CBT or Temazepam: What Happened After Treatment Ended?

When a sleep treatment helps during the first month, ask what happens after the course ends. Set a review date, keep your sleep record and discuss how the plan should change if the improvement fades.

What did the eight-week comparison show?

The 1999 trial¹ randomized 78 screened adults aged at least 55, including 50 women, to CBT, temazepam, both or placebo. The analysis included 72, excluding six early dropouts. CBT involved eight weekly 90-minute group sessions.¹

Diary-reported awake time after falling asleep fell 55% with CBT, 46.5% with temazepam, 63.5% with both and 16.9% with placebo. These were within-group reductions; the active treatments did not differ significantly.¹

Current care should also address what the program involves. The 2025 VA/DoD guideline strongly recommends CBT-I, suggests it over medication as first-line care, and suggests against benzodiazepines for chronic insomnia. The latter two recommendations are weak recommendations. CBT-I combines work on sleep-related thoughts with behavioral treatment; a leaflet about bedtime habits is insufficient by itself.²

What can the two-year follow-up establish?

Only 39 participants from the three active-treatment groups returned diaries at 24 months. Placebo participants were offered active treatment after three months and excluded from long-term comparisons. Some participants resumed sleep medicine.¹

CBT’s improvements appeared better sustained, but follow-up tests assessed change within each group, not confirmatory superiority between treatments. Attrition and resumed medication limit the inference. This was not two years of assigned temazepam treatment or continuous placebo control.¹

The published 2026 AASM combination-treatment guideline conditionally favors starting CBT-I and medication together over medication alone. It conditionally advises against routinely favoring that combination over CBT-I alone. Both recommendations have low-certainty evidence. Some patients may choose the combination because they value an early increase in total sleep time; that choice needs an individual discussion.³

How should an existing prescription be reviewed?

The current US temazepam label describes short-term insomnia treatment, generally 7–10 days. Its boxed warning covers abuse, misuse, addiction, physical dependence and withdrawal, including potentially life-threatening withdrawal after abrupt discontinuation or rapid dose reduction. An existing prescription needs a prescriber-led review, with any dose change planned for the individual.⁴

Opioids, alcohol and other medicines that depress the central nervous system can increase sedation and breathing risks. The label also warns that drowsiness and reduced consciousness increase fall risk, particularly in older people. Bring the full medicine list, including nonprescription sleep products, and describe any daytime sedation or falls.⁴

Before starting CBT-I, mention substantial daytime sleepiness, nighttime falls, bipolar disorder or uncontrolled seizures. The VA/DoD guideline identifies these as reasons to adapt or sometimes delay behavioral treatment. Ask who will supervise the plan and how progress and safety will be checked.²

Did I Do That in My Sleep? explains “What CBT-I Actually Addresses” and “Getting Access,” including questions about trained providers, telehealth, coverage and whether a digital program provides structured insomnia treatment. Use those questions when arranging the next appointment.