Acupuncture and Cognitive Behavioral Therapy for Insomnia After Cancer

An 8-week course of acupuncture or cognitive behavioral therapy was observed to reduce insomnia in people who had completed cancer treatment and were trying to return to normal life but suffered from insomnia (sleeplessness). Researchers will present this study at the 2018 ASCO Annual Meeting in Chicago.

What Is Insomnia?

Primary insomnia can be described as a mild cognitive disorder that sometimes causes difficulty sleeping for days or even months, usually presents with daytime fatigue from lack of sleep and leads to feeling unwell. In some cases, insomnia may even manifest as depression and anxiety (worry, inner distress).

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Around 60% of people who have received cancer treatment experience some form of insomnia, but it generally remains undiagnosed and untreated. In this study, both cognitive behavioral therapy and acupuncture were found highly effective for treating moderate to severe insomnia. We can now say that people who have received cancer treatment and experience sleep problems have more than one option to relieve this complaint.

About the Study

Cognitive behavioral therapy is a newer psychotherapy approach addressing sleep-related thoughts, feelings and behaviors. In addition, people who had received cancer treatment were found to prefer natural, nonmedical approaches for insomnia treatment. Based on findings from other sleep studies, acupuncture was therefore considered potentially useful for inclusion in this study. Acupunctureis available as a complementary intervention in 73% of United States cancer centers.

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The participants had completed cancer treatment and had been diagnosed with cancer approximately 6 years earlier. They had been treated for breast, prostate, head and neck, hematological (originating in blood and bone marrow) and colorectal cancers. In addition, 6% had been diagnosed with more than one type of cancer.

Everyone enrolled in the study had a clinical insomnia diagnosis. Following diagnosis, participants were randomly divided into two groups and received cognitive behavioral therapy or acupuncture for 8 weeks.

Cognitive behavioral therapy delivered by a psychotherapist aimed to:

• Reduce time spent in bed
• Limit activities performed in bed (except sleep and sexual activity)
• Change unhelpful, mistaken thoughts about sleep
• Create a healthy, hygienic environment supporting good sleep (keeping tablet or phone light away, avoiding eating very late or engaging in intense activity, and maintaining regular sleep times).

Reducing Severe Insomnia Symptoms

Insomnia severity was measured using the Insomnia Severity Index, and the reduction from study baseline to week 8 (the end of treatment) was the primary endpoint. Participants were reassessed after 20 weeks. The Insomnia Severity Index is a questionnaire intended to rate the severity of insomnia/sleep-onset

difficulties and other sleep problems, such as their effect on quality of life. Index scores range from 0 to 28: scores of 0-7 indicate no clinically significant insomnia; 8-14 mild insomnia; 15-21 moderate insomnia; and 22-28 severe insomnia.

At the start of the study, 33 people had mild insomnia, 94 had moderate insomnia and 33 had severe insomnia.

Important Findings

Overall, cognitive behavioral therapy was more effective for insomnia: after 8 weeks, insomnia scores fell by 11 points, from 18.5 to 7.5. Those receiving acupuncture improved by 8.3 points (from 17.5 to 9.2). Among people with mild insomnia at baseline, cognitive behavioral therapy produced greater improvement than acupuncture (85% versus 18%).

Participants starting the study with moderate insomnia had similar response rates with cognitive behavioral therapy and acupuncture (75% versus 66%).

Everyone participating in the study experienced improvement in their insomnia 20 weeks after the trial began.

In conclusion both cognitive behavioral therapy and acupuncture appear effective for patients suffering from insomnia after cancer treatment. However, cognitive behavioral therapy provided greater relief in this study. Sleep quality in people who have received cancer treatment must be taken seriously by both the patient and physician, and accessible, effective treatments should be offered.

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