Megan Brooks

June 22, 2016

DENVER — Both cognitive behavioral therapy (CBT-I) and sleep restriction therapy (SRT) ease insomnia symptoms and fatigue in menopausal women. However, unlike SRT, CBT-I-related improvements in insomnia symptoms are "robust," even 6 months after treatment ends.

Led by Vivek Pillai, PhD, from the Henry Ford Health System, Detroit, Michigan, the findings were presented here at SLEEP 2016: 30th Anniversary Meeting of the Associated Professional Sleep Societies.

According to the investigators, insomnia is "highly prevalent among post-menopausal women." Dr Pillai and colleagues examined the efficacy of nurse-administered CBT-I compared with SRT and an information-only control condition in 88 older women with insomnia related to menopause.

The women were screened for contraindicative psychopathology and sleep disorders, using the Structured Clinical Interview for DSM-IV disorders and polysomnography. All the women showed an average wake after sleep onset of more than 45 minutes, according to 2 nights of polysomnography. They were randomly allocated to 6 weeks of CBT-I (n = 35), 2 weeks of SRT (n = 28), or a 6-week information-only control condition (n = 25).

The women completed the Insomnia Severity Index (ISI) and the Fatigue Severity Scale (FSS) scales at baseline, 1 week after treatment, and a 6-month follow-up.

Baseline ISI scores were similar in the three groups (CBT-I, 14.54; SRT, 14.75; control, 15.8), as were baseline FSS scores (CBT-I, 32.46; SRT, 33.11; control, 31.56).

One week after treatment, women in the CBT-I (−8.33) and SRT (−6.54) groups showed a significantly greater reduction in ISI scores than their peers in the control group (−1.80; P < .01).

These reductions were maintained in the CBT-I group at 6 months (−8.13), and were significantly larger than corresponding changes in the control group.

As for FSS scores, both the CBT-I (−5.39) and SRT (−4.57) groups showed a significantly greater reduction (P < .05) at 1-week post-treatment than did the control group (0.37). There were no between-group differences in FSS change scores at 6 months.

These results suggest that CBT-I and SRT both reduce insomnia symptoms and fatigue in women with menopausal insomnia. However, unlike SRT, CBT-I-related improvements in insomnia symptoms persist even 6 months after the end of treatment.

Commenting on the findings for Medscape Medical News, Shelby Harris, PsyD, director, Behavioral Sleep Medicine, Sleep-Wake Disorders Center, Montefiore Health System, New York, noted that sleep restriction is "one component of CBT-I, and a very effective one."

"In this new study, they wanted to see whether we need to do everything else or can we just do sleep restriction. Sleep restriction worked well, but CBT-I, which is much more comprehensive, worked better in the long term," Dr Harris said. "Therefore, it's better to do CBT-I, if possible. Both treatments had good effects right after the study ended, but 6 months down the road, CBT-I tended to be more durable."

Dr Harris also noted that there is only "spotty literature" on postmenopausal women and CBT-I.

"It's an area of research that hasn't been delved into as much. This study was interesting, in that it looked at CBT-I vs sleep restriction and at 6 months out."

The study was supported by the National Institutes of Mental Health. The authors have disclosed no relevant financial relationships.

SLEEP 2016: 30th Anniversary Meeting of the Associated Professional Sleep Societies: Abstract 0557. Presented June 13, 2016.

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