Effects of cognitive behavioral therapy for insomnia on subjective and objective measures of sleep and cognition

Abstract

Study Objectives: To assess the effects of Cognitive Behavioral Therapy for insomnia (CBTi) on subjective and objective sleep, sleep-state misperception as well as self-reported and objective cognitive performance. Methods: We performed a randomized controlled trial with a treatment group and a wait-list control group to assess changes in insomnia symptoms after CBTi (8 sessions/3 months) in 62 participants with chronic insomnia. To this end, we conducted a multimodal investigation of sleep and cognition including subjective measures of sleep difficulties (Insomnia Severity Index (ISI), sleep diaries) and cognitive functioning (Sahlgrenska Academy Self-reported Cognitive Impairment Questionnaire), objective assessments of sleep (polysomnography recording, cognition (attention and working memory tasks), and sleep-state misperception measures, collected at baseline and at 3-months post-randomization. At 6 months post-randomization, we collected similar data from the wait-list group after CBTi. We also assessed ISI one year after CBTi in both groups. Our main analysis investigated changes in sleep and cognition after 3 months (treatment versus wait-list group). In secondary analyses, we pooled data from both groups to observe changes after CBTi. Results: ISI score was reduced and self-reported sleep quality improved after CBTi (treatment group at 3 months and pooled groups after CBTi). Sleep misperception in sleep onset latency and sleep duration decreased after CBTi. In contrast, objective sleep, objective and subjective cognitive functioning did not improve after CBTi. Conclusions: We showed that CBTi has a beneficial effect on variables pertaining to the subjective perception of sleep, which is a central feature of insomnia. However, we observed no significant effect of CBTi on measures of cognitive functioning.

Sleep Instability in Paradoxical Insomnia is Associated with Perception of Sleep

“…One example of treatments aimed to rid paradoxical insomnia patients of this disorder is sleep education, however, only a portion of the subjects responded positively to it - others were unresponsive [10]. Another example of paradoxical insomnia treatments would be Cognitive Behavioral Therapy (CBTi), which proved to decrease the degree of discrepancy between subjective and objective sleep in terms of sleep latency and sleep duration [11], but the extent of improvement decreases with age [12]. These diversifying results encourage further studies to explore the pathophysiology of paradoxical insomnia thoroughly, including using data collected from multi-centered and diverse backgrounds of patients.…”