Effects of cognitive-behavioral therapy for insomnia during sedative-hypnotics withdrawal on sleep and cognition in older adults
Authors: Barbaux Loïc , Cross Nathan E. , Perrault Aurore A. , Es-sounni Mehdi , Desrosiers Caroline , Clerc Doris , Andriamampionona Francis , Lussier David , Tannenbaum Cara , Guimond Anik , Grenier Sébastien , Gouin Jean-Philippe , Dang-Vu Thien Thanh 
Published: February 2025

Objectives

Our objective was to assess the effect of cognitive-behavioral therapy for insomnia (CBTi) on subjective and objective sleep quality (including sleep spindles) and cognition during a sedative-hypnotics withdrawal program in older adults with insomnia disorder.

Methods

We performed a two-arm randomised controlled trial (RCT) of a sedative-hypnotic withdrawal plan alone (WPo group) or combined with CBTi (WP+CBTi group) in 47 older adults with insomnia disorder over a sixteen-week period. Our primary outcomes were change in self-reported insomnia severity (Insomnia Severity Index (ISI)), sleep efficiency (SE) from sleep diaries, and change in SE and spindle density from polysomnographic (PSG) recordings collected at baseline and at post-intervention (16 weeks). Secondary outcomes included other sleep changes from PSG, actigraphy and sleep diaries, sleep and mood questionnaires and neuropsychological assessments (manual dexterity, attention/concentration, verbal inhibition, visuo-spatial abilities).

Results

The withdrawal program was effective in achieving discontinuation and reducing insomnia severity, with similar success with and without CBTi. The combined intervention additionally improved subjective sleep quality and prevented the decrease in subjective sleep duration induced by sedative-hypnotic discontinuation. Neither intervention significantly impacted objective sleep architecture or cognitive performance. Furthermore, reduction in sleep spindle density was observed with combined CBTi and withdrawal, but not with withdrawal alone.

Conclusions

Both withdrawal alone and sedative-hypnotic withdrawal combined with CBTi effectively facilitated discontinuation and reduced insomnia severity, with the combined intervention further enhancing subjective sleep quality and preserving sleep duration. Although neither approach significantly impacted objective sleep architecture or cognitive performance, the potential reduction in sleep spindle density linked to the combined intervention warrants further investigation.

STATEMENT OF SIGNIFICANCE

This study evaluated the combined effects of CBTi and sedative-hypnotic withdrawal on both subjective and objective sleep outcomes, such as sleep spindle density, as well as cognitive performance, in older adults with insomnia disorder. Findings reveal that CBTi, when combined to sedative-hypnotic withdrawal program, not only supports withdrawal success and reduces insomnia severity but also enhances subjective sleep quality and maintains sleep duration, which may be compromised by withdrawal alone. The observed reduction in sleep spindle density, linked to the combined intervention, needs further investigation. These results provide valuable insights into optimizing sedative-hypnotic discontinuation strategies for older adults experiencing chronic insomnia.