Patients with worse baseline pain experienced greater improvements in sleep.

Cognitive-behavioural therapy for insomnia (CBT-I) is considered to be first-line treatment for most patients with chronic insomnia, but its efficacy in patients who are experiencing pain has not been studied extensively. To address this question, researchers performed a secondary analysis of data from a prior randomised trial in which five sessions of CBT-I was compared with general sleep education in older US veterans (mean age, 72 years; 96% men) with chronic insomnia (J Am Geriatr Soc 2013; 61: 947-956). CBT-I was administered by nonclinician sleep coaches who were supervised by behavioural sleep specialists.

Among 106 patients who were randomised to receive CBT-I, more than half reported chronic pain at baseline; higher pain scores were associated with worse insomnia symptoms. CBT-I improved validated measures of insomnia symptoms, sleep quality, fatigue and sleepiness for as long as 12 months post-treatment. Patients with higher self-reported pain had greater improvements in insomnia symptoms immediately post-treatment. Otherwise, the effects of CBT-I were similar in patients with and without pain.

Comment: As a primary care doctor at a Veterans Affairs hospital, I frequently see patients with both chronic pain and chronic insomnia; this study supports the efficacy of CBT-I for these patients. Interestingly, another small study showed that CBT-I not only improved sleep but also relieved pain in patients with osteoarthritis pain (NEJM JW Gen Med 1 Apr 2021 and JAMA Intern Med 2021; 181: 530-538). Unfortunately, supervised CBT-I is not available in all practice settings, but training nonclinicians to deliver CBT-I, as described in this study, could help expand access to this valuable intervention.

Molly S. Brett, MD, Assistant Professor of Clinical Medicine, University of Colorado School of Medicine; Primary Care Physician, Rocky Mountain Regional VA Medical Center, Aurora, USA.

Erickson AJ, et al. The effectiveness of cognitive behavioral therapy for insomnia on sleep outcomes in the context of pain among older adult veterans. J Am Geriatr Soc 2024; 72: 2319-2328.

This summary is taken from the following Journal Watch titles: General Medicine, Ambulatory Medicine, Psychiatry