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.
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.
When looking for a provider to treat your insomnia, choose someone who is certified or, at minimum, trained in cognitive behavioral therapy for insomnia (CBT-I), says Michael Perlis, director of the Behavioral Sleep Medicine Program at the University of Pennsylvania in Philadelphia, who co-led the study. He says CBT-I differs from other forms of CBT, which focus more on a person’s thoughts and feelings to help change behavior. CBT-I focuses on behavioral interventions that affect the regulation of sleep and wakefulness, Perlis says.
Insurance coverage for CBT-I varies depending on your insurance provider and the state you live in. Without insurance, six to 12 weeks of intervention cost about $800 to $1,500.
To find a provider, visit the American Board of Sleep Medicine or the Society of Behavioral Sleep Medicine websites.
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.
June 26, 2015