Is Cognitive Behavior Therapy more Effective than Medication?

According to a review in the New England Journal of Medicine, cognitive behavioral therapy (CBT) is at least as effective as hypnotics for chronic insomnia, and probably provides more sustained benefit (Silber MH, NEJM 2005;353:803-810). For example, in one study, young and middle-aged patients with chronic sleep-onset insomnia were randomized to CBT, Ambien 10 mg QHS, combined CBT and Ambien, or placebo. Patients receiving CBT improved sleep latency and sleep efficiency more than patients in the medication group, and there was no difference between CBT and combination treatment (Jacobs GD, Arch Intern Med 2004;164:1888-1896). These results were replicated in a more recent study comparing CBT with zopiclone (precursor of Lunesta) in 46 older patients (mean age 61) with chronic insomnia (Sivertsen B, JAMA 2006;295:2851-2858).