Can we mix behavioral therapy with hypnotics when treating insomniacs?

This study asks whether insomniacs undergoing behavioral training need to do so while totally free of hypnotics. Twenty-six insomniacs participated in the study, which included extensive monitoring of sleep both in the laboratory and at home. All subjects received six sessions of training in sleep hygiene and relaxation. About half the subjects were also given a hypnotic for occasional use; the others were asked to abstain from all hypnotics. Follow-up was performed immediately after treatment and again 10 months later. When compared with a waiting list, 6 hours of behavioral therapy improved insomniacs' sleep latency and sleep efficiency immediately after treatment, whether or not hypnotics were given concomitantly. Immediately following the 6 hours of therapy, those who had combined pharmacotherapy and behavior therapy improved about the same as those who had received behavior therapy alone. However, on the 10-month follow-up, those who had learned sleep hygiene and relaxation without the help of occasional hypnotics had more sleep and a better sleep efficiency than those who had been allowed an occasional hypnotic. We conclude that when teaching sleep hygiene and behavioral therapy to insomniacs, it might be advantageous to disallow the concomitant use of hypnotics as needed.