weeks and 6 months. The zopiclone group did not differ significantly from the placebo group.

Total wake time at 6 weeks was reduced 52 percent in the cognitive behavioral therapy group compared with 4 percent and 16 percent in the zopiclone and placebo groups, respectively. On average, participants receiving cognitive behavioral therapy improved sleep efficiency by 9 percent at post-treatment compared with a decline of 1 percent in the zopiclone group, a difference that the authors stated was both statistically and clinically significant.

Total sleep time increased significantly in the cognitive behavioral therapy group at 6 months compared with 6 weeks. The zopiclone group showed no significant change at 6 months, maintaining the improvements seen at 6 weeks. Comparing the two active treatment conditions, total wake time, sleep efficiency, and slow-wave sleep were all significantly better in the cognitive behavioral therapy group than in the zopiclone group; total sleep time was not significantly different.