Abstract

Background: Benzodiazepines are prescribed for anxiety and insomnia. In majority of cases, consumption of benzodiazepines becomes chronic and accompanies risks and comorbidities affecting a wide range of cognitive abilities. Cognitive behavioral therapy for insomnia (CBT-i) is the first line therapy for treating insomnia. Implementation of this therapy with benzodiazepine withdrawal programs can improve sleep quality and weaning success rate.
Objective: To evaluate the effect of CBT-i on cognition upon withdrawal from a prolonged benzodiazepine consumption for chronic insomnia.
Methods: 24 insomniacs aged 60 years or older, after undergoing a comprehensive sleep and cognitive evaluation, were randomly assigned into two groups of CBT-i (n=12) and waitlist (n=12). While both groups followed a structured and progressive benzodiazepine withdrawal program over 16 weeks, the CBT-i group additionally received 8 sessions of CBT-i therapy. At the end of the weaning program, both groups underwent the same sleep and cognitive evaluations.
Results: All of sleep diary measures improved in the CBT-i group. Both groups showed improvements in insomnia severity index (p=0.000) and Pittsburgh Sleep Quality Index (p=0.002), while the latter improved more notably in the CBT-i group (p=0.014). Actigraphy, highlighted improved sleep efficiency (p=0.000) and decreased wake after sleep onset (p=0.008) in CBT-i group. The cognitive tests showed improvements in the reading speeds (time, p=0.000; score, p=0.006) and recall copying ability (p=0.040) of the CBT-i group.
Conclusion: This study, highlight the benefits of supplementing benzodiazepine withdrawal with CBT-i related to improvements in sleep quality, while also sheds some lights on its possible effects on cognition.