A Treatment for Insomnia Related to Pain

As we get older joints become sources of pain, and frequently cause insomnia.  Some 60% of people with osteoarthritis report feeling pain at night and many of them have difficulty in sleeping.  A vicious cycle is set up: pain initiates and exacerbates sleep disturbance, whereas disturbed sleep maintains and exacerbates pain.  US sleep researchers have re-analyzed an earlier randomized clinical trial that compared cognitive behavioral therapy (CBT) in patients with osteoarthritis and accompanying insomnia with a control treatment – ‘attention control’.  (Attention control means these subjects had a lay visitor who paid them attention for the period that the other subjects received CBT.)  The results are published in the Journal of Clinical Sleep Medicine.  

23 patients (average age 69, 85% women) were given CBT directed at their insomnia for 8 weekly 2-hour classes in groups of 4-8, and 28 patients (average age 67) were given attention control.  Neither ‘treatments’ addressed pain management.  Sleep and pain were assessed by self reports, at baseline and after treatment, and, for the CBT group, after 1 year.

The CBT group of patients reported falling asleep on average 17 minutes faster, remaining asleep 37 minute longer, and having a 13% increase in sleep efficiency.  They also had a significant improvement on the pain questionnaire.

These results strongly suggest that improving sleep, such as with CBT, can be effective in addressing both symptoms of the pain-insomnia complex.  Improvement persisting for at least a year was an important finding.  But more studies are needed, of course.