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Hypnotics should not be considered for the initial treatment of chronic insomnia. Con
Edward J. Stepanski. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 2005-04-15
Topic: Risk, prevention and care in population studies
Analysis of the use of hypnotic medication versus CBT for insomnia using an established model for ethical medical decision making leads to the conclusion that hypnotics are not appropriate as the initial treatment in cases of chronic insomnia. Instead, CBT should be considered as the initial treatment for chronic insomnia. This decision is based on empirical data demonstrating that CBT is equally effective in the short-term treatment of insomnia and is superior to pharmacologic treatment in the long-term management of insomnia. Long-term management is a critically important concern, since 'chronic' insomnia requires a long-term solution. Using CBT as the initial treatment is also supported by empirical data showing that combining hypnotic use with CBT leads to worse outcomes compared with CBT alone. In addition to the efficacy data described above, patients have been shown to prefer nondrug therapy for insomnia when given the choice. QoL issues support the use of CBT because of the avoidance of side effects associated with use of hypnotic medication, such as residual sedation, psychomotor and cognitive impairment, and perhaps, most importantly, psychologic dependence. The greatest challenge to endorsement of use of CBT arises from contextual issues, such as the out-of-pocket cost to the patient and availability of the treatment. In some instances, these factors may be significant barriers to the use of CBT for insomnia. These barriers can be addressed with improved insurance reimbursement for CBT, in addition to training more providers.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
APA 7th
Stepanski, E. J. (2005). Hypnotics should not be considered for the initial treatment of chronic insomnia. Con. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine.
Vancouver
Stepanski EJ. Hypnotics should not be considered for the initial treatment of chronic insomnia. Con. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine. 2005. PMID: 17561624.
BibTeX
@article{stepanski2005-17561624,
author = {Stepanski, Edward J.},
title = {{Hypnotics should not be considered for the initial treatment of chronic insomnia. Con}},
journal = {Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine},
year = {2005},
pmid = {17561624}
}
Built from the record alzhub holds for this paper, not looked up. This record has no DOI, so the citation leaves it out. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
Key findings
- Analysis of the use of hypnotic medication versus CBT for insomnia using an established model for ethical medical decision making leads to the conclusion that hypnotics are not appropriate as the initial treatment in cases of chronic insomnia.
- Using CBT as the initial treatment is also supported by empirical data showing that combining hypnotic use with CBT leads to worse outcomes compared with CBT alone.
- QoL issues support the use of CBT because of the avoidance of side effects associated with use of hypnotic medication, such as residual sedation, psychomotor and cognitive impairment, and perhaps, most importantly, psychologic dependence.
- In some instances, these factors may be significant barriers to the use of CBT for insomnia.
Why it matters
This article argues that hypnotic medications should not be used as initial treatment for chronic insomnia, favoring cognitive behavioral therapy instead. It mentions cognitive impairment as a side effect of hypnotics but does not study Alzheimer's disease treatment, cure or prevention.
Study details
- Evidence strengthLow
How this study scored 29/100
Published in a peer-reviewed journal. Scored zero for study design, sample size, effect reported, studied in people and randomised / blinded because the record does not state it. We have no data on journal's citation record, so that was left out: it earned 28 of the 96 points we could judge it on, which is 29 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine) |
| Journal's citation record | — / 4 | No journal record from OpenAlex — left out of this score |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 2005 — older than 20 years, still counted |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 3 / 7 | Cited 20 times (OpenAlex, 2026-10-10) |
| Citations per year | 0 / 5 | 0.9 citations a year over 23 year(s) since 2005 |
| Impact for its field and year | 2 / 6 | Cited 2.9× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 0 / 4 | Cited 0 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 2 / 4 | Last-listed author Edward J. Stepanski: h-index 24 (OpenAlex, whole career) |
| Institution's track record | 0 / 3 | Rush University Medical Center: institution h-index 670 (OpenAlex) |
| Multi-centre collaboration | 0 / 3 | OpenAlex lists 1 institution(s) in 1 country — scores zero (affiliation lists can be incomplete) |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 17561624) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 28 / 96 | Scored on 19 of 20 parts. We have no data for the rest, so they are left out: 28 of the 96 points we could judge it on is 29 out of 100. |
| Total | 29 / 100 | — |
What each of these 20 components measures, and what this score is not →
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