Treatment of insomnia reduces fatigue in CFS in those able to comply with the intervention

[Dolphin]

Source: Fatigue: Biomedicine, Health & Behavior 
Preprint
Date: September 7, 2016
URL: http://www.tandfonline.com/doi/full/10.1080/21641846.2016.1222699


Treatment of insomnia reduces fatigue in chronic fatigue syndrome in those able to comply with the intervention
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Zoe Gotts, Vincent Deary, Julia L. Newton, Jason Ellis

Received 24 Jan 2016,
Accepted 05 Aug 2016,
Published online: 07 Sep 2016


Abstract

Background
Effectiveness of cognitive behavioural therapy for insomnia (CBT-I) has not been explored in Chronic Fatigue Syndrome (CFS), a condition where disturbed sleep is a principal symptom. This study aimed to report feasibility, acceptability and initial effectiveness of CBT-I in CFS.

Methods
Sixteen individuals with CFS received face-to-face CBT-I. Treatment comprised six sessions of sleep education, hygiene, restriction, stimulus control and cognitive therapy and completion of daily sleep diaries with an overarching aim to establish regularity in sleep-wake patterns. Patients completed self-report questionnaires (fatigue, pain, mood, sleep preoccupation, insomnia severity, and dysfunctional beliefs about sleep) pre- and post-treatment.

Results
Of the seven who completed the intervention five improved on self-reported sleep parameters (diary measures of sleep onset latency, awakenings during the night) following treatment. However, CBT-I was not acceptable for all (56%). Total fatigue (Chalder Fatigue), dropped from mean 22 to 16. Those not able to complete the intervention had higher fatigue, pain, depression and anxiety and reported more severe insomnia at baseline compared to completers.

Conclusion
CBT-I is an acceptable non-pharmacological approach with potential to treat sleep disturbances in some CFS patients. Strategies to reduce attrition and increase adherence are necessary, possibly telephone or online sessions, for this group.

Keywords: Sleep, fatigue, intervention, chronic fatigue syndrome

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(c) 2016 Taylor & Francis
(c) 2016 IACFS/ME

 

[Dolphin]

Conclusion
CBT-I is an acceptable non-pharmacological approach with potential to treat sleep disturbances in some CFS patients.

My impression is that 44% (or is it 56%?) is a fairly low level of acceptability. So not sure "acceptable" should be use regarding this treatment.

 

[Dolphin]

Treatment of insomnia reduces fatigue in CFS in those able to comply with the intervention

I would have thought that "ability to comply" is not the only reason somebody might find a therapy unacceptable.

 

[Esther12]

Ugh. Just the title is funny.

Not a good sign that Newton put her name on this imo. Utterly unsurprising that people like Gotts and Deary did.

 

[dancer]

Sounds like the Borg. "Resistance is futile." You must comply. Ugh is right.

 

[Seven7]

I have stage 4 issues (staying sleep) no amount of hygene can help me stay sleep

 

[alex3619]

My understanding is that severe circadian issues, like non-24, might in some cases respond but in the long run all treatments fail. All of them. Of course this is for a general understanding, and may or may not apply to ME or CFS, and may or may not be accurate. I read this some time ago, somewhere.

 

[Skippa]

Oh hi, I have excellent sleep hygeine and rarely wake midway through.

Doesn't work for me. Next!

 

[IreneF]

If you find that sleep hygiene helps you, perhaps your issue was with sleep and not CFS/ME at all.

I have intractable sleep problems (delayed sleep phase syndrome) along with my other symptoms. I would like to have a more typical sleep pattern, but I haven't been able to achieve it. I don't often have insomnia, however.

 

[alex3619]

I have intractable sleep problems (delayed sleep phase syndrome) along with my other symptoms. I would like to have a more typical sleep pattern, but I haven't been able to achieve it. I don't often have insomnia, however.

Ditto. In fact if I follow my altered circadian pattern I rarely get insomnia. I get insomnia when I try to fight it.

 

[valentinelynx]

Ditto. In fact if I follow my altered circadian pattern I rarely get insomnia. I get insomnia when I try to fight it.

Ditto, ditto. Severe sleep reversal. Sleep well when I go to bed in the morning and sleep all day.

 

[IreneF]

Ditto, ditto. Severe sleep reversal. Sleep well when I go to bed in the morning and sleep all day.

Yes, been there. Very comfortable for me, with the exception of not being able to interact with anyone in my time zone.

 

[daisybell]

Strategies to reduce attrition and increase adherence might be best addressed by actually listening to patients perhaps?? The majority of us actually know what works for us already.... I know that's a really radical suggestion. Guess what - when we feel worse, we sleep more poorly. Rocket science.

 

[snowathlete]

Why subjective measures when sleep can be measured objectively?

I bet there's not a single pharma treatment for insomnia which only uses subjective measures. I know monitoring someone in a full sleep study is expensive, but there are lots of tools that can be used now even in small studies like this. Seems so obvious.

edit: and with so many dropping out because they found it unacceptable, you have to wonder if those who are left are more likely to be over generous in their self reporting.

 

[user9876]

I would have thought that "ability to comply" is not the only reason somebody might find a therapy unacceptable.

They may just think its not worth the energy. It seems like those not able to complete the study were more severe.

It looks like it is not a controlled trial and open labelled so we would expect the results to be subject to reporting biases.

When they quote improvements I assume that is on those completing the trial but it is not clear from the abstract

 

[Bob]

What a load of trash! And a potentially abusive/coercive title.

It's an open-label trial using self-report measures, without a control arm.

7 out of 16 patients completed the trial.

A total of 5 out of 16 completed the trial and improved in sleep measures. And this is without a control arm of the study!

56% (out of 7? = 4 participants?) thought the intervention was acceptable. (But it's not clear how many responded to the question.)

Ditch it!!!

CBT-I is an acceptable non-pharmacological approach...

No it isn't! Read your abstract!

 

[user9876]

My impression is that 44% (or is it 56%?) is a fairly low level of acceptability. So not sure "acceptable" should be use regarding this treatment.

Since it is not clear what the acceptance rate is this suggests the abstract is poorly written. It is not clear if this refers to all patients or just the 7 who completed. Equally it is not clear whether improvements were on the 7 or measured overall.

Seems like a shocking lack of clarity in the abstract

 

[snowathlete]

What a load of trash! And a potentially abusive/coercive title.

It's an open-label trial using self-report measures, without a control arm.

7 out of 16 patients completed the trial.

A total of 5 out of 16 completed the trial and improved in sleep measures. And this is without a control arm of the study!

56% (out of 7? = 4 participants?) thought the intervention was acceptable. (But it's not clear how many responded to the question.)

Ditch it!!!


No it isn't! Read your abstract!

Has to be the worst things about science nowadays, that regardless of whether a study is well designed and conducted, regardless of the result, the results get spun as something other than what they are. This study is a failure in several ways that are obvious from the extract (even those many facts are not clear from the extract), yet they claim success.

 

[user9876]

Has to be the worst things about science nowadays, that regardless of whether a study is well designed and conducted, regardless of the result, the results get spun as something other than what they are. This study is a failure in several ways that are obvious from the extract (even those many facts are not clear from the extract), yet they claim success.

Success should of course be the increase of knowledge which includes both positive and negative results.

 

[snowathlete]

Success should of course be the increase of knowledge which includes both positive and negative results.

Indeed, what I meant was they claimed the study was a success (i.e. the intervention worked) when it didn't. It would have been a success for science if they presented the results more objectively, even though the results were negative (i.e. the intervention didn't work).