Monday, May 23, 2016

Phone-Based CBT for Insomnia May Improve Symptoms in Menopausal Women

A study published today in JAMA Internal Medicine suggests that phone-based cognitive-behavioral therapy for insomnia (CBT-I) may improve sleep in women experiencing insomnia associated with menopause. The study also found CBT-I reduced the degree to which hot flashes interfered with daily functioning.

The findings suggest CBT-I may offer an alternative therapeutic option for women who are hesitant to use sedatives or hormonal therapies to treat these two menopause-related symptoms, which can adversely affect mood, productivity, and physical health.

The study involved 106 Seattle-area women aged 40 to 65 who reported moderate insomnia and at least two hot flashes a day. All of the women were asked to keep daily logs of their sleep patterns throughout the study and rate the quantity, frequency, and severity of their hot flashes at the beginning of the study, and again at eight weeks and 24 weeks later. Half of the participants received six, 20- to 30-minute CBT-I phone sessions over 8 weeks, which included advice how to identify factors that negatively affect sleep and reduce physiological arousal at bedtime; the other half received phone sessions in menopause education control (MEC), which included general strategies for symptom self-management.

After eight weeks, the authors found that women receiving CBT-I showed greater improvements in both insomnia and sleep quality scores compared with those that received MEC, with 70% of CBT-I participants achieving scores equating to no insomnia (compared with 24% in the control group). The CBT-I group also had greater improvements in their diary-reported sleep latency, wake time, and sleep efficiency. These differences persisted at the 24 week mark, even after the sessions had ended.

While the authors found no between-group differences in self-reported hot flash frequency and severity, women in the CBT-I group reported less hot flash interference with daily functioning at 8 and 24 weeks relative to MEC.

Because the professionals delivering the sessions were not sleep specialists, the authors noted, “Our findings support the potential for training non-sleep specialists to deliver telephone-based CBT-I to women with insomnia and vasomotor symptoms in a variety of primary and women’s health care settings.”

They concluded, “Telephone-based CBT-I allows upscaling to reach large populations of menopausal women seeking treatment for sleep problems. Centralized telephone CBT-I should be tested as a dissemination model, similar to effective telephone-based counseling programs for smoking cessation.”

For related information, see the Psychiatric News article “Older Age at Menopause May Reduce Risk of Depression.”

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