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Healthy Habits

Sleep Solution?

Cognitive behavioral therapy for insomnia might offer hope to sleep-deprived cancer survivors. By Brenda Conaway

A cancer diagnosis alone is enough to keep you up at night. Add to that the fatigue, pain and nausea many experience as part of their treatment and sleepless nights can start adding up. For many cancer survivors, insomnia lingers after treatment is over, becoming chronic and hard to treat. However, cognitive behavioral therapy for insomnia (CBT-I)—a therapy that aims to change sleep habits and behaviors, as well as misconceptions about sleep and insomnia—might offer a promising solution for a better night’s rest. 

A study in the Jan. 10, 2015, Journal of Clinical Oncology evaluated CBT-I in cancer survivors who underwent chemotherapy or radiation therapy and reported difficulty falling or staying asleep for at least three months. The study of 73 survivors also examined whether Nuvigil (armodafinil) improved the effectiveness of CBT-I. Nuvigil is used to treat excessive sleepiness caused by narcolepsy or shift work sleep disorder, a condition in which people are sleepy during waking hours and have difficulty falling asleep. 

How to Find a CBT-I Provider
Learn more about choosing a CBT-I specialist.
Participants were placed into four groups: CBT-I with Nuvigil, CBT-I with a placebo, Nuvigil alone or a placebo alone. Participants who received CBT-I either with Nuvigil or with a placebo reported similar significant improvements in their insomnia and sleep quality that persisted at least three months after the end of therapy. Nuvigil did not provide any additional improvement. Participants who received just Nuvigil or a placebo reported no 
measurable benefits.
When you get poor sleep for weeks and months, “not sleeping well becomes your new normal,” says Joseph Roscoe, lead author of the study and a sleep researcher at the University of Rochester Medical Center in New York. For example, a person suffering from insomnia might be in bed for eight hours a night, but sleep only for six.
During the seven-week study, all participants followed set rules, such as not watching TV in bed and using the bedroom only for sleep and sexual activity, and kept a diary to find out how much time they spent awake in bed trying to fall asleep. Participants in the CBT-I group also spoke weekly with therapists and followed set sleep schedules.
Roscoe says the first few weeks of therapy can be rigorous because participants’ sleep is restricted, and they are instructed to wake up at the same time every day and to avoid napping. However, he says, CBT-I’s effects are lasting and the therapy can help cancer survivors readopt a healthier pattern of sleep.


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