Our results suggest that CBT represents a viable intervention for primary sleep-maintenance insomnia. This treatment leads to clinically significant sleep improvements within 6 weeks and these improvements appear to endure through 6 months of follow-up.

Cognitive-behavioral therapy represents a promising intervention for sleep disturbance in FM patients. Larger clinical trials of this intervention with FM patients seem warranted.

Findings suggest that 4 individual, biweekly sessions represents the optimal dosing for the CBT intervention tested. Additional dose-response studies are warranted to test CBT models that contain additional treatment components or are delivered via group therapy.

CBT is effective for reducing dysfunctional beliefs about sleep and such changes are associated with other positive outcomes in insomnia treatment.

Background Blunted blood pressure dipping is an established predictor of adverse cardiovascular outcomes. Although blunted blood pressure dipping is more common in African Americans than whites, the factors contributing to this ethnic difference are not well understood. This study examined the relationships of blood pressure dipping to ethnicity, body mass index, sleep quality, and fall in sympathetic nervous system activity during the sleep-period. Methods On 3 occasions, 128 participants with untreated high clinic blood pressure (130–159/85–99 mmHg) underwent assessments of 24-hour ambulatory blood pressure, sleep quality (evaluated by sleep interview, self-report, actigraphy) and sleep-period fall in sympathetic activity (measured by waking/sleep urinary catecholamine excretion). Results Compared to whites (n=72), African Americans (n=56) exhibited higher sleep-period systolic (p=.01) and diastolic blood pressure (p<.001), blunted systolic blood pressure dipping (p=.01), greater body mass index (p=.049) and poorer sleep quality (p=.02). Systolic blood pressure dipping was correlated with body mass index (r=−0.32, p<.001), sleep quality (r=0.30, p<.001), and sleep-period fall in sympathetic activity (r=0.30, p<.001). Multiple regression analyses indicated that these 3 factors were independent determinants of sleep-period systolic blood pressure dipping; ethnic differences in dipping were attenuated when controlling for these factors. Conclusions Blunted blood pressure dipping was related to higher body mass index, poorer sleep quality, and a lesser decline in sleep-period sympathetic nervous system activity. Although African American ethnicity also was associated with blunted dipping compared to whites in unadjusted analyses, this ethnic difference was diminished when body mass index, sleep quality and sympathetic activity were taken into account.