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.