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Todd Arnedt J, Conroy DA, Stewart H, Yeagley E, Bowyer G, Bohnert KM, Ilgen MA. Cognitive behavioral therapy for insomnia to reduce cannabis use: Results from a pilot randomized controlled trial. Drug Alcohol Depend 2023; 246:109835. [PMID: 36940598 DOI: 10.1016/j.drugalcdep.2023.109835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/26/2023] [Accepted: 03/02/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Individuals with regular cannabis use demonstrate adverse health outcomes, yet infrequently seek treatment. Insomnia, a common co-occurring complaint, could be targeted to reduce cannabis use and improve functioning in these individuals. In an intervention development study, we refined and tested the preliminary efficacy of a telemedicine-delivered CBT for insomnia tailored to individuals with regular cannabis use for sleep (CBTi-CB-TM). METHODS In this single-blind randomized trial, fifty-seven adults (43 women, mean age 37.6 ± 12.8 years) with chronic insomnia and cannabis use for sleep ≥3 times/week received CBTi-CB-TM (n = 30) or sleep hygiene education (SHE-TM, n = 27). Participants completed self-reported assessments of insomnia (Insomnia Severity Index [ISI]) and cannabis use (Timeline Followback [TLFB] and daily diary data) at pre-treatment, post-treatment, and 8-week follow-up. RESULTS ISI scores improved significantly more in the CBTi-CB-TM compared to SHE-TM condition (β = -2.83, se=0.84, P = 0.004, d=0.81). At 8-week follow-up, 18/30 (60.0 %) CBTi-CB-TM compared to 4/27 (14.8 %) SHE-TM participants were in remission from insomnia (X2 =12.8, P = 0.0003). The TLFB showed a small reduction in past 30-day cannabis use for both conditions (β = -0.10, se=0.05, P = 0.026); CBTi-CB-TM participants demonstrated greater post-treatment reductions in the % of days cannabis was used within 2 h of bedtime (-29.1 ± 7.9 % fewer days vs. 2.6 ± 8.0 % more days, P = 0.008). CONCLUSIONS CBTi-CB-TM is feasible, acceptable, and demonstrated preliminary efficacy for improving sleep and cannabis-related outcomes among non-treatment-seeking individuals with regular cannabis use for sleep. Although sample characteristics limit generalizability, these findings support the need for adequately powered randomized controlled trials with longer follow-up periods.
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Affiliation(s)
- J Todd Arnedt
- Sleep and Circadian Research Laboratory, Department of Psychiatry, Michigan Medicine, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, USA.
| | - Deirdre A Conroy
- Sleep and Circadian Research Laboratory, Department of Psychiatry, Michigan Medicine, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, USA
| | - Haylie Stewart
- The Addiction Center, Department of Psychiatry, Michigan Medicine, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, USA
| | - Emily Yeagley
- The Addiction Center, Department of Psychiatry, Michigan Medicine, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, USA; Center for Clinical Management Research, Ann Arbor VA Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, USA
| | - Gabrielle Bowyer
- The Addiction Center, Department of Psychiatry, Michigan Medicine, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, USA
| | - Kipling M Bohnert
- Department of Epidemiology and Biostatistics, Michigan State University, 909 Wilson Road Room B601, East Lansing, MI 48824, USA
| | - Mark A Ilgen
- The Addiction Center, Department of Psychiatry, Michigan Medicine, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, USA; Center for Clinical Management Research, Ann Arbor VA Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, USA
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Maltseva M, Schubert-Bast S, Zöllner JP, Bast T, Mayer T, von Spiczak S, Ruf S, Trollmann R, Wolff M, Hornemann F, Klotz KA, Jacobs J, Kurlemann G, Neubauer BA, Polster T, Syrbe S, Bertsche A, Bettendorf U, Kluger G, Flege S, Rosenow F, Kay L, Strzelczyk A. Sleep quality, anxiety, symptoms of depression, and caregiver burden among those caring for patients with Dravet syndrome: a prospective multicenter study in Germany. Orphanet J Rare Dis 2023; 18:98. [PMID: 37120555 PMCID: PMC10148440 DOI: 10.1186/s13023-023-02697-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 04/06/2023] [Indexed: 05/01/2023] Open
Abstract
BACKGROUND This study measured sleep quality among caregivers of patients with Dravet syndrome (DS) and assessed the impacts of mental health problems and caregiver burden on sleep quality. METHODS This multicenter, cross-sectional study of patients with DS and their caregivers throughout Germany consisted of a questionnaire and a prospective 4-week diary querying disease characteristics, demographic data, living conditions, nocturnal supervision, and caregivers' work situations. Sleep quality was assessed using the Pittsburgh Sleeping Quality Index (PSQI). The Hospital Anxiety and Depression Scale (HADS) and the Burden Scale for Family Caregivers (BSFC) were used to measure anxiety, symptoms of depression, and caregiver burden. RESULTS Our analysis included 108 questionnaires and 82 four-week diaries. Patients with DS were 49.1% male (n = 53), with a mean age of 13.5 ± 10.0 years. Caregivers were 92.6% (n = 100) female, with a mean age of 44.7 ± 10.6 years. The overall mean PSQI score was 8.7 ± 3.5, with 76.9% of participants (n = 83) scoring 6 or higher, indicating abnormal sleep quality. The HADS for anxiety and depression had overall mean scores of 9.3 ± 4.3 and 7.9 ± 3.7, respectively; 61.8% and 50.9% of participants scored above the cutoff value of 8 for anxiety and depression, respectively. Statistical analyses revealed caregiver anxiety levels and patients' sleep disturbances as major factors influencing PSQI scores. The overall mean BSFC score of 41.7 ± 11.7 indicates a moderate burden, with 45.3% of caregivers scoring 42 or higher. CONCLUSIONS Sleep quality is severely affected among caregivers of patients with DS, correlating with anxiety, comorbidities, and patients' sleep disturbances. A holistic therapeutic approach should be implemented for patients with DS and their caregivers, focusing on the sleep quality and mental health of caregivers. TRIAL REGISTRATION German Clinical Trials Register (DRKS), DRKS00016967. Registered 27 May 2019, http://www.drks.de/DRKS00016967.
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Affiliation(s)
- Margarita Maltseva
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
- Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Susanne Schubert-Bast
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
- Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
- Department of Neuropediatrics, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Johann Philipp Zöllner
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
- Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Thomas Bast
- Epilepsy Center Kork, Kehl-Kork, Germany
- Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Thomas Mayer
- Epilepsy Center Kleinwachau, Dresden-Radeberg, Germany
| | - Sarah von Spiczak
- Northern German Epilepsy Centre for Children and Adolescents, Kiel-Raisdorf, Germany
| | - Susanne Ruf
- Department of Neuropediatrics, University of Tübingen, Tübingen, Germany
| | - Regina Trollmann
- Department of Neuropediatrics, Friedrich-Alexander University, Erlangen, Germany
| | - Markus Wolff
- Center of Pediatric Neurology, Vivantes Hospital Neukoelln, Berlin, Germany
- Swiss Epilepsy Center, Klinik Lengg AG, Zürich, Switzerland
| | - Frauke Hornemann
- Department of Neuropediatrics, Leipzig University Hospital for Children and Adolescents, Leipzig, Germany
| | - Kerstin A Klotz
- Department of Neuropediatrics and Muscle Disorders, Medical Center - University of Freiburg, Freiburg im Breisgau, Germany
| | - Julia Jacobs
- Department of Neuropediatrics and Muscle Disorders, Medical Center - University of Freiburg, Freiburg im Breisgau, Germany
- Department of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Bernd A Neubauer
- Department of Neuropediatrics, Justus-Liebig-University Giessen, Giessen, Germany
| | | | - Steffen Syrbe
- Division of Pediatric Epileptology, Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Astrid Bertsche
- Department of Neuropediatrics, University Hospital for Children and Adolescents, Rostock, Germany
- Department of Neuropediatrics, University Hospital for Children and Adolescents, Greifswald, Germany
| | | | - Gerhard Kluger
- Clinic for Neuropediatrics and Neurorehabilitation, Epilepsy Center for Children and Adolescents, Schoen Clinic Vogtareuth, Vogtareuth, Germany
- Research Institute "Rehabilitation, Transition, and Palliation", PMU Salzburg, Salzburg, Austria
| | | | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
- Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Lara Kay
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
- Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany.
- Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany.
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Immich G, Frisch D, Oberhauser C, Schuh A, Stier-Jarmer M. Effekte einer ambulanten Kneippkur als multimodale
Lebensstilintervention für die primäre Insomnie: eine
randomisierte kontrollierte Studie. PHYSIKALISCHE MEDIZIN, REHABILITATIONSMEDIZIN, KURORTMEDIZIN 2022. [DOI: 10.1055/a-1954-5007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Zusammenfassung
Einleitung In Deutschland leiden 6–10% der Menschen an
klinisch relevanten Schlafstörungen, insbesondere unter der arbeitenden
Bevölkerung. Werden diese chronisch, können sie zu
schwerwiegenden Erkrankungen führen und einen beträchtlichen
Teil der Abwesenheit vom Arbeitsplatz ausmachen. Deshalb wurde ein
Kneippkurprogramm für nicht-organische Schlafstörungen als ein
nicht-medikamentöses Behandlungskonzept im Kurort Füssen
entwickelt und überprüft.
Methodik Randomisierte monozentrische klinische Studie mit 5
Erhebungszeitpunkten (prä-/post-Intervention, 1, 3 und 6 Monate
nach Intervention). Intervention: 19-tägiges multimodales Kneippprogramm
(Ordnungstherapie, Hydro- und Thermotherapie, Bewegungstherapie).
