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To the Editor: In their study of treatment of chronic primary insomnia in older adults, Dr Sivertsen and colleagues¹ found that cognitive behavioral therapy (CBT) resulted in improved short- and long-term outcomes compared with zopiclone on 3 out of 4 outcome measures.

However, they did not have data specifically addressing daytime sleepiness as an outcome measure, which they note would have been interesting to compare with the observed changes in slow-wave sleep. The absence of this information limits the implications of this study; I believe that research in this area should concentrate more on daytime functioning as an outcome measure of this widespread disorder.

Insomnia research is shifting to conceptualize the disorder as one in which a more fundamental and widespread alteration in arousal physiology is occurring throughout the day—not simply a problem that manifests only at night.² Patients with insomnia generally appear more alert than individuals without insomnia during . . . [Full Text of this Article]

Raj Persaud, FRCPsych
r.persaud@iop.kcl.ac.uk
Bethlem Royal and Maudsley Hospitals NHS Trust
Beckenham, Kent, United Kingdom

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RELATED LETTERS

Treatment of Chronic Insomnia With Cognitive Behavioral Therapy vs Zopiclone
Gerson T. Lesser
JAMA. 2006;296(20):2435-2436.
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Treatment of Chronic Insomnia With Cognitive Behavioral Therapy vs Zopiclone—Reply
Børge Sivertsen
JAMA. 2006;296(20):2436.
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