Insomnia Therapy Helps Osteoarthritis Patients
Reported August 18, 2009
(Ivanhoe Newswire) – A new study shows the use of cognitive behavioral therapy for insomnia (CBT-I) is an effective treatment for older patients with osteoarthritis and the attendant pain which causes insomnia.
According to the study, sleep quality is a major concern for people with osteoarthritis, with 60 percent of people with 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.
Results showed treatment improved both immediate and long-term self-reported sleep and pain in older patients with osteoarthritis and insomnia without directly addressing pain control. Participants who received CBT-I reported significantly decreased sleep loss and wake after sleep onset. The treatment also significantly reduced pain and increased sleep efficiency. These improvements persisted in 19 of 23 CBT-I patients 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, Wash., 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 exists by itself, rather it typically coexists with other illness, 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,” Vitello was quoted as saying. “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.”
Twenty-three 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 who did not receive CBT-I reported no significant improvements.
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. Participants received polysomnographic assessment in their homes in order to exclude individuals with sleep apnea.
Sleep and pain were assessed by self-report at baseline, after treatment and, for CBT-I only, at one-year follow-up. Sleep logs were recorded prior to and after treatment and at the one-year follow-up and included information about sleep latency, wake after sleep onset and sleep efficiency. Subjects had to be over the age of 55, have insomnia that had persisted for at least six months and have been diagnosed with osteoarthritis. A majority of the sample was female.
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.
SOURCE: Journal of Clinical Sleep Medicine, August 15, 2009