Primäre Zielgröße: Subjektive Schlafqualität
(PSQI-Gesamtscore von 0–21 Punkte:≤5 Punkte=gesunder
Schlaf, PSQI-Wert 5–10 Punkte=schlechte Schlafqualität,
PSQI-Gesamtscore>10 Punkte=chronische Schlafstörung).
Sekundäre Zielgrößen: Allgemeines Wohlbefinden
(WHO-5-Wellbeing-Index), chronische Stressbelastung (TICS), dysfunktionale
Überzeugungen zum Schlaf (DAB-16), Teilnehmerzufriedenheit.
Ergebnisse 96 Erwachsene mit Schlafstörungen (mittleres Alter 56
Jahre, 83% weiblich) wurden in eine Interventionsgruppe IG
(N=47) und Wartekontrollgruppe WG (N=49) randomisiert. Zu
Studienbeginn gab es keine relevanten Gruppenunterschiede (PSQI-Gesamtwerte: IG
11,7±3,1, WG: 10,6±3,0). Nach 1, 3 und 6 Monaten erhöhte
sich der Anteil guter Schläfer deutlich stärker in IG versus WG:
34 vs. 10% nach 1 Monat, 40 vs. 12% nach 3 Monaten sowie 28 vs.
14% nach 6 Monaten. Nach 1, 3 und 6 Monaten reduzierte sich der mittlere
PSQI-Gesamtscore deutlich stärker in IG als in der WG:
− 4,44 Pkt. vs. − 1,14 Pkt. nach 1 Monat
(p=0,001), − 4,19 Pkt. vs. − 1,14 Pkt.
nach 3 Monaten (p=0,014]) und − 3,53 Pkt. vs.
− 1,28 Pkt. nach sechs Monaten (p=0,111). Dabei erzielte
die IG eine klinisch relevante Reduktion des PSQI-Scores von minus 3 Punkten zu
allen Messzeitpunkten im Follow-up. Vergleichbare positive Effekte zeigten sich
bei der IG bzgl. des allgemeinen Wohlbefindens, der chronischen Stressbelastung
und den dysfunktionalen Gedanken zum Schlaf.
Schlussfolgerung Die ambulante multimodale Kneippkur erzielte signifikante
Verbesserungen bei Schlafqualität und Wohlbefinden sowie eine Reduktion
der chronischen Stressbelastung bei Erwachsenen mit nicht-organischen
Schlafstörungen. Die Nachhaltigkeit der Effekte über 6 Monate
hinaus müssten in weiteren Studien untersucht werden.
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Affiliation(s)
- Gisela Immich
- Lehrstuhl für Public Health und Versorgungsforschung (IBE),
Pettenkofer School of Public Health, Ludwig-Maximilians-Universität,
München, Germany
| | - Dieter Frisch
- Institut für Evidenzbasierte Kurortmedizin und
Gesundheitsförderung (IKOM), Sachgebiet GE8, Bayerisches Landesamt
für Gesundheit und Lebensmittelsicherheit, Bad Kissingen, Germany
| | - Cornelia Oberhauser
- Lehrstuhl für Public Health und Versorgungsforschung (IBE),
Pettenkofer School of Public Health, Ludwig-Maximilians-Universität,
München, Germany
| | - Angela Schuh
- Lehrstuhl für Public Health und Versorgungsforschung (IBE),
Pettenkofer School of Public Health, Ludwig-Maximilians-Universität,
München, Germany
| | - Marita Stier-Jarmer
- Lehrstuhl für Public Health und Versorgungsforschung (IBE),
Pettenkofer School of Public Health, Ludwig-Maximilians-Universität,
München, Germany
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Arnedt JT, Cardoni ME, Conroy DA, Graham M, Amin S, Bohnert KM, Krystal AD, Ilgen MA. Telemedicine-delivered cognitive-behavioral therapy for insomnia in alcohol use disorder (AUD): study protocol for a randomized controlled trial. Trials 2022; 23:59. [PMID: 35057834 PMCID: PMC8771184 DOI: 10.1186/s13063-021-05898-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 11/30/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Alcohol use disorder (AUD) is a leading preventable cause of morbidity and mortality, but relapse rates are high even with available treatments. Insomnia is a robust predictor of relapse and pilot studies have shown that CBT for insomnia improves insomnia and daytime functioning in adults with AUD and insomnia. The impact of CBT for insomnia on relapse, however, is unclear. This trial will compare telemedicine-delivered CBT for insomnia (CBT-TM) with sleep hygiene education (SHE-TM) on improving insomnia/sleep, daytime symptom, and drinking outcomes in treatment-seeking AUD adults with insomnia. The study will also determine the effects of treatment on sleep mechanisms and their association with clinical outcomes. METHODS This is a single-site randomized controlled trial with planned enrollment of 150 adults meeting criteria for both AUD and chronic insomnia. Eligible participants will be randomized 1:1 to 6 sessions of telemedicine-delivered Cognitive Behavioral Therapy for Insomnia (CBT-TM) or Sleep Hygiene Education (SHE-TM) with clinical assessments conducted at pre-treatment, post- treatment, and at 3, 6, and 12 months post-treatment. Overnight polysomnography will be conducted before and after treatment. Primary clinical outcomes will include post-treatment scores on the Insomnia Severity Index and the General Fatigue subscale of the Multidisciplinary Fatigue Inventory, and the percent of days abstinent (PDA) on the interview-administered Time Line Follow Back. EEG delta activity, derived from overnight polysomnography, will be the primary endpoint to assess the sleep homeostasis mechanism. DISCUSSION This adequately powered randomized controlled trial will provide clinically relevant information about whether targeting insomnia is effective for improving treatment outcomes among treatment-seeking adults with AUD. Additionally, the study will offer new scientific insights on the impact of an evidence-based non-medication treatment for insomnia on a candidate mechanism of sleep dysfunction in this population - sleep homeostasis. TRIAL REGISTRATION CClinicalTrials.gov NCT # 04457674 . Registered on 07 July 2020.
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Affiliation(s)
- J Todd Arnedt
- Sleep and Circadian Research Laboratory, Department of Psychiatry, Michigan Medicine, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI, 48109-2700, USA.
| | - M Elizabeth Cardoni
- Sleep and Circadian Research Laboratory, Department of Psychiatry, Michigan Medicine, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI, 48109-2700, USA
| | - Deirdre A Conroy
- Sleep and Circadian Research Laboratory, Department of Psychiatry, Michigan Medicine, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI, 48109-2700, USA
| | - Mandilyn Graham
- Sleep and Circadian Research Laboratory, Department of Psychiatry, Michigan Medicine, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI, 48109-2700, USA
| | - Sajni Amin
- Sleep and Circadian Research Laboratory, Department of Psychiatry, Michigan Medicine, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI, 48109-2700, USA
| | - Kipling M Bohnert
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, USA
| | - Andrew D Krystal
- UCSF Weill Institute for Neurosciences, University of California San Francisco, San Francisco, USA
| | - Mark A Ilgen
- University of Michigan Addiction Treatment Services, Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, USA
- VA Center for Clinical Management Research (CCMR) Department of Veterans Affairs Healthcare System, Michigan, Ann Arbor, USA
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Yeung K, Zhu W, McCurry SM, Von Korff M, Wellman R, Morin CM, Vitiello MV. Cost-effectiveness of telephone cognitive behavioral therapy for osteoarthritis-related insomnia. J Am Geriatr Soc 2022; 70:188-199. [PMID: 34633061 PMCID: PMC8742775 DOI: 10.1111/jgs.17469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/22/2021] [Accepted: 08/23/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Osteoarthritis-related insomnia is the most common form of comorbid insomnia among older Americans. A randomized clinical trial found that six sessions of telephone-delivered cognitive behavioral therapy for insomnia (CBT-I) improved sleep outcomes in this population. Using these data, we evaluated the incremental cost-effectiveness of CBT-I from a healthcare sector perspective. METHODS The study was based on 325 community-dwelling older adults with insomnia and osteoarthritis pain enrolled with Kaiser Permanente of Washington State. We measured quality-adjusted life years (QALYs) using the EuroQol 5-dimension scale. Arthritis-specific quality of life was measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Insomnia-specific quality of life was measured using the Insomnia Severity Index (ISI) and nights without clinical insomnia (i.e., "insomnia-free nights"). Total healthcare costs included intervention and healthcare utilization costs. RESULTS Over the 12 months after randomization, CBT-I improved ISI and WOMAC by -2.6 points (95% CI: -2.9 to -2.4) and -2.6 points (95% CI: -3.4 to -1.8), respectively. The ISI improvement translated into 89 additional insomnia-free nights (95% CI: 79 to 98) over the 12 months. CBT-I did not significantly reduce total healthcare costs (-$1072 [95% CI: -$1968 to $92]). Improvements in condition-specific measures were not reflected in QALYs gained (-0.01 [95% CI: -0.01 to 0.01]); at a willingness-to-pay of $150,000 per QALY, CBT-I resulted in a positive net monetary benefit of $369 with substantial uncertainty (95% CI: -$1737 to $2270). CONCLUSION CBT-I improved sleep and arthritis function without increasing costs. These findings support the consideration of telephone CBT-I for treating insomnia among older adults with comorbid OA. Our findings also suggest potential limitations of the general quality of life measures in assessing interventions designed to improve sleep and arthritis outcomes.
