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In Reply: Dr Jindal provides a plausible and elegant explanation of why CBT is more effective when used singly compared with its combination with hypnotic medication for maintenance therapy of persistent insomnia. While there is evidence showing that CBT produces better long-term outcomes than medication or combined therapy,^1-4 this was the first study to document the superior outcome of CBT in the context of maintenance therapies.

It is generally preferable to minimize exposure to hypnotic drugs, particularly if CBT is available and patients achieve adequate treatment response with this approach. However, CBT is not always available, and not all patients respond to this intervention. Hence, sleep medication, which may be the most readily available treatment, should be seen as a rescue and short-term therapy for acute insomnia resulting from stressful life events or major changes in schedule. Its role and efficacy in long-term management of insomnia remains controversial and poorly . . . [Full Text of this Article]

Charles M. Morin, PhD
cmorin@psy.ulaval.ca
École de Psychologie
Université Laval
Quebec City, Quebec, Canada

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