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The study by Edinger et al¹ on cognitive-behavioral therapy (CBT) for insomnia clearly demonstrates the value of directly targeting sleep disturbances among patients with fibromyalgia (FM), and their impressive results support the emerging sleep medicine paradigm to treat "insomnia as a disorder."² The large treatment effects for many self-report measures prove that treating insomnia as if it were a comorbid condition is highly beneficial to FM patients.

Ironically, owing to limitations in the design, this excellent research has likely underestimated the true potential to improve sleep quality in FM patients. Although CBT is the most potent and sustainable form of therapy for unwanted sleeplessness, it largely affects psychological dimensions of insomnia, not physiological ones. As the study demonstrated, actigraphic data of objective sleep showed almost no group differences because objective sleep hardly changed. The best explanation for the absence of physiological change in insomnia or sleep quality would be that . . . [Full Text of this Article]

AUTHOR INFORMATION
Barry Krakow, MD

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