The Differences in Sleep Skills between Insomnia Patients with and without Need of Hypnotics

Background and Objective Hypnotics are widely prescribed for the treatment of insomnia; however, cognitive behavioral therapy for insomnia (CBT-I) is considered as a primary treatment. We checked ordinary sleep skills of insomnia patients and changes in sleep skills after CBT-I, and evaluated the difference in sleep skills between patients with and without need of hypnotics. Methods A total of 131 outpatients who had visited our sleep clinic with insomnia were recruited. Enrollment criteria included at least 12 weeks of insomnia periods, less than 16 in Beck Depression Inventory score, and agreement to receive 9 sessions of CBT-I for 12 weeks. After 12 weeks of CBT-I, patients were divided into two groups: still in need and no need of hypnotics. Changes in sleep skills were compared between these groups. Results Sleep hygiene, sleep stimulus-control skills, and sleep Visual Analogue Scales (VAS) were statistically improved after CBT-I (all, p < 0.001). Forty-six (35.1%) patients did not need hypnotics anymore; however, 85 (64.9%) still needed hypnotics after CBT-I. Sleep VAS (25.26 ± 8.52 vs. 32.64 ± 8.95, p < 0.001), practicing regular moderate exercise (3.67 ± 0.92 vs. 2.76 ± 1.06, p = 0.030), and having a relaxing bedtime routine (4.08 ± 0.55 vs. 2.76 ± 0.76, p < 0.001) were different in the two groups. Conclusions Among CBT-I skills, regular moderate exercise and a relaxing bedtime routine seem to be key components. For reducing chronic use of hypnotics, and better outcome of CBT-I, clinicians should focus more on these two components.