Cognitive behavior therapy for chronic insomnia occurring within the context of medical and psychiatric disorders

Smith, Michael T.; Huang, Mary I.; Manber, Rachel

doi:10.1016/j.cpr.2005.04.004

Cited by 390 publications

(233 citation statements)

References 183 publications

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“…While early treatment studies focused predominantly on primary insomnia and excluded patients with co-existing disorders (as it was presumed to be secondary insomnia), more recent investigations have shown that patients with a range of psychiatric and medical conditions can also benefit from insomnia-specific therapy (Smith, Huang, & Manber, 2005). Several controlled studies have shown that CBT is effective for insomnia associated with chronic pain (Currie, Wilson, Pontefract, & deLaplante, 2000), fibromyalgia (Edinger, Wohlgemuth, Krystal, & Rice, 2005), cancer (Espie et al, 2008;Savard, Simard, Ivers, & Morin, 2005), and with various medical conditions in older adults (Lichstein, Wilson, & Johnson, 2000;Rybarczyk et al, 2005).…”

Section: Insomnia 12 Treatment Of Comorbid Insomniamentioning

confidence: 99%

Chronic insomnia: Recent advances and innovations in treatment developments and dissemination.

Morin¹

2010

Canadian Psychology / Psychologie canadienne

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Insomnia is a prevalent public health problem that carries an important psychosocial and economic burden for those affected, their families, employers, and for society at large. Despite its negative impacts, insomnia often remains untreated and, when treatment is initiated, it is predominantly with medication, an option that is not always acceptable to people with insomnia. There is extensive evidence that psychological approaches, primarily cognitive behavioural therapy, are effective, produce durable and generalizable outcomes, and should be the first line therapy for chronic insomnia. Nonetheless, these approaches remain under utilised in clinical (medical) practise. Several innovative and cost-effective treatment delivery models (e.g., telephone consultations, Internet-based treatment) have yielded promising results but despite these advances, there remains a problem of supply. A significant challenge for the future will be to disseminate more efficiently validated therapies and practise guidelines and increase their use in clinical practise. Additional training opportunities are also needed for psychologists to develop expertise in a new emerging behavioural sleep medicine subspecialty.

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Section: Insomnia 12 Treatment Of Comorbid Insomniamentioning

confidence: 99%

Chronic insomnia: Recent advances and innovations in treatment developments and dissemination.

Morin¹

2010

Canadian Psychology / Psychologie canadienne

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“…17,21 Despite many studies on the epidemiology and covariates of sleep disturbance in HIV-infected adults, little is known about the specifi c types of sleep problems experienced in this population. Therefore, the purpose of this paper is to describe total sleep time as well as problems with falling asleep and staying asleep in the HIV/AIDS adult population.…”

Section: S C I E N T I F I C I N V E S T I G a T I O N Smentioning

confidence: 99%

“…[11][12][13][14] The specifi c type of sleep disturbance experienced by this population needs to be better understood in order to provide the most effective intervention to improve symptoms, daytime functioning, and quality of life. 8,[15][16][17][18] Fragmented sleep occurs in chronic health conditions and may not even be perceived by the patient. 19,20 With this type of sleep loss, it is rare to fi nd complaints of initiation insomnia, but complaints of daytime sleepiness or fatigue are common and can lead to diffi culty concentrating, poor cognitive functioning, depressive symptoms, and inability to be productive during the day.…”

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confidence: 99%

Types of Sleep Problems in Adults Living with HIV/AIDS

Lee

Gay

Portillo

et al. 2012

Journal of Clinical Sleep Medicine

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Objective: To characterize specifi c types of sleep problems experienced by adults with HIV. Method: The design was cross-sectional involving sleep questionnaires, diaries, and wrist actigraphy. The convenience sample included 290 adults living with HIV, 22-77 years of age. Measures included self-report for sleep onset latency, and wrist actigraphy estimates of total sleep time at night, wake after sleep onset, and daytime sleep. Results: Nearly half (45%) of the sample slept < 6 h per night. Diffi culty falling asleep was reported by 34%, and 56% had fragmented sleep according to actigraphy; 20% had both problems, and 30% were good sleepers. Participants reporting diffi culty falling asleep had actigraphy and clinical measures similar to the good sleepers, but subjectively they experienced greater sleep disturbance and symptom burden (particularly anxiety and morning fatigue) and reported more use of sleep medication. Participants with fragmented sleep reported low levels of sleep disturbance and symptom burden similar to the good sleepers, despite actigraphy measures indicating they obtained less sleep both at night and during the day. Sleep fragmentation was also associated with sociodemographic factors and slightly lower CD4+ T-cell counts. Participants reporting both sleep problems had actigraphy and clinical profi les similar to those who had only fragmented sleep, but their symptom experience was similar to participants with only sleep initiation diffi culties. Types of Sleep Problems in Adults Living with HIV/AIDS S C I E N T I F I C I N V E S T I G A T I O N SS leep problems affect about 30% of the population in the United States and are associated with higher healthcare utilization and use of sleep medication, as well as poor work performance and mood disorders.1 Adults living with a chronic illness are at higher risk for sleep problems, and depending on the definition, sleep problems are experienced by 30% to 100% of HIVpositive adults. [2][3][4][5][6][7][8][9] It is unclear what type of sleep problem adults with HIV experience, or whether their sleep disturbance is related to the infection itself or to the medical treatment and side effects of medications. Sleep disturbance is not only prevalent, but also one of the more intense and distressful symptoms experienced in this population. [8][9][10] In HIV infection, poor sleep has been associated with disease progression, medication therapy, employment status, and lack of knowledge about behaviors that promote good sleep. [11][12][13][14] The specifi c type of sleep disturbance experienced by this population needs to be better understood in order to provide the most effective intervention to improve symptoms, daytime functioning, and quality of life. 8,[15][16][17][18] Fragmented sleep occurs in chronic health conditions and may not even be perceived by the patient. 19,20 With this type of sleep loss, it is rare to fi nd complaints of initiation insomnia, but complaints of daytime sleepiness or fatigue are common and can lead to diffi culty concentrat...

