This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (18)  • Contact me when this article is cited  Related Content  • Related letters  • Similar articles in this journal  Topic Collections  • Neurology  • Psychiatry  • Randomized Controlled Trial  • Alert me on articles by topic  Social Bookmarking   What's this?

A Randomized Clinical Trial

Jack D. Edinger, PhD; William K. Wohlgemuth, PhD; Andrew D. Krystal, MD; John R. Rice, MD

Arch Intern Med. 2005;165:2527-2535.

Background  Insomnia is common and debilitating to fibromyalgia (FM) patients. Cognitive-behavioral therapy (CBT) is effective for many types of patients with insomnia, but has yet to be tested with FM patients. This study compared CBT with an alternate behavioral therapy and usual care for improving sleep and other FM symptoms.

Methods  This randomized clinical trial enrolled 47 FM patients with chronic insomnia complaints. The study compared CBT, sleep hygiene (SH) instructions, and usual FM care alone. Outcome measures were subjective (sleep logs) and objective (actigraphy) total sleep time, sleep efficiency, total wake time, sleep latency, wake time after sleep onset, and questionnaire measures of global insomnia symptoms, pain, mood, and quality of life.

Results  Forty-two patients completed baseline and continued into treatment. Sleep logs showed CBT-treated patients achieved nearly a 50% reduction in their nocturnal wake time by study completion, whereas SH therapy– and usual care–treated patients achieved only 20% and 3.5% reductions on this measure, respectively. In addition, 8 (57%) of 14 CBT recipients met strict subjective sleep improvement criteria by the end of treatment compared with 2 (17%) of 12 SH therapy recipients and 0% of the usual care group. Comparable findings were noted for similar actigraphic improvement criteria. The SH therapy patients showed favorable outcomes on measures of pain and mental well-being. This finding was most notable in an SH therapy subgroup that self-elected to implement selected CBT strategies.

Conclusions  Cognitive-behavioral therapy represents a promising intervention for sleep disturbance in FM patients. Larger clinical trials of this intervention with FM patients seem warranted.

Author Affiliations: Veterans Affairs Medical Center (Dr Edinger) and Department of Psychiatry and Behaviorial Sciences (Drs Edinger, Wohlgemuth, and Krystal) and Division of Rheumatology, Department of Medicine (Dr Rice), Duke University Medical Center, Durham, NC.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

RELATED LETTERS

Potential Impact of Sleep Disorder Treatment in Fibromyalgia Patients
Barry Krakow
Arch Intern Med. 2006;166(12):1323.
EXTRACT | FULL TEXT  

Potential Impact of Sleep Disorder Treatment in Fibromyalgia Patients—Reply
Jack D. Edinger
Arch Intern Med. 2006;166(12):1323-1324.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Potential impact of sleep disorder treatment in fibromyalgia patients.
Krakow
Arch Intern Med 2006;166:1323-1323.
FULL TEXT  

Potential Impact of Sleep Disorder Treatment in Fibromyalgia Patients--Reply
Edinger
Arch Intern Med 2006;166:1323-1324.
FULL TEXT