Randomized trial of a cognitive-behavioral intervention for insomnia in breast cancer survivors.

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.