Cognitive-behavioural treatment of insomnia secondary to chronic pain.

Abstract

My subjects with insomnia secondary to chronic pain were assigned randomly to either a cognitive-behavioural therapy (n = 25) or a minimal contact symptom-monitoring/waiting-list control group (n = 25). The therapy consisted of a multicomponent seven-week group intervention aimed at promoting good sleep habits, teaching relaxation skills, and changing negative thoughts about sleep. Subjects in the control group monitored their sleep using a sleep diary for seven weeks; they also received weekly supportive phone calls from a therapist. Treated subjects were significantly more improved than control subjects on measures of sleep onset latency, wake time after sleep onset, sleep efficiency, sleep quality, and nocturnal activity levels (obtained from ambulatory monitors). A small, but significant, decrease in pain levels was also found in the treated subjects, but depression and medication use remained unchanged. At a 3 month follow-up, treated subjects showed good maintenance of most therapeutic gains. These results provide the first evidence from a randomized controlled trial that cognitive-behavioural therapy is an effective treatment for insomnia that is secondary to chronically painful medical conditions.