Cognitive behaviour therapy (CBT) for insomnia delivered by nurse specialists decreases sleep onset latency (SOL) and wake-after sleep onset (WASO) in people treated for cancer

Insomnia is a problem for 25% of people treated for cancer but, despite being common and impacting upon quality of life, scarce attention has been paid to sleep in this population. This study investigated the efficacy of CBT, delivered by cancer nurse specialists, in (i) decreasing clinical complaints of chronic insomnia, and (ii) improving quality of daytime functioning. This pragmatic trial involved 150 adults, who had had breast, prostate, colorectal or gynaecological cancer, randomised 2 : 1 to CBT or treatment as usual (TAU) in two centres, the Beatson Oncology Centre Glasgow, and Aberdeen Royal Infirmary. All participants met clinical and research diagnostic criteria for insomnia associated with a medical condition. Insomnia remained persistent after active anti-cancer therapy. The CBT Glasgow Model comprises: manualised treatment delivered by nurse specialists to small groups across five, weekly sessions. Primary outcomes were: (i) subjectively assessed sleep (diary), (ii) objectively estimated sleep (actigraphy) and (iii) quality of life at post-treatment and 6 month follow-up. CBT was associated with mean nightly reduction in SOL and WASO (22 and 46 min respectively) relative to little change in TAU (2 and 6) at 6 months follow-up [t(113) = 3.68, P = 0.0001; t(113) = 3.46, P = 0.001] Following CBT, improvements in health-related QoL were also obtained compared to TAU. Therapists and participants found the treatment programme both feasible and acceptable. Importantly, demographic and clinical factors did not contraindicate response to this form of insomnia treatment. The results from this trial conducted in oncology suggest that effective, practical help can be provided at relatively small cost to improve the sleep pattern and sleep quality of people treated for cancer. The potential of nurse specialists and clinical psychologists to work together in delivering this important aspect of psychological care is considerable.