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Affiliation(s)
- Kai Yeung
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA,University of Washington, The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, Seattle, Washington, USA
| | - Weiwei Zhu
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Susan M. McCurry
- Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle, Washington, USA
| | - Michael Von Korff
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Robert Wellman
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Charles M. Morin
- Department of Psychology, Université Laval, Quebec City, Quebec, Canada
| | - Michael V. Vitiello
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
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Arnedt JT, Conroy DA, Mooney A, Furgal A, Sen A, Eisenberg D. Telemedicine versus face-to-face delivery of cognitive behavioral therapy for insomnia: a randomized controlled noninferiority trial. Sleep 2021; 44:5870824. [PMID: 32658298 DOI: 10.1093/sleep/zsaa136] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 06/17/2020] [Indexed: 12/22/2022] Open
Abstract
STUDY OBJECTIVES In a randomized controlled noninferiority trial, we compared face-to-face and telemedicine delivery (via the AASM SleepTM platform) of cognitive-behavioral therapy (CBT) for insomnia for improving insomnia/sleep and daytime functioning at posttreatment and 3-month follow-up. A secondary objective compared the modalities on treatment credibility, satisfaction, and therapeutic alliance. METHODS A total of 65 adults with chronic insomnia (46 women, 47.2 ± 16.3 years of age) were randomized to 6 sessions of CBT for insomnia delivered individually via AASM SleepTM (n = 33, CBT-TM) or face-to-face (n = 32, CBT-F2F). Participants completed sleep diaries, the Insomnia Severity Index (ISI), and daytime functioning measures at pretreatment, posttreatment, and 3-month follow-up. Treatment credibility, satisfaction, and therapeutic alliance were compared between treatment modalities. The ISI was the primary noninferiority outcome. RESULTS Based on a noninferiority margin of four points on the ISI and, after adjusting for confounders, CBT-TM was noninferior to CBT-F2F at posttreatment (β = 0.54, SE = 1.10, 95% CI = 1.64 to 2.72) and follow-up (β = 0.34, SE = 1.10, 95% CI = 1.83 to 2.53). Daytime functioning measures, except the physical composite scale of the SF-12, were significantly improved at posttreatment and follow-up, with no difference between treatment formats. CBT-TM sessions were, on average, nearly 10 min shorter, yet participant ratings of therapeutic alliance were similar to CBT-F2F. CONCLUSIONS Telemedicine delivery of CBT for insomnia is not inferior to face-to-face for insomnia severity and yields similar improvements on other sleep and daytime functioning outcomes. Further, telemedicine allows for more efficient treatment delivery while not compromising therapeutic alliance. CLINICAL TRIAL REGISTRATION NUMBER NCT03293745.
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Affiliation(s)
- J Todd Arnedt
- Sleep and Circadian Research Laboratory, Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Deirdre A Conroy
- Sleep and Circadian Research Laboratory, Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Ann Mooney
- Sleep and Circadian Research Laboratory, Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Allison Furgal
- Department of Family Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI.,Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Ananda Sen
- Department of Family Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI.,Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI
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Sweetman A, Putland S, Lack L, McEvoy RD, Adams R, Grunstein R, Stocks N, Kaambwa B, Van Ryswyk E, Gordon C, Vakulin A, Lovato N. The effect of cognitive behavioural therapy for insomnia on sedative-hypnotic use: A narrative review. Sleep Med Rev 2020; 56:101404. [PMID: 33370637 DOI: 10.1016/j.smrv.2020.101404] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/12/2020] [Accepted: 07/26/2020] [Indexed: 01/09/2023]
Abstract
Although cognitive behavioural therapy for insomnia (CBTi) is the recommended 'first-line' treatment for insomnia, most patients are initially treated with sedative-hypnotic medications. Given the risk of impaired cognitive and psychomotor performance, serious adverse events, and long-term dependence associated with sedative-hypnotics, guidelines recommend that prescriptions should be limited to short-term use and that patients are provided with support for withdrawal where possible. CBTi is an effective insomnia treatment in the presence of sedative-hypnotic use. Furthermore, guidelines recommended that CBTi techniques are utilised to facilitate withdrawal from sedative-hypnotics. However, there is very little research evaluating the effect of CBTi on reduced medication use. The current narrative review integrates 95 studies including over 10,000 participants, investigating the effect of CBTi on reduced sedative-hypnotic use in different populations (e.g., hypnotic-dependent patients, older adults, military personnel), settings (e.g., primary care settings, psychiatric inpatients), CBTi modalities (e.g., self-administered reading/audio materials, digital, and therapist-administered), and in combination with gradual dose reduction programs. Based on this research, we discuss the theoretical mechanistic effects of CBTi in facilitating reduced sedative-hypnotic use, provide clear recommendations for future research, and offer pragmatic clinical suggestions to increase access to CBTi to reduce dependence on sedative-hypnotics as the 'default' treatment for insomnia.
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Affiliation(s)
- Alexander Sweetman
- The Adelaide Institute for Sleep Health: A Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia; National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia.
| | | | - Leon Lack
- College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia; National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia
| | - R Doug McEvoy
- The Adelaide Institute for Sleep Health: A Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia; National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia
| | - Robert Adams
- The Adelaide Institute for Sleep Health: A Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia; The Health Observatory, Discipline of Medicine, The Queen Elizabeth Hospital Campus, University of Adelaide, Woodville, South Australia, Australia; Respiratory and Sleep Service, Southern Adelaide Local Health Network, Bedford Park, Adelaide, South Australia, Australia; National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia
| | - Ron Grunstein
- Sleep and Chronobiology Research Group, Woolcock Institute of Medical Research, University of Sydney, New South Wales, Australia; National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia
| | - Nigel Stocks
- Discipline of General Practice, Adelaide Medical School, University of Adelaide, South Australia, Australia; National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia
| | - Billingsley Kaambwa
- Health Economics, College of Medicine and Public Health, Bedford Park, Adelaide, South Australia, Australia; National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia
| | - Emer Van Ryswyk
- The Adelaide Institute for Sleep Health: A Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia; National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia
| | - Christopher Gordon
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, NSW, Australia; Sleep and Chronobiology Research Group, Woolcock Institute of Medical Research, University of Sydney, New South Wales, Australia; National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia
| | - Andrew Vakulin
- The Adelaide Institute for Sleep Health: A Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia; National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia
| | - Nicole Lovato
- The Adelaide Institute for Sleep Health: A Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia; National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia
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Economic evaluation of cognitive behavioural therapy for insomnia (CBT-I) for improving health outcomes in adult populations: A systematic review. Sleep Med Rev 2020; 54:101351. [DOI: 10.1016/j.smrv.2020.101351] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 01/10/2023]
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Swanson LM, Kalmbach DA, Raglan GB, O’Brien LM. Perinatal Insomnia and Mental Health: a Review of Recent Literature. Curr Psychiatry Rep 2020; 22:73. [PMID: 33104878 PMCID: PMC9109228 DOI: 10.1007/s11920-020-01198-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/14/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW The perinatal period is a time of high risk for insomnia and mental health conditions. The purpose of this review is to critically examine the most recent literature on perinatal insomnia, focusing on unique features of this period which may confer specific risk, associations with depression and anxiety, and emerging work on perinatal insomnia treatment. RECENT FINDINGS A majority of perinatal women experience insomnia, which may persist for years, and is associated with depression and anxiety. Novel risk factors include personality characteristics, nocturnal perinatal-focused rumination, and obesity. Mindfulness and physical activity may be protective. Cognitive-behavioral therapy for insomnia is an effective treatment. Perinatal insomnia is exceedingly common, perhaps due to factors unique to this period. Although closely linked to perinatal mental health, more work is needed to establish causality. Future work is also needed to establish the role of racial disparities, tailor treatments, and determine whether insomnia treatment improves perinatal mental health.
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Affiliation(s)
- Leslie M. Swanson
- Department of Psychiatry, University of Michigan, Ann Arbor, MI;,Corresponding Author: Leslie M. Swanson, Department of Psychiatry, University of Michigan, 4250 Plymouth Rd, Ann Arbor, MI 48109,
| | - David A. Kalmbach
- Sleep Disorders and Research Center, Henry Ford Hospital, Detroit, MI
| | - Greta B. Raglan
- Department of Psychiatry, University of Michigan, Ann Arbor, MI
| | - Louise M. O’Brien
- Department of Neurology, Sleep Disorders Center, University of Michigan, Ann Arbor, MI
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Depression prevention in digital cognitive behavioral therapy for insomnia: Is rumination a mediator? J Affect Disord 2020; 273:434-441. [PMID: 32560938 DOI: 10.1016/j.jad.2020.03.184] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 03/24/2020] [Accepted: 03/30/2020] [Indexed: 11/23/2022]
Abstract
Background There has been growing support for digital Cognitive Behavioral Therapy (dCBT-I) as a scalable intervention that both reduces insomnia and prevents depression. However, the mechanisms by which dCBT-I reduces and prevents depression is less clear. Methods This was a randomized controlled trial with two parallel arms: dCBT-I (N=358), or online sleep education as the control condition (N=300). Outcome variables were measured at pre-treatment, post-treatment, and one-year follow-up, and included the Insomnia Severity Index (ISI), the Quick Inventory of Depressive Symptomatology (QIDS-SR16), and the Perseverative Thinking Questionnaire (PTQ). The analyses tested change in PTQ scores as a mediator for post-treatment insomnia, post-treatment depression, and incident depression at one-year follow-up. Results Reductions in rumination (PTQ) were significantly larger in the dCBT-I condition compared to control. Results also showed that reductions in rumination significantly mediated the improvement in post-treatment insomnia severity (proportional effect = 11%) and post-treatment depression severity (proportional effect = 19%) associated with the dCBT-I condition. Finally, reductions in rumination also significantly mediated the prevention of clinically significant depression via dCBT-I (proportional effect = 42%). Limitations Depression was measured with a validated self-report instrument instead of clinical interviews. Durability of results beyond one-year follow-up should also be tested in future research. Conclusions Results provide evidence that rumination is an important mechanism in how dCBT-I reduces and prevents depression.
