Association between insomnia patients' pre-treatment characteristics and their responses to distinctive treatment sequences.

Publication Type:

Journal Article


Sleep, Volume 45, Issue 1 (2022)


Adult, Cognitive Behavioral Therapy, Female, Humans, Male, Middle Aged, Sleep, Sleep Initiation and Maintenance Disorders, Trazodone, Treatment Outcome, Zolpidem


<p><b>STUDY OBJECTIVES: </b>It is common to provide insomnia patients a second treatment when the initial treatment fails, but little is known about optimal treatment sequences for different patient types. This study examined whether pre-treatment characteristics/traits predict optimal treatment sequences for insomnia patients.</p><p><b>METHODS: </b>A community sample of 211 adults (132 women; Mage = 45.6 ± 14.9 years) with insomnia were recruited. Patients were first treated with behavioral therapy (BT) or zolpidem (Zol). Non-remitting BT recipients were randomized to a second treatment with either Zol or cognitive therapy; non-remitting Zol recipients underwent BT or Trazodone as a second treatment. Remission rates were assessed at the end of the first and second 6-week treatments. We then compared the remission rates of dichotomous groups formed on the basis of gender, age, pretreatment scores on SF36 and Multidimensional Fatigue Scale, the presence/absence of psychiatric/medical comorbidities or pain disorders, and mean subjective sleep duration and efficiency within and across treatment sequences.</p><p><b>RESULTS: </b>Lower remission rates were noted for those: with a pain disorder, poor mental health perceptions, high MFI fatigue scores, and lower sleep times and efficiencies. Patients with a pain disorder responded best to the BT-to-Zol sequence, whereas patients with more mental impairment, severe fatigue, short sleep, and low sleep efficiency responded poorly to treatment starting with BT.</p><p><b>CONCLUSIONS: </b>Pain, fatigue, poor mental health status, and subjective sleep duration and efficiency all affect response to different insomnia treatment sequences. Findings may guide clinicians in matching insomnia treatments to their patients.</p><p><b>CLINICAL TRIAL REGISTRATION: </b> Identifier: NCT01651442, Protocol version 4, April 20, 2011, registered June 26, 2012,

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