Randomized trial of a cognitive-behavioral intervention for insomnia in breast cancer survivors
Abstract
PURPOSE/OBJECTIVES: To determine the efficacy of a cognitive-behavioral intervention for treating insomnia in breast cancer survivors. DESIGN: Randomized controlled trial. SETTING: University and medical center settings. SAMPLE: 72 women at least three months after primary treatment for breast cancer with sleep-onset or sleep maintenance insomnia at least three nights per week for at least three months as determined through daily sleep diaries. METHODS: Random assignment to a multicomponent intervention (stimulus control instructions, sleep restriction, and sleep education and hygiene) or a single-component control group (sleep education and hygiene). MAIN RESEARCH VARIABLES: Sleep-onset latency, wake after sleep onset, total sleep time, time in bed, sleep efficiency, and sleep quality. FINDINGS: After the intervention, both groups improved on sleep-onset latency, wake after sleep onset, total sleep time, time in bed, sleep efficiency, and sleep quality based on daily sleep diaries. A between-group difference existed for time in bed. Wrist actigraph data showed significant pre- to postintervention changes for sleep-onset latency, wake after sleep onset, total sleep time, and time in bed. When compared to the control group, the multicomponent intervention group rated overall sleep as more improved. CONCLUSIONS: A nonpharmacologic intervention is effective in the treatment of insomnia in breast cancer survivors. IMPLICATIONS FOR NURSING: Breast cancer survivors can benefit from a cognitive-behavioral intervention for chronic insomnia. Sleep education and hygiene, a less complex treatment than a multicomponent intervention, also is effective in treating insomnia.
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The less convincing effects of CBT-I on sleep quality could be due to negative or smaller effects in studies assessing sleep quality without focusing on insomnia severity, including studies with active controls or studies not using insomnia as an inclusion criterion.
“This result could be due to negative or smaller effects in studies assessing sleep quality without focusing on insomnia severity, including studies with active controls (50, 58) or studies not using insomnia as an inclusion criterion (85).”
From Interventions for insomnia in cancer patients and survivors-a comprehensive systematic review and meta-analysis (2024) · cites this paper as [58]
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- Authors
- Epstein, D. R., & Dirksen, S. R.
- Affiliations
- Carl T. Hayden Veterans Affairs Medical Center (US)
- United States Department of Veterans Affairs (US)
- ORCID
- Epstein, Dana R.
- Venue
- Oncology nursing forum
- Publisher
- Oncology Nursing Society (ONS)
- Published
- 2007-09-01
- Volume
- 34
- Issue
- 5
- Pages
- E51-E59
- ISSN
- 0190-535X (ISSN-L)
- 1538-0688
- OpenAlex
- W1985313405
- Cited by
- 152
- References
- 62
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 3 · 2023: 5 · 2022: 3 · 2021: 5 · 2020: 1 · 2019: 4 · 2018: 5 · 2017: 10 · 2016: 11 · 2015: 16 · 2014: 15 · 2013: 5 · 2012: 11
- FWCI
- 16.30
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Oncology nursing forum (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Cancer Institute (CA91868)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
- Keywords
- insomnia, breast cancer survivors, cognitive-behavioral intervention, sleep latency, sleep maintenance insomnia, sleep restriction, stimulus control, non-pharmacological treatment, sleep quality, time in bed, wake after sleep onset
- MeSH terms
- Adult, Aged, Analysis of Variance, Breast Neoplasms, Feasibility Studies, Female, Humans, Sleep Initiation and Maintenance Disorders, Middle Aged, Pilot Projects, Cognitive Behavioral Therapy, Survivors
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