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Abstract
Chronic sleep deprivation is a common, treatable condition among adolescents. Growing literature supports a myriad consequences that impact overall health, behavior, mood, and academic performance in this vulnerable age group during a time when there are rapid changes in physical development and emotional regulation. This article reviews the epidemiology and health effects of sleep deprivation in adolescents as well as common disorders leading to sleep loss and evidence to support treatment. Although a variety of important sleep disorders may disrupt quality of sleep in adolescents, such as obstructive sleep apnea, restless leg syndrome, and narcolepsy, this article will focus on common disorders that affect the quantity of sleep, such as poor sleep hygiene, circadian rhythm disorders, and insomnia.
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Natsky AN, Vakulin A, Chai-Coetzer CL, Lack L, McEvoy RD, Kaambwa B. Economic evaluation of cognitive behavioural therapy for insomnia (CBT-I) for improving health outcomes in adult population: a systematic review protocol. BMJ Open 2019; 9:e032176. [PMID: 31699744 PMCID: PMC6858181 DOI: 10.1136/bmjopen-2019-032176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Insomnia is associated with a number of adverse consequences that place a substantial economic burden on individuals and society. Cognitive behavioural therapy for insomnia (CBT-I) is a promising intervention that can improve outcomes in people who suffer from insomnia. However, evidence of its cost-effectiveness remains unclear. In this study, we will systematically review studies that report on economic evaluations of CBT-I and investigate the potential economic benefit of CBT-I as a treatment for insomnia. METHODS AND ANALYSIS The search will include studies that use full economic evaluation methods (ie, cost-effectiveness, cost-utility, cost-benefit, cost-consequences and cost-minimisation analysis) and those that apply partial economic evaluation approaches (ie, cost description, cost-outcome description and cost analysis). We will conduct a preliminary search in MEDLINE, Google Scholar, MedNar and ProQuest dissertation and theses to build the searching terms. A full search strategy using all identified keywords and index terms will then be undertaken in several databases including MEDLINE, Psychinfo, Proquest, Cochrane, Scopus, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Web of Science and EMBASE. We will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for protocol guidelines in this review. Only articles in the English language and those reporting on adult populations will be included. We will use standardised data extraction tools for economic evaluations to retrieve and synthesise information from selected studies into themes and summarised in a Joanna Briggs Institute dominance ranking matrix. ETHICS AND DISSEMINATION No formal ethics approval will be required as we will not be collecting primary data. Review findings will be disseminated through a peer-reviewed publication, workshops, conference presentations and a media release. PROSPERO REGISTRATION NUMBER CRD42019133554.
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Affiliation(s)
- Andrea Natalie Natsky
- Department of Health Economics, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Andrew Vakulin
- Adelaide Institute for Sleep Health: A Flinders Centre for Research Excellence, Flinders University, Adelaide, South Australia, Australia
- NeuroSleep and Woolcock Institute of Medical Research, University of Sydney, Camperdown, New South Wales, Australia
| | - Ching Li Chai-Coetzer
- Adelaide Institute for Sleep Health: A Flinders Centre for Research Excellence, Flinders University, Adelaide, South Australia, Australia
- Sleep Health Service, Southern Adelaide Local Health Network, SA Health, Bedford Park, South Australia, Australia
| | - Leon Lack
- Adelaide Institute for Sleep Health: A Flinders Centre for Research Excellence, Flinders University, Adelaide, South Australia, Australia
| | - R Doug McEvoy
- Adelaide Institute for Sleep Health: A Flinders Centre for Research Excellence, Flinders University, Adelaide, South Australia, Australia
- Department of Medicine, Flinders University, Adelaide, South Australia, Australia
| | - Billingsley Kaambwa
- Department of Health Economics, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
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Zhang H, Li Y, Li M, Chen X. Retracted: A randomized controlled trial of mindfulness-based stress reduction for insomnia secondary to cervical cancer: Effects on sleep. Cancer Rep (Hoboken) 2019; 2:e1190. [PMID: 32721075 DOI: 10.1002/cnr2.1190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 03/29/2019] [Accepted: 04/09/2019] [Indexed: 11/06/2022] Open
Abstract
Retraction: 'A randomized controlled trial of mindfulness-based stress reduction for insomnia secondary to cervical cancer: Effects on sleep' DOI https://doi.org/10.1002/cnr2.1190 by Huashuang Zhang, Yang Li, Mingming Li, Xiaowen Chen. The above article, published online on 29 May 2019 in Wiley Online Library (http://onlinelibrary.wiley.com), has been retracted by agreement between the authors, Huashuang Zhang, Yang Li, Mingming Li, Xiaowen Chen, the journal Editor in Chief Nidhi Bansal, and John Wiley and Sons Ltd. The retraction has been agreed because of an honest error discovered by the authors in the data presented in Table 4 that impacts the overall conclusions of the article.
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Affiliation(s)
- Huashuang Zhang
- College of Nursing, Wuchang University of Technology, Wuhan, China
| | - Yang Li
- Department of Oncology, The Third Hospital of Wuhan, Wuhan, China
| | - Mingming Li
- College of Nursing, Wuchang University of Technology, Wuhan, China
| | - Xiaowen Chen
- College of Nursing, Wuchang University of Technology, Wuhan, China
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The effects of brief chat-based and face-to-face psychotherapy for insomnia: a randomized waiting list controlled trial. Sleep Med 2019; 61:63-72. [DOI: 10.1016/j.sleep.2019.03.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 03/27/2019] [Accepted: 03/28/2019] [Indexed: 11/18/2022]
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Zhang H, Li Y, Li M, Chen X. A randomized controlled trial of mindfulness-based stress reduction for insomnia secondary to cervical cancer: Sleep effects. Appl Nurs Res 2019; 48:52-57. [DOI: 10.1016/j.apnr.2019.05.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 05/27/2019] [Indexed: 10/26/2022]
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Hare CJ, Crangle CJ, Carney CE, Hart T. Insomnia Symptoms, Subjective Appraisals, and Fatigue: A Multiple Mediation Model. Behav Sleep Med 2019; 17:269-280. [PMID: 28609122 DOI: 10.1080/15402002.2017.1342167] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE AND BACKGROUND Fatigue and insomnia are common debilitating symptoms associated with multiple sclerosis (MS). Negative subjective appraisals of symptoms may influence both insomnia and fatigue severity, but this relationship has not been examined among those with MS. The relationship between insomnia symptoms and both physical and cognitive fatigue were examined. Health-related self-efficacy, fatigue catastrophization, and rumination were examined as potential mediators of the relationship between insomnia symptoms and fatigue. PARTICIPANTS Participants diagnosed with MS (N = 115) were recruited from hospital and community settings in a large metropolitan city. METHODS Participants completed self-report questionnaires, including: Modified Fatigue Impact, Insomnia Severity Index, MS Quality of Life Questionnaire-54, Fatigue Catastrophizing Scale, Multidimensional Health Locus of Control Scale, and the Rumination-Reflection Questionnaire. Two multiple mediation analyses were performed using bootstrapping techniques, examining the cognitive and physical domains of fatigue as separate outcomes. RESULTS AND CONCLUSIONS Mediation analyses revealed a significant association between insomnia symptom severity and the cognitive and physical domains of fatigue. Fatigue catastrophizing was the only significant mediator, accounting for 25% of the variance in the relationship between insomnia symptoms and the cognitive fatigue. However, fatigue catastrophizing did not significantly mediate the relationship between insomnia symptoms and physical fatigue, indicating physical and cognitive fatigue may reflect distinct processes in fatigue expression in those with MS.
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Affiliation(s)
- Crystal J Hare
- a Department of Psychology , Ryerson University , Toronto , Canada
| | | | - Colleen E Carney
- a Department of Psychology , Ryerson University , Toronto , Canada
| | - Tae Hart
- a Department of Psychology , Ryerson University , Toronto , Canada
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Chakravorty S, Vandrey RG, He S, Stein MD. Sleep Management Among Patients with Substance Use Disorders. Med Clin North Am 2018; 102:733-743. [PMID: 29933826 PMCID: PMC6289280 DOI: 10.1016/j.mcna.2018.02.012] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Sleep and substance use disorders commonly co-occur. Insomnia is commonly associated with use and withdrawal from substances. Circadian rhythm abnormalities are being increasingly linked with psychoactive substance use. Other sleep disorders, such as sleep-related breathing disorder, should be considered in the differential diagnosis of insomnia, especially in those with opioid use or alcohol use disorder. Insomnia that is brief or occurs in the context of active substance use is best treated by promoting abstinence. A referral to a sleep medicine clinic should be considered for those with chronic insomnia or when another intrinsic sleep disorder is suspected.
