Introduction
insomnia, Insomnia, sleep disorder
SECONDARY
Insomnia is a highly prevalent sleep disorder that tends to be persistent or recurrentCurrent recommended treatments for insomnia in clinical practice guidelines include 2 major approaches: psychological therapies (ie, cognitive behavioral therapy [CBT]) and medications (eg, benzodiazepine-receptor agonists and sedating antidepressants).Only a few studies have directly compared the efficacy of CBT and medications for daytime symptoms in insomnia, with mixed findings. In a randomized clinical trial (RCT) of young and middle-aged patients with chronic sleep-onset insomnia, no significant differences were found among CBT, medications, and combination therapy on mood-related changes after intervention.The main objectives of this study were to compare short-term and long-term changes in daytime functions of 4 treatment sequences using psychological (behavioral and cognitive) and pharmacologic therapies (zolpidem and trazodone) for insomnia. In particular, the study aimed to compare the efficacy of behavioral therapy (BT) and zolpidem as first-stage therapies for improvement of daytime functions. For those whose insomnia did not remit after first-stage therapy, the added value of a second treatment was evaluated. Daytime functions investigated in the current study were among the predefined secondary outcomes of a previously published trial.