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It’s a Catch-22 that even those with a common cold experience: Illness disrupts sleep. Poor sleep makes the symptoms of the illness worse.
What’s true for a cold also holds for more serious conditions that co-occur with insomnia. Depression, post-traumatic stress disorder, alcohol dependence, fibromyalgia, cancer and chronic pain often give rise to insomnia, just as sleeplessness
exacerbates the symptoms of these diseases. Historically, insomnia was
considered a symptom of other diseases. Today it is considered an
illness in its own right and recognized as an amplifier of other mental and physical ailments. When a person is chronically tired, pain can be more painful, depression deeper, anxiety heightened.
What
should doctors address first, insomnia or the co-occurring condition?
How about both at the same time? A new study suggests that a therapy
that improves sleep also reduces symptoms of other illnesses that often
disrupt it.
The study published in JAMA Internal Medicine
examined the effect of cognitive behavioral therapy for insomnia in
patients with serious mental and physical conditions. As its name
suggests, C.B.T.-I. is a treatment that works through the mind. As I
wrote about a few weeks ago, the therapy treats insomnia without medications, combining good sleep hygiene
techniques with more consistent wake times, relaxation techniques and
positive sleep attitudes and thoughts. Several clinical trials have
shown that C.B.T.-I. provides as good or better relief
of symptoms of insomnia than prescription drugs, with improvements in
sleep that are more durable. C.B.T.-I. can usually be delivered
relatively inexpensively through an online course costing about $40.
Compared
with those who didn’t receive C.B.T.-I., patients who did increased the
time asleep in bed by about 12 percentage points, fell asleep about 25
minutes faster and decreased the amount of time awake in the middle of
the night by about 45 minutes, according to Jade Wu, lead study author
and a Boston University doctoral student in psychology.
The
study also found that slightly more than one in three patients who
received C.B.T.-I. recovered from insomnia, compared with only about one
in six in control groups who did not receive C.B.T.-I. As medical
treatments go, this is an exceedingly high cure rate. Reflecting its strong performance in clinical trials, C.B.T.-I. is recommended by the American Academy of Sleep Medicine as the first-line treatment for insomnia.
Analyzing data across 2,189 patients, collected in 37 randomized trials, the researchers found
that C.B.T.-I. is also helpful for those with chronic mental or
physical illnesses. The researchers found that when insomnia is treated
with C.B.T.-I., symptoms of some other illnesses abate, too, at least
somewhat. It was found to reduce alcohol use in alcoholics, decrease symptoms of depression, reduce severity of P.T.S.D. symptoms, alleviate fatigue in breast cancer patients and reduce chronic pain.
For those who are both chronically tired and chronically sick, the route to additional relief of both may be through the mind.
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