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Affiliation(s)
- Subhajit Chakravorty
- Department of Psychiatry, Perelman School of Medicine, Corporal Michael J. Crescenz VA Medical Center, MIRECC, 2nd Floor, Postal Code 116, 3900 Woodland Avenue, Philadelphia, PA 19104, USA.
| | - Ryan G Vandrey
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA
| | - Sean He
- Post-baccalaureate studies program, College of Liberal Arts and Professional Studies, University of Pennsylvania, 3440 Market Street Suite 100, Philadelphia, PA 19104, USA; Department of R & D, Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104, USA
| | - Michael D Stein
- Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA
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Abstract
BACKGROUND Insomnia is a prevalent sleep disorder, and it has been increasingly associated with cardiovascular morbidity and mortality. The reasons for this relationship are not completely understood but may involve endothelial dysfunction. In this study, we hypothesized that insomnia symptoms would be associated with reduced endothelial function. METHODS Working adults (n = 496, 67.5% female, 78.6% white, mean age 48.7 [SD, 10.8] years, body mass index 28.2 [SD, 6.7] kg/m, diabetes 5.8%, hypertension 20.0%, hyperlipidemia 17.9%, heart disease 2.6%) enrolled in the Emory-Georgia Tech Predictive Health Institute study completed baseline demographic, clinical, depression (Beck Depression Inventory II), anxiety (General Anxiety Disorder 7), sleep (Pittsburg Sleep Quality Index), and noninvasive endothelial function (brachial artery flow-mediated dilation [FMD]) measures. Insomnia symptoms were defined as subjective sleep latency of 30 minutes or longer, nighttime or early morning awakenings, and/or sleep medication use occurring 3 times or more per week in the past month. RESULTS Insomnia symptoms were reported by 39.5% of participants. Multivariable regression models showed that insomnia symptoms, age, baseline artery diameter, and dyslipidemia were inversely related to FMD. After adjusting for age, baseline artery diameter, and dyslipidemia, participants reporting insomnia symptoms had lower FMD than did participants reporting better sleep (adjusted FMD mean, 6.13% [SD, 0.28%] vs 6.83% [SD, 0.26%], P = .035). CONCLUSION In this study, insomnia symptoms were associated with reduced FMD. Research examining the therapeutic benefits of treating insomnia on endothelial function and future cardiovascular risk is warranted.
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Sakamoto I, Igaki M, Ichiba T, Suzuki M, Kuriyama K, Uchiyama M. Effects of Bedtime Periocular Warming on Sleep Status in Adult Female Subjects: A Pilot Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2017; 2017:6419439. [PMID: 29234416 PMCID: PMC5651103 DOI: 10.1155/2017/6419439] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 09/07/2017] [Indexed: 11/18/2022]
Abstract
Several studies have reported that suitable manipulation of human skin or body temperature can lead to improved sleep. To clarify the effect of skin warming on human sleep, 38 female subjects, who occasionally had difficulty with falling asleep, were studied. The participants underwent two experimental sessions, which were carried out in two consecutive follicular phases and randomly crossed over. The participants wore hot or sham eye masks in one 14-day session. The first half of each 14-day session was designated the baseline period (BL) without any interventions and the later half was designated the intervention period (INT), in which they wore either the hot or sham eye mask for 10 minutes at bedtime. All the participants were instructed to keep a sleep diary every morning for the BL and INT. The results showed that the hot eye mask was significantly preferred over the sham one with respect to comfort and that feelings of restfulness and being refreshed upon wakening in the morning were significantly better with the hot eye mask than with the sham. These results suggest that bedtime periocular warming has favorable effects on subjective well-being on awakening, possibly due to the sense of comfort experienced at bedtime.
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Affiliation(s)
- Ichiro Sakamoto
- Personal Health Care Laboratory, Kao Corporation, Tokyo, Japan
| | - Michihito Igaki
- Personal Health Care Laboratory, Kao Corporation, Tokyo, Japan
| | - Tomohisa Ichiba
- Personal Health Care Laboratory, Kao Corporation, Tokyo, Japan
- Department of Psychiatry, Nihon University School of Medicine, Tokyo, Japan
| | - Masahiro Suzuki
- Department of Psychiatry, Nihon University School of Medicine, Tokyo, Japan
| | - Kenichi Kuriyama
- Department of Psychiatry, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Makoto Uchiyama
- Department of Psychiatry, Nihon University School of Medicine, Tokyo, Japan
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Sedov ID, Goodman SH, Tomfohr-Madsen LM. Insomnia Treatment Preferences During Pregnancy. J Obstet Gynecol Neonatal Nurs 2017; 46:e95-e104. [PMID: 28343943 DOI: 10.1016/j.jogn.2017.01.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2017] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE To determine pregnant women's preferences for the treatment of insomnia: cognitive behavioral therapy (CBT-I), pharmacotherapy, or acupuncture. DESIGN A cross-sectional survey of pregnant women. SETTING We recruited participants in person at a low-risk maternity clinic and a pregnancy and infant trade show and invited them to complete an online questionnaire. PARTICIPANTS The sample (N = 187) was primarily White (70%), married or common-law married (96%), and on average 31 years of age; the mean gestational age was 28 weeks. METHODS Participants read expert-validated descriptions of CBT-I, pharmacotherapy, and acupuncture and then indicated their preferences and perceptions of each approach. RESULTS Participants indicated that if they experienced insomnia, they preferred CBT-I to other approaches, χ2(2) = 38.10, p < .001. They rated CBT-I as the most credible treatment (η2partial = .22, p < .001) and had stronger positive reactions to it than to the other two approaches (η2partial = .37, p < .001). CONCLUSION Participants preferred CBT-I for insomnia during pregnancy. This preference is similar to previously reported preferences for psychotherapy for treatment of depression and anxiety during pregnancy. It is important for clinicians to consider women's preferences when discussing possible treatment for insomnia.
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Reynolds SA, Ebben MR. The Cost of Insomnia and the Benefit of Increased Access to Evidence-Based Treatment. Sleep Med Clin 2017; 12:39-46. [DOI: 10.1016/j.jsmc.2016.10.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Riemann D, Baum E, Cohrs S, Crönlein T, Hajak G, Hertenstein E, Klose P, Langhorst J, Mayer G, Nissen C, Pollmächer T, Rabstein S, Schlarb A, Sitter H, Weeß HG, Wetter T, Spiegelhalder K. S3-Leitlinie Nicht erholsamer Schlaf/Schlafstörungen. SOMNOLOGIE 2017. [DOI: 10.1007/s11818-016-0097-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Self-referral to group cognitive behavioural therapy: Is it effective for treating chronic insomnia? L'ENCEPHALE 2016; 42:395-401. [PMID: 27745721 DOI: 10.1016/j.encep.2016.08.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 08/10/2016] [Accepted: 08/11/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To evaluate the effectiveness of a short (3 session) programme of group cognitive behavioural therapy (CBT) on insomnia, sleepiness and symptoms of anxiety and depression. METHODS Prospective observational study of group CBT with follow-up at 3 months. Participants were self-referred patients with chronic insomnia. Outcome measures were the insomnia severity scale (ISI), the Epworth sleepiness scale (ESS), depression (Pichot scale), and the number of anxiety symptoms. RESULTS Participation in CBT was offered to 489 patients of whom 474 completed the programme and 154 were followed up at 3 months. Significant improvements in insomnia were seen: ISI score (17.74-14.27, P<0.0001) after CBT and at follow-up (13.78, P<0.0001). At the end of CBT, 76% (59/78) with initial severe insomnia and 52% (132/255) with moderate insomnia were improved, maintained at 3 months in 71% (15/21) with severe insomnia and 56% (50/90) with moderate insomnia. Depression and anxiety symptoms were significantly improved: mean depression symptoms (4.15-3.35, P<0.0001) and anxiety symptoms (4.52-3.95, P<0.0001), maintained at 3 months with mean depression symptoms (3.17, P<0.0001) and mean anxiety symptoms (3.62, P<0.0001). Sleepiness increased between baseline and the end of the group (6.67-7.24, P=0.015) followed by a reduction at 3 months (7.19-6.34 at 3 months, P=0.001). Initial ISI score but neither sex nor age were predictive of outcome. CONCLUSIONS A short programme of CBT can improve sleep, depression and anxiety symptoms in self-referred patients suffering from chronic insomnia with good adherence and maximum benefit in patients with severe insomnia.
