Initial evaluation of an Internet intervention to improve the sleep of cancer survivors with insomnia

Abstract

Objective Insomnia is a common complaint among cancer survivors. Fortunately, cognitive-behavioral therapy for insomnia (CBT-I) has been shown to be an effective treatment in this population. However, it is rarely implemented given its limited availability. To address this barrier, we examined the ability of an easily-accessible online CBT-I program to improve insomnia symptoms in cancer survivors. Methods Twenty-eight cancer survivors with insomnia were randomly assigned to either an Internet insomnia intervention (n=14) or to a waitlist control group (n=14). The online program, Sleep Healthy Using the Internet, delivers the primary components of CBT-I (sleep restriction, stimulus control, cognitive restructuring, sleep hygiene, and relapse prevention). Pre- and post-assessment data were collected via online questionnaires and daily sleep diaries. Results Participants in the Internet group showed significant improvements at post-assessment compared to those in the control group in overall insomnia severity (F1,26=22.8; P<.001), sleep efficiency (F1,24=11.45; P=.002), sleep onset latency (F1,24=5.18; P=.03), soundness of sleep (F1,24=9.34; P=.005), restored feeling upon awakening (F1,24=11.95; P=.002), and general fatigue (F1,26=13.88; P=.001). Although other group x time interactions were not significant, overall adjusted effect sizes for all sleep variables as well as for fatigue, depression, anxiety, and quality of life ranged from small to large. Conclusions CBT-I delivered through an interactive, individually-tailored Internet intervention may be a viable treatment option for cancer survivors experiencing insomnia.

Are we sleeping on the job? Insomnia among men with prostate cancer

“…Three randomised controlled trials (RCT) investigating the effect of CBT on insomnia included men with prostate cancer. Of these, Garland et al included 8 men with prostate cancer (7% of total) [59] and Ritterband et al included 4 men [60] , but the cancer site was not identified and neither trial presented results specifically for men with prostate cancer. One RCT encompassed 150 patients with cancer at mixed sites including men with prostate cancer (N = 34; 23%) suffering from insomnia for at least 6 months [53] .…”

Attribution, cognition and psychopathology in persistent insomnia disorder: outcome and mediation analysis from a randomized placebo-controlled trial of online cognitive behavioural therapy

“…3 Recently, online CBT has shown promising results. [4][5][6] We conducted the first randomized placebo controlled trial of online CBT demonstrating significant improvements in both sleep pattern and daytime functioning. 7 Consistent with the formulation of insomnia as a psychophysiological condition, we feel it is important to reflect not only upon the impact of CBT on sleep, but also its impact on a range of secondary outcomes that are likely maintaining factors, such as attribution, cognition and psychopathological status.…”

Insomnia before and after childbirth: The risk of developing postpartum pain—A longitudinal population-based study

“…With regards to behavioral interventions which now largely are considered the treatment of choice for persistent insomnia [33], cognitive-behavioral therapy addressing both pain and sleep, has been found to be effective [32]. Future research should examine to what extent low threshold interventions addressing comorbid sleep and pain may be effective, as internet-based self-help treatments have shown promising results in treating both conditions individually [34][35][36]. Moreover, given the significant contribution of depressive symptoms in explaining the observed sleep-pain association, we also recommend screening for depression during and after pregnancy, in addition to adequately identifying, preventing and treating insomnia for this population.…”