Persistent insomnia in cancer survivors can be greatly improved through cognitive behavioural therapy, according to University of Glasgow researchers.

Cognitive behavioural therapy (CBT) - known as the ‘talking cure’ - improvged the sleep quality of those involved in the research, according to results published in the Journal of Clinical Oncology.

A Cancer Research UK-funded trial, run by Professor Colin Espie of the University of Glasgow Sleep Centre, analysed the effect of CBT on sleep quality in 150 participants who had completed cancer treatment. They had all reported chronic insomnia lasting an average of two years.

Around one third of all cancer survivors have sleep problems.

Participants were divided into two groups. One group received CBT from cancer nurses, who were trained to deliver the CBT but had no prior experience in sleep medicine. Cancer nurses were used in this trial to demonstrate that the therapy could be delivered by non sleep specialists. The other group followed their usual clinical practice.

The group receiving CBT reported that it eliminated an average of 55 minutes of wakefulness per night, straight after receiving the therapy. This group also reported less day fatigue, and reduced anxiety and depression. A six-month follow up showed there were still benefits, while those in the control group reported no change.

Professor Colin Espie, director of University of Glasgow Sleep Centre and lead author, said: “When people with cancer receive the all clear from their cancer they want to get on with their lives. Developing chronic insomnia can be a massive shock and a barrier to recovery. It causes fatigue, depression and anxiety and people often feel they have gone from one problem to another.

“Insomnia is seldom satisfactorily addressed in cancer patients. Once they have left the care system the thought of taking more medication is soul destroying but they don’t know what to do. Better psychological care, practical advice and information at all stages of their treatment are needed.”

The CBT was administered in five small group sessions of up to six participants across five consecutive weeks. Patients recorded results in sleep diaries for three ten day assessment periods. The diary measured behaviour such as sleep initiation, restlessness, waking from sleep in the night and sleep efficiency – percentage of time in bed spent asleep. Other outcomes measured included day-time fatigue and health-related quality of life.

Kate Arnold, Cancer Research UK’s patient information director, said: “Persistent insomnia is a troubling and debilitating problem which can erode quality of life.  It is important to research realistic ways of overcoming insomnia in people recovering from cancer treatment and not accept it as something that goes with the territory.

 “Patients need a full care programme with advice and information to identify and tackle problems such as insomnia both during their cancer treatment and after having the disease in order to enjoy life after cancer.”

First published: 1 October 2008

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