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Partial Reinforcement Strategy Feasible for Chronic Insomnia

Poorer sleep continuity noted for intermittent dosing with 10 mg zolpidem, three to five times/week

TUESDAY, Aug. 11, 2015 (HealthDay News) — A partial reinforcement strategy with 10 mg zolpidem seems to be effective for maintenance therapy for chronic insomnia, according to a study published online July 7 in Sleep Medicine.

Michael Perlis, Ph.D., from the University of Pennsylvania in Philadelphia, and colleagues examined management of chronic insomnia in the long term, comparing a partial reinforcement strategy with nightly and intermittent dosing strategies. Seventy-four individuals with chronic insomnia received 10 mg zolpidem for four weeks. Responders were randomly allocated to 12 weeks of nightly dosing with 10 mg or 5 mg; intermittent dosing with 10 mg (three to five days weekly); or partial reinforcement dosing with 10 mg (nightly pill use with 50 percent active medication and 50 percent placebo).

The researchers found that in 55 compliant individuals, treatment response was maintained over time for all four strategies. Of those who remained in remission, poorer sleep continuity was seen for subjects in the intermittent dosing group.

“While best considered a preliminary study, the present findings suggest that the partial reinforcement strategy may be a viable means toward maintaining treatment gains over time with less active medication,” the authors write.

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