CBT, sleep restriction therapy, ‘superior’ for menopause-related insomnia

Cognitive behavioral therapy for insomnia and sleep restriction therapy more effectively treated menopause-related insomnia disorder when compared to sleep hygiene education, according to findings recently published in Sleep.

Research involving cognitive-behavioral interventions for menopause-related insomnia is scarce, according to Christoper L. Drake, PhD, bioscientific staff investigator at the Thomas Roth Sleep Disorders and Research Center in Detroit and colleagues.

“Most treatment options to improve sleep in menopause involve pharmacotherapy, but have produced mixed or weak results,” they added.

To evaluate non-pharmacological treatment for menopause-related insomnia, Drake and colleagues randomly assigned 152 postmenopausal women from the Detroit area in an approximately 1:1:1 ratio to receive either sleep hygiene education, sleep replacement therapy or CBT for insomnia.

Researchers found from baseline to post-treatment, the Insomnia Severity Index decreased 7.7 points (P < .001) for patients in the CBT for insomnia group, 6.56 points (P < .001) for those in the sleep restriction therapy group and 1.12 (P = .01) in the sleep hygiene group (P = .01). The patients in the CBT for insomnia group also obtained 40 to 43 more minutes of nightly sleep and higher remission rates (54% to 84%) than those who received sleep replacement therapy (38% to 57%) and sleep hygiene education (4% to 33%) immediately after treatment and 6 months later.

“We showed that CBT for insomnia and sleep restriction therapy are superior treatments for menopause-related insomnia when compared with sleep hygiene education,” Drake and colleagues wrote. “Although [sleep hygiene education] is a common insomnia-focused treatment and may slightly improve some aspects of sleep, our results roundly reject it as an appropriate standalone treatment for menopausal insomnia.”

They added that their research was the first to:

• test CBT for insomnia efficacy in women with a behavioral sleep medicine specialist diagnosing DSM-5 chronic insomnia disorder that began or was exacerbated during or after the menopause transition;
• demonstrate the superiority of CBT for insomnia for menopausal insomnia to an insomnia-focused minimal treatment control condition (such as sleep hygiene education) that approximates a real-world comparator; and
• compare CBT for insomnia vs. sleep restriction therapy menopausal insomnia in a randomized controlled trial.

“Improvements in sleep latency, sleep maintenance, and overall insomnia symptomatology were sustained 6 months later, reflecting durable treatment effects,” they wrote.

Drake and colleagues suggested future studies duplicate their efforts, but review the women’s insomnia symptoms for more than 6 months post-treatment. – by Janel Miller

Disclosures: Drake reports serving on the Merck & Co.’s speakers bureau and receiving research support from Actelion, Aladdin Dreamer, Eisai Co., Jazz, Merck & Co., and Teva. Please see the study for all other authors’ relevant financial disclosures.