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Zhou ES, Partridge AH, Recklitis CJ. A pilot trial of brief group cognitive-behavioral treatment for insomnia in an adult cancer survivorship program. Psychooncology 2016; 26:843-848. [PMID: 26872123 DOI: 10.1002/pon.4096] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 12/17/2015] [Accepted: 01/18/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Cognitive-behavioral therapy for insomnia (CBT-Insomnia) is effective, yet rarely available for cancer survivors. This is unfortunate because survivors are at elevated risk for insomnia, which is associated with significant health consequences in this already at-risk population. Barriers to delivering CBT-Insomnia in oncology settings include a lack of trained providers, distance to cancer centers, and treatment duration. PURPOSE To address insomnia treatment barriers, we adapted standard CBT-Insomnia treatment and evaluated a pilot group-based approach for feasibility and efficacy in an adult cancer survivorship program. METHODS Thirty-eight cancer survivors (mean age = 52.2 years) enrolled in our three-session program delivered over 1 month. They were primarily diagnosed with breast cancer (58.6%) and were an average of 6.0 years post-diagnosis and 3.6 years post-treatment. Participants completed sleep logs throughout the study and measures of sleep at baseline and week 4. RESULTS Participants reported experiencing insomnia symptoms an average of 2.4 years, with 89.7% indicating that the cancer experience had caused/exacerbated symptoms. Significant pre/post-intervention group improvements in sleep efficiency (77.3% to 88.5%), sleep quality, and insomnia symptoms were reported (all ps < .01). Less than 1 in 3 had discussed insomnia symptoms with their oncology providers in the prior year. CONCLUSIONS Pilot data indicate that a brief, group-based CBT-Insomnia intervention in a survivorship setting is both feasible and efficacious. There is a need to increase awareness about insomnia and its treatment among both cancer survivors and oncology providers. If validated in future studies, this novel approach can improve cancer survivors' access to much needed insomnia treatment. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Eric S Zhou
- Dana-Farber Cancer Institute, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Ann H Partridge
- Dana-Farber Cancer Institute, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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de Bruin EJ, Bögels SM, Oort FJ, Meijer AM. Efficacy of Cognitive Behavioral Therapy for Insomnia in Adolescents: A Randomized Controlled Trial with Internet Therapy, Group Therapy and A Waiting List Condition. Sleep 2015; 38:1913-26. [PMID: 26158889 PMCID: PMC4667374 DOI: 10.5665/sleep.5240] [Citation(s) in RCA: 115] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 05/28/2015] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES To investigate the efficacy of cognitive behavioral therapy for insomnia (CBTI) in adolescents. DESIGN A randomized controlled trial of CBTI in group therapy (GT), guided internet therapy (IT), and a waiting list (WL), with assessments at baseline, directly after treatment (post-test), and at 2 months follow-up. SETTING Diagnostic interviews were held at the laboratory of the Research Institute of Child Development and Education at the University of Amsterdam. Treatment for GT occurred at the mental health care center UvAMinds in Amsterdam, the Netherlands. PARTICIPANTS One hundred sixteen adolescents (mean age = 15.6 y, SD = 1.6 y, 25% males) meeting DSM-IV criteria for insomnia, were randomized to IT, GT, or WL. INTERVENTIONS CBTI of 6 weekly sessions, consisted of psychoeducation, sleep hygiene, restriction of time in bed, stimulus control, cognitive therapy, and relaxation techniques. GT was conducted in groups of 6 to 8 adolescents, guided by 2 trained sleep therapists. IT was applied through an online guided self-help website with programmed instructions and written feedback from a trained sleep therapist. MEASUREMENTS AND RESULTS Sleep was measured with actigraphy and sleep logs for 7 consecutive days. Symptoms of insomnia and chronic sleep reduction were measured with questionnaires. Results showed that adolescents in both IT and GT, compared to WL, improved significantly on sleep efficiency, sleep onset latency, wake after sleep onset, and total sleep time at post-test, and improvements were maintained at follow-up. Most of these improvements were found in both objective and subjective measures. Furthermore, insomnia complaints and symptoms of chronic sleep reduction also decreased significantly in both treatment conditions compared to WL. Effect sizes for improvements ranged from medium to large. A greater proportion of participants from the treatment conditions showed high end-state functioning and clinically significant improvement after treatment and at follow-up compared to WL. CONCLUSIONS This study is the first randomized controlled trial that provides evidence that cognitive behavioral therapy for insomnia is effective for the treatment of adolescents with insomnia, with medium to large effect sizes. There were small differences between internet and group therapy, but both treatments reached comparable endpoints. CLINICAL TRIAL REGISTRATION This study was part of the clinical trial: Effectiveness of cognitive behavioral therapy for sleeplessness in adolescents; URL: http://www.isrctn.com/ISRCTN33922163; registration: ISRCTN33922163.
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Affiliation(s)
- Eduard J. de Bruin
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, the Netherlands
| | - Susan M. Bögels
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, the Netherlands
| | - Frans J. Oort
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, the Netherlands
| | - Anne Marie Meijer
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, the Netherlands
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Morasco BJ, O'Hearn D, Turk DC, Dobscha SK. Associations Between Prescription Opioid Use and Sleep Impairment among Veterans with Chronic Pain. PAIN MEDICINE 2014; 15:1902-10. [DOI: 10.1111/pme.12472] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Finan PH, Buenaver LF, Coryell VT, Smith MT. Cognitive-Behavioral Therapy for Comorbid Insomnia and Chronic Pain. Sleep Med Clin 2014; 9:261-274. [PMID: 25477769 DOI: 10.1016/j.jsmc.2014.02.007] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This article summarizes the literature on cognitive-behavioral therapy for insomnia (CBT-I) in patients with comorbid insomnia and chronic pain. An empirical rationale for the development of CBT-I in chronic pain is provided. The six randomized controlled trials in this area are described and contrasted. The data suggest that CBT-I for patients with comorbid insomnia and chronic pain produces clinically meaningful improvements in sleep symptoms. Effects on pain are inconsistent, but tend to favor functional measures over pain severity. Hybrid interventions for insomnia and pain have demonstrated feasibility, but larger trials must be conducted to determine efficacy relative to CBT-I alone. Future efforts should employ more comprehensive assessments of pain and psychosocial factors.
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Cognitive behavioral therapy for chronic insomnia in occupational health services: Analyses of outcomes up to 24 months post-treatment. Behav Res Ther 2014; 56:16-21. [DOI: 10.1016/j.brat.2014.02.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 01/31/2014] [Accepted: 02/20/2014] [Indexed: 11/18/2022]
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Lovato N, Lack L, Wright H, Kennaway DJ. Evaluation of a brief treatment program of cognitive behavior therapy for insomnia in older adults. Sleep 2014; 37:117-26. [PMID: 24470701 DOI: 10.5665/sleep.3320] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy of a brief 4-w group-administered treatment program of cognitive behavior therapy for insomnia (CBT-I) for older adults with sleep maintenance insomnia. DESIGN Randomized controlled trial of CBT-I compared to waitlist control with comparisons at pretreatment, posttreatment, and 3-mo follow-up. SETTING Flinders University Sleep and Circadian Rhythm Research Laboratory, Adelaide, South Australia. PARTICIPANTS One-hundred eighteen adults with sleep maintenance insomnia (mean age = 63.76 y, standard deviation = 6.45 y, male = 55). INTERVENTIONS A 4-w, group-based treatment program of CBT-I including bedtime restriction therapy, sleep education, and cognitive restructuring. MEASUREMENTS Seven-day sleep diaries, actigraphy, and several self-report measures to assess perceived insomnia severity, daytime functioning, and confidence in and beliefs about sleep. RESULTS The brief group-administered CBT-I program produced improvements in the timing and quality of sleep including later bedtimes, earlier out-of-bed times, reduced wake after sleep onset, and improved sleep efficiency. Participants also reported a reduction of the Insomnia Severity Index, Flinders Fatigue Scale, Epworth Sleepiness Scale, Daytime Feeling and Functioning Scale, Sleep Anticipatory Anxiety Questionnaire, the Dysfunctional Beliefs and Attitudes Scale, and increased Sleep Self-Efficacy Scale. CONCLUSIONS The treatment program used in the current study has demonstrated potential for a brief, inexpensive, and effective treatment of sleep maintenance insomnia in the older adult population.
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Affiliation(s)
- Nicole Lovato
- School of Psychology, Flinders University, Adelaide, South Australia
| | - Leon Lack
- School of Psychology, Flinders University, Adelaide, South Australia
| | - Helen Wright
- School of Psychology, Flinders University, Adelaide, South Australia
| | - David J Kennaway
- Robinson Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, South Australia
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Lovato N, Lack L, Wright H, Kennaway DJ. Predictors of improvement in subjective sleep quality reported by older adults following group-based cognitive behavior therapy for sleep maintenance and early morning awakening insomnia. Sleep Med 2013; 14:888-93. [DOI: 10.1016/j.sleep.2013.05.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Revised: 04/24/2013] [Accepted: 05/02/2013] [Indexed: 11/24/2022]
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Self-report instruments for assessing sleep dysfunction in an adult traumatic brain injury population: a systematic review. Sleep Med Rev 2013; 17:411-23. [PMID: 23706309 DOI: 10.1016/j.smrv.2013.02.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 02/11/2013] [Accepted: 02/11/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To review the number and characteristics of self-reported sleep measures used to evaluate impaired sleep/wakefulness in traumatic brain injury (TBI) populations. METHODS We conducted a comprehensive peer-reviewed literature search of Medline, Embase, PsycINFO, CINAHL, and various bibliographies. Only standardized self-report measures for evaluating sleep dysfunction and its signs were taken into consideration. RESULTS Sixteen self-report measures used in TBI research and clinical practices were identified. Five were generic, five symptom-related, and six were condition-specific measures. The Pittsburgh sleep quality index and Epworth sleepiness scale were partially validated in post-acute TBI. CONCLUSION Although no instrument has been specifically developed for TBI patients, there are scientific benefits to using the existing measures. However, additional research is needed to examine their applicability to the TBI population. The design and introduction of a new instrument able to triage sleep-related complaints between depressive, other medical, and primary sleep disorders-with a section for caregiver reports-might assist in the identification of the etiology of sleep dysfunction in persons with TBI. In choosing or developing a sleep measure, researchers and clinicians must consider the specific domains they want to screen, diagnose, or monitor. Polysomnography is recommended for diagnosing specific sleep disorders that cannot be diagnosed solely using a self-report measure.
