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Randomized Trial of a Cognitive-Behavioral Intervention for Insomnia in Breast Cancer Survivors

Dana R. Epstein
Shannon R. Dirksen
ONF 2007, 34(5), E51-E59 DOI: 10.1188/07.ONF.E51-E59

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.

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