Cognitive Behavioral Therapy More Effective Than Sleep Education for Insomnia in MS

Catherine F. Siengsukon, PT, PhD

Cognitive behavioral therapy (CBT) appears to be an effective, nonpharmacologic treatment for insomnia and concomitant symptoms associated with it in patients with multiple sclerosis, according to findings from a small randomized study presented at the 2019 Annual Meeting of the Consortium of Multiple Sclerosis Centers (CMSC), May 28-June 1, in Seattle, Washington.

According to the investigators, led by Catherine Siengsukon, PT, PhD, associate professor in the department of neurology at the University of Kansas Medical Center, at least 40% of people with MS report experiencing chronic insomnia. Insomnia in this vulnerable population has been associated with increased levels of fatigue, anxiety, depression, reduced cognitive and physical function, poor interpersonal relationships, and the reduced ability to perform occupational functions as well as activities of daily living.

In this study, the investigators sought to compare a 6-week, in-person intervention with CBT for insomnia and a brief education program in patients with MS who reported symptoms of insomnia. Endpoints included changes in Insomnia Severity Index (ISI), Modified Fatigue Impact Scale (MFIS), Patient Health Questionnaire for depression (PHQ-9), and Generalized Anxiety Disorder (GAD-7).

Overall, 19 participants (18 women) completed the study, of whom 16 had relapsing-remitting MS and 3 had secondary progressive disease. Patients who were randomly assigned to the CBT group (n = 10) showed significant improvements on the ISI (P <.001; 70% improvement), MFIS (P =.008; 56.6% improvement), and PHQ-9 (P =.033; 66.7% improvement), but no significant change on the GAD (P =.115; 36.5% improvement). Those assigned to the brief education program (n = 9) showed a significant improvement on ISI (P <.001; 42.3% improvement) and the MFIS (P =.009; 36.6% improvement), but no significant change on the PHQ-9 (P =.197; 36% improvement) or GAD (P =.737; 7.5% improvement).

While both interventions suggested some improvement in insomnia symptoms, CBT was associated with a larger degree of improvement. Notably, only those in the CBT group showed a significant improvement in depression, and no participants demonstrated an improvement in anxiety.

“CBT-I appears to be an efficacious nonpharmacologic treatment to improve insomnia symptoms and concomitant symptoms in people with MS, with greater efficacy than brief sleep education,” the investigators concluded.

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REFERENCE

Coffyn S, Wileman A, D’Silva S, et al. Impact of cognitive behavioral therapy for insomnia or brief sleep education on insomnia symptoms, fatigue, depression, and anxiety in individuals with multiple sclerosis. Presented at: 2019 CMSC Annual Meeting. May 28-June 1, 2019; Seattle, WA. Abstract DXA04.