Cognitive behavior therapy to facilitate benzodiazepine discontinuation among hypnotic-dependent patients with insomnia

Five hypnotic-dependent insomnia patients received cognitive behavior therapy combined with a supervised medication tapering schedule in a multiple baseline design. Four participants discontinued medication within 6–8 weeks and the fifth decreased drug intake by 90% over baseline. At the 3-month follow-up, 3 patients remained drug-free, 1 patient was using a hypnotic less than once a week, and 1 patient continued nightly use of a very small dose of hypnotic drug. Sleep patterns deteriorated from baseline to the end of the medication withdrawal phase, with sleep efficiency decreasing by 9% according to sleep diaries (83% to 74%) and by 6% based on polysomnographic assessment (78% to 72%). The 3-month follow-up data showed a reverse in the pattern of sleep deterioration, with sleep efficiency returning near or above baseline level. These findings suggest that cognitive behavior therapy, combined with a supervised medication taper schedule, is beneficial for the management to drug-dependent insomnia.