Despite chronic hypnotic drug use ostensibly to manage persistent insomnia, patients in the trial reported very high levels of sleep disturbance and very low levels of sleep quality. In routine general practice settings, psychological treatment for insomnia can improve sleep quality, reduce hypnotic drug use, and improve health-related quality of life at a favourable cost among long-term hypnotic users with chronic sleep difficulties. These positive outcomes appear robust over time, persisting for at least 1 year among the more treatment-adherent patients. While these benefits may be reduced among those patients presenting with higher levels of psychological distress, the present study clearly indicates that older age per se presents no barrier to successful treatment outcomes.
CBT for insomnia should be considered by primary care commissioners and practitioners when implementing National Service Framework recommendations for benzodiazepine use, and when addressing the insomnia management needs of patients with longer term sleep difficulties.