Adherence to behavioral recommendations of CBTI predicts medication use after a structured medication taper.

STUDY OBJECTIVES: Cognitive behavioral therapy for insomnia (CBTI) has been paired with supervised medication tapering (SMT) to help hypnotic-dependent individuals discontinue their hypnotics. This study examined the hypothesis that higher participant adherence to behavioral recommendations of CBTI will predict lower odds of using sleep medications three months after completion of a combined CBTI/SMT protocol.

METHODS: Fifty-eight individuals who used sedative hypnotics completed four CBTI sessions followed by SMT. Logistic regression was used to examine the association of stability of time in bed (TIB) and stability of rise time (measured as the within-person standard deviation) at completion of CBTI with two outcomes at 3-month follow-up: use of sedative hypnotics and use of any medication/substance for sleep.

RESULTS: Participants with more stability in their rise time after CBTI than at baseline (i.e., a decrease in their within-person standard deviation) had 69.5% lower odds of using sedative hypnotics at follow-up (OR=0.305, 95% CI=0.095-0.979, p=.046) than individuals who had no change or a decrease in the stability of their rise time. Results were similar for TIB: participants with more stability in their TIB after CBTI than at baseline had 83.2% lower odds of using sedative hypnotics (OR=0.168, 95% CI=0.049-0.580, p=.005). Increase in stability of rise time and stability of TIB was also associated with reduced odds of using any medication/substance for sleep at follow-up.

CONCLUSIONS: Participants who implement behavioral recommendations of CBTI appear to have more success with discontinuing use of sleep medications.

CLINICAL TRIAL REGISTRATION: Registry: ClinicalTrials.gov; Name: The Role of Tapering Pace and Selected Traits on Hypnotic Discontinuation; Identifier: NCT02831894; URL: https://clinicaltrials.gov/ct2/show/NCT02831894.