Postmenopausal insomnia: CBTI appears to have the edge

  • Kalmbach DA & al.
  • J Clin Sleep Med
  • 15 Jul 2019

  • International Clinical Digest
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Takeaway

  • Among women with postmenopausal insomnia, both cognitive behavioral therapy for insomnia (CBTI) and sleep restriction therapy (SRT) were superior to standard sleep hygiene education (SHE) for improving fatigue, energy, sleepiness, and work performance.
  • CBTI was also superior for improving emotional health.

Why this matters

Key results

  • At 6 months, compared with the SHE control, SRT and especially CBTI yielded greater improvements in:
    • Fatigue Severity Scale scores (–0.69, –3.13, –5.35; P<.01>
    • Energy scores on the Short Form-36 (1.27, 4.57, 5.92; P<.01>
    • Diary-based sleepiness (–1.54, –5.40, –6.10; P<.01>
    • Work performance (work time impaired; –1.10, –3.92, –4.01; P=.02).
  • Only CBTI yielded significant improvement from baseline in QoL ascertained from Short Form-36 emotional well-being (2.47; P=.02).
  • All groups had significant improvements in daytime, nighttime hot flashes.
  • Irrespective of group, improved sleep was associated with reduced pain.

Study design

  • Single-center randomized controlled trial among 150 postmenopausal women with perimenopausal-/postmenopausal-onset or exacerbation of chronic insomnia.
  • Randomization:
    • SHE (control).
    • SRT for 4 weeks.
    • CBTI for 6 weeks.
  • Main outcomes: fatigue, daytime function, work performance, emotional health.
  • Funding: National Institute of Nursing Research.

Limitations

  • Long-term benefits unknown.
  • Mode of delivery of interventions varied.
  • Unknown generalizability.