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“…CBT-I has welldocumented benefits, including improvements in insomnia, sleep continuity, and daytime symptoms among patients with a number of comorbid medical conditions. [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] CBT-I also may improve sleep for HF patients who dislike the adverse effects of hypnotic medications 12 and are at especially high risk for insomnia and disabling daytime symptoms 34 that are often attributed to HF itself. However, the effects of CBT-I in HF patient have not been examined, and it is not clear that the results of previous studies of CBT-I in people with other chronic medical conditions are generalizable to the HF population.…”

mentioning

confidence: 99%

Feasibility and Efficacy of a Self-Management Intervention for Insomnia in Stable Heart Failure

Redeker

Jeon

Andrews

et al. 2015

Journal of Clinical Sleep Medicine

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Background: Chronic insomnia is common among patients with heart failure (HF) and may contribute to fatigue and poor function. However, to date there have been no randomized controlled trials focused on treatment of insomnia or daytime symptoms in this population. Objective: The purpose of this study was to examine the preliminary effi cacy, feasibility, and acceptability of a selfmanagement intervention (cognitive behavioral therapy [CBT-I]) for insomnia among patients with stable HF. Methods: We conducted a pilot randomized controlled trial (RCT) in which patients with stable Class I-III HF (n = 25/52.1% women; mean age = 59 ± 14.8 years) were randomized in groups to CBT-I (n = 29) or an attention control condition (HF self-management with sleep hygiene; n = 19). Participants completed 2 weeks of wrist actigraphy, the insomnia severity index, and measures of fatigue, depression, sleepiness, and functional performance at baseline and follow-up. We computed the size of the effects on the dependent variables and used MANOVA to evaluate the effects of CBT-I on insomnia and fatigue. Results: CBT-I was feasible and acceptable and had a statistically signifi cant effect on insomnia and fatigue, while controlling for the effects of comorbidity and age. Conclusions: CBT-I has short-term effi cacy as a treatment for chronic insomnia among patients with stable HF. Future studies are needed to address its sustained effects. Keywords: self-management, heart failure, insomnia, cognitive behavioral therapy, sleep, fatigue, depression Citation: Redeker NS, Jeon S, Andrews L, Cline J, Jacoby D, Mohsenin V. Feasibility and effi cacy of a self-management intervention for insomnia in stable heart failure. J Clin Sleep Med 2015;11(10):1109 -1119 .pii: jc-00335-14 http://dx.doi.org/10.5664/jcsm.5082 H eart failure (HF), a disabling chronic condition that affl icts over fi ve million Americans, 1 is associated with excess morbidity and mortality, comorbidity, poor daytime function, and high symptom burden. Almost 75% of HF patients report poor sleep.2,3 Insomnia, characterized by diffi culty initiating and maintaining sleep, early morning awakenings, non-restorative sleep, and daytime dysfunction, occurs in 25% to 56% of HF patients, 2-5 who report higher rates than "healthy" controls 2 and the general population. Chronic insomnia contributes to incident HF and death. 6 It is distressing and associated with symptoms, such as fatigue, nocturnal dyspnea, depression, anxiety, pain, and excessive daytime sleepiness, poor quality of life, and decrements in functional performance. 3,5,[7][8][9][10][11][12][13] Health care providers frequently attribute sleep disturbance, including insomnia symptoms, to the pathophysiology (e.g., fl uid congestion) and symptoms of HF itself (e.g., nocturnal dyspnea, nocturia) or to sleep disordered breathing that occurs in about half the population.14 However, sleep disordered breathing does not consistently explain insomnia, self-reported sleep quality, or fatigue; and insomnia was closely associated with...

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Cognitive behavior therapy for chronic insomnia occurring within the context of medical and psychiatric disorders

Cited by 390 publications

References 183 publications

Chronic insomnia: Recent advances and innovations in treatment developments and dissemination.

Chronic insomnia: Recent advances and innovations in treatment developments and dissemination.

Types of Sleep Problems in Adults Living with HIV/AIDS

Feasibility and Efficacy of a Self-Management Intervention for Insomnia in Stable Heart Failure

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