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September 22/29, 1999

Behavioral and Pharmacological Treatment for Insomnia—Reply

Author Affiliations

Margaret A.WinkerMD, Deputy EditorIndividualAuthorPhil B.FontanarosaMD, Interim CoeditorIndividualAuthor

JAMA. 1999;282(12):1130-1131. doi:10-1001/pubs.JAMA-ISSN-0098-7484-282-12-jbk0922

In Reply: In response to Dr Finucane, there is no consensus as to how we should measure outcome when treating insomnia. However, when insomnia is the presenting complaint, it makes sense to monitor changes in sleep parameters as an index of improvement (as we would monitor pain intensity as a marker of progress if treating chronic pain). We agree, however, that there is a need to examine outcome beyond symptom reduction and to incorporate measures of daytime performance, fatigue, mood, and psychological well-being. In our study, several secondary measures were collected. For example, 1 item from the Sleep Impairment Index scale assessed the perceived interference of the sleep problem with daytime functioning. This rating was improved in all 3 treatments but not in the placebo condition. Treated patients also reported modest, but reliable, improvements of psychological (ie, depressive) symptoms. We also administered neuropsychological tests measuring attention, concentration, memory, and other cognitive functions. Only mild and selective deficits were present at baseline on those measures and, naturally, there was little room for improvement after treatment.

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