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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 |
