![]() Main Outcomes and Measures The primary end points were the treatment response and remission rates, defined by the Insomnia Severity Index total score. The study took place at Institut Universitaire en Santé Mentale de Québec, Université Laval, Québec City, Québec, Canada, and at National Jewish Health, Denver, Colorado, and enrollment of patients took place from August 2012 through July 2017. Objective To evaluate the comparative efficacy of 4 treatment sequences involving psychological and medication therapies for insomnia and examine the moderating effect of psychiatric disorders on insomnia outcomes.ĭesign, Setting, and Participants In a sequential multiple-assignment randomized trial, patients were assigned to first-stage therapy involving either behavioral therapy (BT n = 104) or zolpidem (zolpidem n = 107), and patients who did not remit received a second treatment involving either medication (zolpidem or trazodone) or psychological therapy (BT or cognitive therapy ). Importance Despite evidence of efficacious psychological and pharmacologic therapies for insomnia, there is little information about what first-line treatment should be and how best to proceed when initial treatment fails. University of New England, Armidale, NSW, Australia Kathryn Hadley Bed(Hons)PrimEd, PGDipPsych, GradDipPsychAdv1, Ben Benazzouz BSC(Hons)Psych1 Helen Puusepp-Benazzouz MD, PhD2ġ. Likewise, such a gender discrepancy might partially explain the noted significant differences between improvement in the behaviour therapy first-line treatment group, versus the Zolpidem medication group (sleep onset latency reduction of 21.1 and 11.7 minutes respectively wake after sleep onset reduction of 33.0 and 16.6 minutes respectively), as both groups comprised of more women than men. As there is a dose-dependent effect of the medication, and Zolpidem was capped at 5mg for women, it is pertinent to know whether the improvement in the time taken to fall asleep (sleep onset latency) and time awake after sleep onset (wake after sleep onset), was lower in women compared to participating men whose final dose was 10mg. However, dosage for men was titrated up to 10mg based on the therapeutic response, adverse effects, and participant’s age. All participants started Zolpidem with an initial dose of 5mg, and dosage was not increased in women. ![]() In this study, half of the patients were randomised to receive Zolpidem medication as the first line of treatment, and 63% (68/107) of this group were women. 1 investigated the effect of psychological and pharmacological therapies for insomnia. ![]() Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.
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