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Am J Psychiatry 1991; 148:121-126
Copyright © 1991 by American Psychiatric Association
Efficacy of behavioral versus triazolam treatment in persistent sleep- onset insomnia
HY McClusky, JB Milby, PK Switzer, V Williams and V Wooten
Department of Psychology, University of Alabama, Birmingham.
OBJECTIVE: This study compared differential effects of behavioral therapy
and triazolam in a clinical population with sleep-onset insomnia. Triazolam
was hypothesized to decrease sleep latency and frequency and duration of
awakening, with some effects during the first night's administration. But
at follow-up, sleep measures were predicted to return to baseline levels.
Behavioral treatment was hypothesized to effect sleep after 2 or more weeks
of training which persisted at follow-up. METHOD: Thirty patients with
average sleep latencies of 81.48 minutes, who reported chronic insomnia for
an average of 2.6 years, were randomly assigned to one of two treatment
groups: behavioral stimulus control/relaxation training and triazolam.
RESULTS: Both treatments decreased sleep latency but differentially.
Triazolam was effective immediately but maintained only some gains at
follow-up. Behavioral treatment decreased sleep latency beginning the
second week, when subjects expected no improvement, with gains maintained
at follow- up. Comparisons showed that triazolam group latencies returned
toward baseline, while behavioral group gains were maintained at follow-up.
CONCLUSIONS: Triazolam treatment showed superior immediate treatment
effects, while behavioral treatment showed superior treatment effects at
follow-up, effects that accrued during the training period and
differentially persisted at follow-up. One treatment strategy implied by
these results would be to combine these two interventions concurrently.
This would seem to use the immediate effects produced by the medication
until the behavioral skills were learned, at which point medication would
be terminated. This strategy could offer immediate relief and sustained
effects at drug termination.
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