Managing insomnia : pharmacotherapy versus cognitive behavioural therapy

Abstract

Treatment modalities to treat and manage insomnia include pharmacotherapy, cognitive behavioural therapy (CBT) or a combination of both treatments. The primary aim in the management of insomnia is to provide adequate sleep thus improve quality of life. The research question reads: Is pharmacotherapy more effective than Cognitive behavioural therapy in the management of insomnia? The PICO framework guided this dissertation and included, Adults suffering from Insomnia as the population, Pharmacotherapy as the intervention, Cognitive Behavioural Therapy (CBT) as the comparison and Better quality of life as the outcome. Inclusion criteria consisted of studies with participants’ aged 18 years or older suffering from insomnia, published in English within the last 15 years including any type of pharmacotherapy. Studies had to be peer-reviewed, included symptoms of insomnia, diagnosed either per the Diagnostic and Statistical Manual of Mental Disorders (DSM) or the International classification of sleep disorder (ICSD) guidelines. The Exclusion criteria limited studies published prior to 2001, not in English, with participants less than 18 years of age. The literature search yielded 9 relevant articles. The Oxford Appraisal Skills Programme (CASP, 2014) tools were used to evaluate and critique the various study designs identified, namely Meta-analysis, Randomised Controlled Trials, Systematic Reviews and Clinical Case Series. Results show that CBT and Cognitive Behavioural Therapy for Insomnia (CBT-I) seem to be the most effective long-term treatment for insomnia, providing the least burden for patients, thus improving their quality of life. Although new data is still emerging, there is a strong need to understand how best to integrate both behavioural and pharmaceutical approaches to maximize the effectiveness of treatment and ultimately ameliorate the quality of life of insomnia sufferers.