Insomnia Clinical Trial
Official title:
Self-help Program for Hypnotics Withdrawal in Chronic Insomniac Patients: A Randomized Controlled Clinical Trial
Persistent insomnia has a high prevalence in French general population affecting between 15.8
% and 19 % of adults. In France, the disease is mainly managed by general practitioners (GP)
who usually proposed intermediate half-life benzodiazepines and Z-drugs in first-line
treatment. French Health authorities recommend restricting the consumption of both hypnotics
to no more than 4 weeks, considering their potential adverse effects (memory impairment,
altered sleep physiology, motor-vehicle crash), and the risk of tolerance and dependence.
However, it appears that a majority of patients become chronic users. Therefore,
discontinuation of benzodiazepines/Z-drugs is recommended, but it may appear as a challenge
due to withdrawal symptoms and psychological factors (anticipatory anxiety, fear of rebound
insomnia).
Numerous studies have shown that programs based on Cognitive-Behavioural Therapy (CBT)
principles improve sleep and daily life quality leading to hypnotic taper and maintain of
hypnotic abstinence in insomniac patients. Cognitive-Behavioural Therapy (CBT) is based on 4
components: sleep restriction, stimulus control, cognitive therapy and sleep hygiene
education. This therapy is dependent on a therapeutic alliance between practitioner and
patient. Unfortunately, there are an insufficient number of trained CBT experts especially in
France.
The implementation of an internet-delivered self-help program based on time-in-bed
restriction and stimulus control may be an issue within the context of general practice.
Online programs based on CBT principles have been proved to be effective in improving the
sleep and daytime functioning in this population, but the studies were realized in small
patients groups.
Investigators hypothesis is that a simple and internet-delivered short-term program based on
sleep restriction therapy and stimulus control (following to a GP consultation) may
facilitate hypnotics discontinuation (benzodiazepines/Z-drugs) in patient with insomnia
disorder still reporting sleep complaints in comparison with a tapering alone (no access to
the self-help program).
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