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Arnedt JT, Cuddihy L, Swanson LM, Pickett S, Aikens J, Chervin RD. Randomized controlled trial of telephone-delivered cognitive behavioral therapy for chronic insomnia. Sleep 2013; 36:353-62. [PMID: 23450712 DOI: 10.5665/sleep.2448] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
STUDY OBJECTIVES To compare the efficacy of telephone-delivered cognitive-behavioral therapy for insomnia to an information pamphlet control on sleep and daytime functioning at pretreatment, posttreatment, and 12-wk follow-up. DESIGN Randomized controlled parallel trial. SETTING N/A. PARTICIPANTS Thirty individuals with chronic insomnia (27 women, age 39.1 ± 14.4 years, insomnia duration 8.7 ± 10.7 years). INTERVENTIONS Cognitive behavioral therapy for insomnia (CBTI) delivered in up to eight weekly telephone sessions (CBTI-Phone, n = 15) versus an information pamphlet control (IPC, n = 15). MEASUREMENTS AND RESULTS Sleep/wake diary, sleep-related questionnaires (Insomnia Severity Index, Pittsburgh Sleep Quality Index, 16-item Dysfunctional Beliefs and Attitudes about Sleep), and daytime symptom assessments (fatigue, depression, anxiety, and quality of life) were completed at pretreatment, posttreatment, and 12-wk follow-up. Linear mixed models indicated that sleep/wake diary sleep efficiency and total sleep time improved significantly at posttreatment in both groups and remained stable at 12-wk follow-up. More CBTI-Phone than IPC patients showed posttreatment improvements in unhelpful sleep-related cognitions (P < 0.001) and were classified as "in remission" from insomnia at follow-up (P < 0.05). Posttreatment effect sizes on most daytime symptoms were large (Cohen d = 0.8-2.5) for CBTI-Phone patients and small to moderate (Cohen d = -0.1-0.6) for IPC patients. All CBTI-Phone patients completed posttreatment and 12-wk follow-up assessments, but three IPC patients discontinued the study. CONCLUSIONS The findings provide preliminary support for telephone-delivered CBTI in the treatment of chronic insomnia. Future larger-scale studies with more diverse samples are warranted. Some individuals with insomnia may also benefit from pamphlet-delivered CBTI with brief telephone support. CITATION Arnedt JT; Cuddihy L; Swanson LM; Pickett S; Aikens J; Chervin RD. Randomized controlled trial of telephone-delivered cognitive behavioral therapy for chronic insomnia. SLEEP 2013;36(3):353-362.
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Affiliation(s)
- J Todd Arnedt
- Sleep and Chronophysiology Laboratory, Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109-2700, USA.
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Järnefelt H, Lagerstedt R, Kajaste S, Sallinen M, Savolainen A, Hublin C. Cognitive behavior therapy for chronic insomnia in occupational health services. JOURNAL OF OCCUPATIONAL REHABILITATION 2012; 22:511-521. [PMID: 22460608 DOI: 10.1007/s10926-012-9365-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION The aim of this study was to examine the implementation and effectiveness of a cognitive behavioral group intervention model for chronic insomnia (CBT-I) in occupational health services (OHS). We also studied if insomnia symptoms and intervention effects differed on work days and days off. METHODS The study design was a non-randomized group intervention, including a waiting period prior to CBT as a control condition. We followed up the results for a period of 6 months. Outcomes were assessed using a sleep diary, questionnaires, and actigraphy. The CBT-I groups were led by trained OHS nurses. RESULTS A total of 26 participants completed the study. The intervention improved significantly participants' different self-reported sleep variables, perceived severity of insomnia, sleep-related dysfunctional cognitions, and psychiatric and somatic symptoms. The effects lasted, and partly increased during the follow-up. The participants generally slept significantly better on days off than on work days, but the treatment improved sleep on both. CONCLUSIONS The study showed that a non-pharmacological treatment of insomnia can be implemented into OHS with a reasonable amount of effort and that the treatment delivered by trained OHS nurses yields promising results. These findings, however, need to be interpreted cautiously, due to the non-randomized design and small sample size.
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Affiliation(s)
- Heli Järnefelt
- Finnish Institute of Occupational Health (FIOH), Topeliuksenkatu 41 a A, 00250, Helsinki, Finland.
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Abad VC, Guilleminault C. Diagnosis and treatment of sleep disorders: a brief review for clinicians. DIALOGUES IN CLINICAL NEUROSCIENCE 2012. [PMID: 22033666 PMCID: PMC3181779 DOI: 10.31887/dcns.2003.5.4/vabad] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Sleep disorders encompass a wide spectrum of diseases with significant individual health consequences and high economic costs to society. To facilitate the diagnosis and treatment of sleep disorders, this review provides a framework using the International Classification of Sleep Disorders, Primary and secondary insomnia are differentiated, and pharmacological and nonpharmacological treatments are discussed. Common circadian rhythm disorders are described in conjunction with interventions, including chronotherapy and light therapy. The diagnosis and treatment of restless legs syndrome/periodic limb movement disorder is addressed. Attention is focused on obstructive sleep apnea and upper airway resistance syndrome, and their treatment. The constellation of symptoms and findings in narcolepsy are reviewed together with diagnostic testing and therapy, Parasomnias, including sleep terrors, somnambulism, and rapid eye movement (REM) behavior sleep disorders are described, together with associated laboratory testing results and treatment.
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Affiliation(s)
- Vivien C Abad
- Stanford University Sleep Disorders Clinic and Research Center, Stanford University, School of Medicine, Stanford, Calif, USA
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Blanaru M, Bloch B, Vadas L, Arnon Z, Ziv N, Kremer I, Haimov I. The effects of music relaxation and muscle relaxation techniques on sleep quality and emotional measures among individuals with posttraumatic stress disorder. Ment Illn 2012; 4:e13. [PMID: 25478114 PMCID: PMC4253375 DOI: 10.4081/mi.2012.e13] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 05/02/2012] [Accepted: 05/23/2012] [Indexed: 11/23/2022] Open
Abstract
Posttraumatic stress disorder (PTSD), an anxiety disorder with lifetime prevalence of 7.8%, is characterized by symptoms that develop following exposure to traumatic life events and that cause an immediate experience of intense fear, helplessness or horror. PTSD is marked by recurrent nightmares typified by the recall of intrusive experiences and by extended disturbance throughout sleep. Individuals with PTSD respond poorly to drug treatments for insomnia. The disadvantages of drug treatment for insomnia underline the importance of non-pharmacological alternatives. Thus, the present study had three aims: first, to compare the efficiency of two relaxation techniques (muscular relaxation and progressive music relaxation) in alleviating insomnia among individuals with PTSD using both objective and subjective measures of sleep quality; second, to examine whether these two techniques have different effects on psychological indicators of PTSD, such as depression and anxiety; and finally, to examine how initial PTSD symptom severity and baseline emotional measures are related to the efficiency of these two relaxation methods. Thirteen PTSD patients with no other major psychiatric or neurological disorders participated in the study. The study comprised one seven-day running-in, no-treatment period, followed by two seven-day experimental periods. The treatments constituted either music relaxation or muscle relaxation techniques at desired bedtime. These treatments were randomly assigned. During each of these three experimental periods, subjects' sleep was continuously monitored with a wrist actigraph (Ambulatory Monitoring, Inc.), and subjects were asked to fill out several questionnaires concerned with a wide spectrum of issues, such as sleep, depression, and anxiety. Analyses revealed a significant increase in objective and subjective sleep efficiency and a significant reduction in depression level following music relaxation. Moreover, following music relaxation, a highly significant negative correlation was found between improvement in objective sleep efficiency and reduction in depression scale. The study's findings provide evidence that music relaxation at bedtime can be used as treatment for insomnia among individuals with PTSD.
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Affiliation(s)
| | - Boaz Bloch
- Psychiatric Department, Haemek Medical Center, Afula
| | - Limor Vadas
- Department of Psychology and The Center for Psychobiological Research, The Max Stern Academic College of Emek Yezreel, Israel
| | - Zahi Arnon
- Department of Psychology and The Center for Psychobiological Research, The Max Stern Academic College of Emek Yezreel, Israel
| | - Naomi Ziv
- Department of Psychology and The Center for Psychobiological Research, The Max Stern Academic College of Emek Yezreel, Israel
| | - Ilana Kremer
- Psychiatric Department, Haemek Medical Center, Afula
| | - Iris Haimov
- Department of Psychology and The Center for Psychobiological Research, The Max Stern Academic College of Emek Yezreel, Israel
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Katofsky I, Backhaus J, Junghanns K, Rumpf HJ, Hüppe M, von Eitzen U, Hohagen F. Effectiveness of a cognitive behavioral self-help program for patients with primary insomnia in general practice – A pilot study. Sleep Med 2012; 13:463-8. [DOI: 10.1016/j.sleep.2011.12.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Revised: 12/14/2011] [Accepted: 12/15/2011] [Indexed: 10/28/2022]
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Milner CE, Belicki K. Assessment and Treatment of Insomnia in Adults: A Guide for Clinicians. JOURNAL OF COUNSELING AND DEVELOPMENT 2011. [DOI: 10.1002/j.1556-6678.2010.tb00015.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Crönlein T, Zulley J. The options available in cognitive behavioral therapy to prevent chronification of insomnia. EPMA J 2011. [PMID: 23199166 PMCID: PMC3405393 DOI: 10.1007/s13167-011-0095-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Insomnia is a very frequent problem among the general population, and it has a high socio-economic impact on health care management. It produces high costs because of absenteeism and accidents, and it is considered to be a risk factor for the development of psychiatric diseases and other medical disorders. However, only a low proportion of insomniacs ever seek professional help. The reasons are still unknown, but most insomniacs probably consider their problem untreatable unless they undergo a therapy with hypnotics. Knowledge about alternative therapy methods beyond sleep medication is scarce, and specialized psychotherapy is not always available. Since dysfunctional behavior and beliefs are considered to be the central perpetuating factors for primary insomnia, the role of educational programs in terms of prevention and treating mild forms of insomnia is discussed. These workshops could be a part of a step-by-step treatment of insomnia as has been proposed recently by Espie.
