Cognitive behavioral therapy for insomnia in breast cancer survivors: A randomized controlled crossover study

Insomnia is characterized by complaints of difficulty initiating or maintaining sleep, or non-restorative sleep which last for at least one month and which cause clinically significant distress or impairment in functioning. Estimates of insomnia in women with breast cancer range from approximately 20% to 70%, with reports of poor sleep lasting for years after completion of the cancer treatment. Insomnia in breast cancer patients is often associated with depression, anxiety, fatigue, and low quality of life. This study aimed at understanding whether an individual cognitive behavioral treatment for insomnia (CBT-I) would result in improvements in sleep as well as improvements in fatigue, depression, anxiety and quality of life (QOL) in breast cancer survivors. Fourteen breast cancer survivors (age M= 61, SD=11.6, range = 45- 85) were randomly assigned to either 6 weeks of CBT-I followed by 6 weeks of follow up, or 6 weeks of treatment as usual (TAU) followed by 6 weeks of CBT-I. The hypotheses tested were that subjective and objective measures of sleep would improve during CBT-I compared to during TAU, that the QOL, fatigue, depression and anxiety would improve during CBT-I compared to during TAU, and that the effects of CBT-I on sleep and other symptoms would be maintained at 6 weeks. The results revealed that the participants assigned to receiving the CBT-I in the first six weeks had improved self-rated insomnia after treatment compared to the participants assigned to TAU (Insomnia severity index. Post-CBT-I: M=12.20, SD=6.57, range=2-19; Post-TAU: M=20.71, SD=3.99, range=16-26, p=0.03). The pooled analyses of pre and post CBT-I treatment for all 14 participants revealed significant improvements in self-rated insomnia and sleep quality as well as improvements in objective measures of sleep. The analyses of the group that received CBT-I followed by 6 weeks of follow-up revealed that the sleep benefits gained during treatment were maintained at follow-up. In addition, QOL significantly improved at follow-up. No significant effects were found for psychological or fatigue variables. The results are comparable to the sleep findings in previous studies that looked at group CBT-I therapies in breast cancer survivors, but differ in the effects found in psychological, fatigue and QOL measures. These results show that individual CBT-I is efficacious in improving sleep in breast cancer survivors. Further studies with greater sample size will help better understand the relationship between treating insomnia and psychological, fatigue and QOL variables in breast cancer survivors