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.