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CC BY-NC-ND 4.0 · Sleep Sci 2023; 16(04): e417-e424
DOI: 10.1055/s-0043-1776881
Original Article

Characteristics of Patients with Subjective Sleep Problems after Cognitive Behavioral Therapy for Insomnia: Secondary Analyses of a Randomized Controlled Trial

Christina Sandlund 
1   Karolinska Institutet, Neurobiology, Care Sciences and Society, Stockholm, Sweden
2   Region Stockholm, Academic Primary Health Care Centre, Stockholm, Sweden
,
Jeanette Westman
1   Karolinska Institutet, Neurobiology, Care Sciences and Society, Stockholm, Sweden
2   Region Stockholm, Academic Primary Health Care Centre, Stockholm, Sweden
3   Marie Cederschiöld University, Health Sciences, Stockholm, Sweden
,
Annika Norell-Clarke
4   Örebro University, Law, Psychology and Social Work, Örebro, Sweden
5   Kristianstad University, Health Sciences, Kristianstad, Sweden
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Abstract

Objective Cognitive behavioral therapy for insomnia (CBT-I) is the first-line treatment for insomnia, but half of the patients do not reach remission. This study aimed to explore subjective remission by investigating the characteristics of patients who reported lingering sleep problems after CBT-I.

Methods Secondary analyses of a randomized controlled trial of group CBT-I in 72 primary care patients with insomnia disorder. Sociodemographic characteristics and outcomes (insomnia severity, sleep variables, hypnotics use, fatigue, depressive symptoms, and dysfunctional beliefs/attitudes), including baseline data and symptom change, were investigated in relation to patients' posttreatment response to the yes-or-no question “Would you say that you have sleep problems?”

Results A total of 56.9% of patients reported sleep problems after CBT-I. At baseline, they had worse depressive symptoms (14.9 (SD 7.5) vs. 10.2 (SD 5.9), p = 0.006) and more awakenings (2.6 (SD 1.5) vs. 1.8 (SD 1.3), p = 0.034) than those in subjective remission from sleep problems. Patients in the non-remission and remission groups showed similar improvements in sleep, fatigue, and depressive symptoms, but patients in the non-remission group had improved less in insomnia severity, dysfunctional beliefs/attitudes about sleep, and hypnotic use. In patients with more pronounced depressive symptoms before CBT-I, change in depressive symptoms during treatment partially explained subjective remission from sleep problems.

Discussion More severe depressive symptoms prior to CBT-I and less improvements in depressive symptoms during treatment predicted remaining subjective sleep problems after treatment. These findings highlight the importance of assessing depressive symptoms in primary care patients with insomnia, as patients with pronounced depressive symptoms may need tailored treatment.

Keywords

cognitive behavioral therapy - sleep initiation and maintenance disorders - depression - primary health care - treatment outcome - self-assessment

Financial Support

Region Stockholm.




Publication History

Received: 03 April 2022

Accepted: 31 January 2023

Article published online:
22 November 2023

© 2023. Brazilian Sleep Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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