CBT is a treatment approach that addresses feelings and behaviors. The method is based on the premise that individuals can change the way they think to help themselves feel better even if the situation does not change.
Results showed that treatment improves both immediate and long-term self-reported sleep and pain in older patients with osteoarthritis and associated insomnia without directly addressing pain control.
Participants who received cognitive behavioral therapy for insomnia (CBT-I) reported significantly less time to fall asleep as well as reduced pain and increased sleep efficiency.
These improvements persisted in CBT-I patients (19 of 23) who were further assessed for sleep quality and perceived pain at a one-year follow-up visit.
According to lead author Michael V. Vitiello, PhD, professor at the University of Washington in Seattle, results indicate that insomnia is not merely a symptom of osteoarthritis but rather a co-existing illness.
Vitiello said improving sleep can result in an improvement in osteoarthritis, which is particularly important because, at least in older adults, insomnia rarely exits by itselfrather, it typically coexists with other illnesses, pain conditions and depression.
“The particular strength of CBT-I is that once an individual learns how to improve their sleep, study after study has shown that the improvement persists for a year or more,” said Vitiello.
“What we and others are showing is that CBT-I can not only improve sleep but that improvement of sleep may lead to improvement in co-existing medical or psychiatric illnesses, such as osteoarthritis or depression, and in the case of our study, that these additional benefits can be seen in the long term.”
A total of 23 patients with a mean age of 69 years were randomly assigned to CBT-I, while 28 patients with a mean age of 66.5 years were assigned to a stress management and wellness control group. Participants in the control group reported no significant improvements in any measure.
CBT-I intervention consisted of eight weekly, two-hour classes ranging in size from four to eight participants. All classes were conducted in an academic medical center in downtown Chicago and were spread out over the calendar year.
According to background information in the study, sleep quality is a major concern for people with osteoarthritis, with 60 percent of people who have the disease reporting pain during the night. Chronic pain initiates and exacerbates sleep disturbance; disturbed sleep in turn maintains and exacerbates chronic pain and related dysfunction.
The findings indicate that successful treatment of sleep disturbance may improve the quality of life for patients in this population. The authors recommend that CBT-I, which specifically targets sleep, be incorporated into behavioral interventions for pain management in osteoarthritis and possibly for other chronic pain conditions as well.