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Affiliation(s)
- Tatjana Crönlein
- Department of Psychiatry, University of Regensburg, Universitaetsstraße 84, 93042 Regensburg, Germany
- Department of Psychiatry, University of Regensburg, Bezirksklinikum, Universitätsstraße 84, 93042 Regensburg, Germany
| | - Jürgen Zulley
- Department of Psychiatry, University of Regensburg, Universitaetsstraße 84, 93042 Regensburg, Germany
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Pinto LR, Alves RC, Caixeta E, Fontenelle JA, Bacellar A, Poyares D, Aloe F, Rizzo G, Minhoto G, Bittencourt LR, Ataide L, Assis M, Pradella-Hallinan M, Pinto MCR, Rodrigues RND, Hasan R, Fonseca R, Tavares S. New guidelines for diagnosis and treatment of insomnia. ARQUIVOS DE NEURO-PSIQUIATRIA 2011; 68:666-75. [PMID: 20730332 DOI: 10.1590/s0004-282x2010000400038] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Accepted: 03/18/2010] [Indexed: 11/22/2022]
Abstract
The Brazilian Sleep Association brought together specialists in sleep medicine, in order to develop new guidelines on the diagnosis and treatment of insomnias. The following subjects were discussed: concepts, clinical and psychosocial evaluations, recommendations for polysomnography, pharmacological treatment, behavioral and cognitive therapy, comorbidities and insomnia in children. Four levels of evidence were envisaged: standard, recommended, optional and not recommended. For diagnosing of insomnia, psychosocial and polysomnographic investigation were recommended. For non-pharmacological treatment, cognitive behavioral treatment was considered to be standard, while for pharmacological treatment, zolpidem was indicated as the standard drug because of its hypnotic profile, while zopiclone, trazodone and doxepin were recommended.
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Belleville G, Cousineau H, Levrier K, St-Pierre-Delorme MÈ. Meta-analytic review of the impact of cognitive-behavior therapy for insomnia on concomitant anxiety. Clin Psychol Rev 2011; 31:638-52. [PMID: 21482322 DOI: 10.1016/j.cpr.2011.02.004] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Revised: 02/07/2011] [Accepted: 02/08/2011] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Concomitant anxiety and insomnia is a frequent problem encountered by mental health professionals. PRIMARY OBJECTIVE To assess the impact of cognitive-behavior therapy for insomnia (CBT-I) on associated anxiety. METHOD Systematic search for clinical trials of CBT-I in PsycInfo, Medline, and Proquest Dissertations and Theses. RESULTS Of the 216 CBT-I trials reviewed, 72 (33.3%) reported data on anxiety. The combined effect size (ES) of CBT-I on anxiety was 0.406 [95% CI 0.318-0.493], indicating a small to moderate effect of CBT-I on concomitant anxiety. Anxiety and anxiety-related constructs were measured with 31 different questionnaires or questionnaire subscales, the majority of which were used only once in the sample of studies. CONCLUSIONS CBT-I has only a moderate impact on anxiety in individuals who present insomnia with or without a comorbid anxiety disorder. A careful evaluation of residual anxiety should be conducted subsequent to CBT-I. Further research should focus on standardizing the assessment of anxiety in insomnia research.
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Affiliation(s)
- Geneviève Belleville
- École de Psychologie, Université Laval, Pavillon Félix-Antoine-Savard, Québec, Canada .
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Theadom A, Cropley M. ‘This constant being woken up is the worst thing’ – experiences of sleep in fibromyalgia syndrome. Disabil Rehabil 2010; 32:1939-47. [DOI: 10.3109/09638281003797331] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
More than 70 million people in the United States experience primary insomnia (PI) at some point in their life, resulting in an estimated $65 billion in health care costs and lost productivity. PI is therefore one of the most common health care problems in the United States. To mollify the negative effects of PI, scholars have sought to evaluate and improve treatments of this costly health care problem. A breadth of research has demonstrated that cognitive behavioral therapy (CBT) is an effective intervention for PI. The goal of this article is to provide an overview of CBT for PI, including evidence regarding treatment efficacy, effectiveness, and practitioner considerations.
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Affiliation(s)
- Kimberly A Babson
- Department of Psychology, University of Arkansas, 216 Memorial Hall, Fayetteville, AR 72701, USA.
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Prytys M, Whittinger N, Coventry S, Idusohan H, Brown J. Psycho‐educational CBT insomnia workshops for the general public: an audit of access and clinical outcomes. JOURNAL OF PUBLIC MENTAL HEALTH 2010. [DOI: 10.5042/jpmh.2010.0159] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Abstract
The management of hypnotic discontinuation following regular and prolonged use may be a challenging task for patients and clinicians alike. Current evidence suggests that a stepped-care approach may be a cost-effective approach to assist patients in tapering hypnotics. This approach may involve simple information about the need to discontinue medication, implementation of a supervised and systematic tapering schedule, with or without professional guidance, and cognitive-behavioral therapy. Research evidence shows that this approach appears promising; further research is however necessary to identify treatment and individual characteristics associated with better outcome.
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Affiliation(s)
- Lynda Bélanger
- Université Laval, Québec, Canada
- Centre de Recherche Université Laval/Robert-Giffard, Québec
| | - Geneviève Belleville
- Université du Québec à Montréal, Canada
- Centre de Recherche Fernand-Seguin, Hôpital Louis-H.-Lafontaine, Montréal, Canada
| | - Charles Morin
- Université Laval, Québec, Canada
- Centre de Recherche Université Laval/Robert-Giffard, Québec
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Group Cognitive-Behavioral Therapy for Insomnia in a VA Mental Health Clinic. COGNITIVE AND BEHAVIORAL PRACTICE 2008. [DOI: 10.1016/j.cbpra.2008.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Riemann D, Spiegelhalder K, Vorderholzer U, Kaufmann R, Seer N, Klöpfer C, Hornyak M, Berger M, Espie C, Perlis M. Primäre Insomnien: Neue Aspekte der Diagnostik und Differentialdiagnostik, Ätiologie und Pathophysiologie sowie Psychotherapie. SOMNOLOGIE 2007. [DOI: 10.1007/s11818-007-0298-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Backhaus J, Junghanns K, Born J, Hohaus K, Faasch F, Hohagen F. Impaired declarative memory consolidation during sleep in patients with primary insomnia: Influence of sleep architecture and nocturnal cortisol release. Biol Psychiatry 2006; 60:1324-30. [PMID: 16876140 DOI: 10.1016/j.biopsych.2006.03.051] [Citation(s) in RCA: 171] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2005] [Revised: 02/20/2006] [Accepted: 03/22/2006] [Indexed: 11/29/2022]
Abstract
BACKGROUND A central cognitive function of sleep is to consolidate newly acquired memories for long-term storage. Here, we investigated whether the overnight consolidation of declarative memory in patients with chronic sleep disturbances is impaired, owing to less slow wave sleep (SWS) and an increased cortisol release. METHODS Polysomnographic recordings, serum cortisol concentrations, and overnight memory consolidation in 16 patients with primary insomnia were compared with those of 13 healthy control subjects. RESULTS Patients displayed distinctly less overnight consolidation of declarative memory (p < .05), which was significantly correlated with SWS in the control subjects (r = .69) but with rapid eye movement (REM) sleep in the patients (r = .56), who had a diminished amount of SWS (p < .05). Increased cortisol levels in the middle of the night were associated with impaired retrieval of declarative memory after sleep for both control subjects (r = -.52) and patients (r = -.46). CONCLUSIONS Primary insomnia is associated with a diminished sleep-related consolidation of declarative memory. Efficient overnight consolidation of declarative memory is associated with high amounts of SWS and low serum cortisol levels during the early part of the night. Where SWS is decreased, REM sleep might play a partly compensatory role in the consolidation of declarative memory.
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Affiliation(s)
- Jutta Backhaus
- Department of Psychiatry and Psychotherapy, University of Luebeck, Luebeck, Germany.
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Verbeek IH, Konings GM, Aldenkamp AP, Declerck AC, Klip EC. Cognitive behavioral treatment in clinically referred chronic insomniacs: group versus individual treatment. Behav Sleep Med 2006; 4:135-51. [PMID: 16879078 DOI: 10.1207/s15402010bsm0403_1] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In this study, we compared the effect of group and cognitive behavioral treatment (CBT) in clinically referred patients with chronic insomnia. The participants were 32 individually treated primary insomniacs and 74 individuals with either primary or secondary insomnia treated in a group (5-7 patients per group). The primary outcome measures were subjective sleep, quality of life (QOL), and psychological well-being. CBT produced significant changes in sleep onset latency, total sleep time, sleep efficiency, and wake after sleep onset. For total sleep time and sleep efficiency, the improvements were maintained at follow-up as well. In the questionnaires, significant improvements from treatment were seen for the Sickness Impact Profile, Sleep Evaluation Form, and Dysfunctional Beliefs and Attitudes About Sleep. All these improvements remained significant at follow-up. We conclude that CBT for insomnia is effective for both individual and group treatment. Improvements were seen in subjective sleep parameters, QOL, attitudes about sleep, and sleep evaluation in general, both posttreatment and at follow-up.
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Affiliation(s)
- Ingrid H Verbeek
- Center for Sleep and Wake Disorders Kempenhaeghe, Heeze, The Netherlands.
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