Cognitive Behavioral Therapy for Insomnia in Breast Cancer Survivors: A Review of the Literature.

Debora Aricò,Alberto Raggi,Raffaele Ferri

doi:10.3389/fpsyg.2016.01162

Abstract

Background: Insomnia is a common sleep disorder in patients with breast cancer and studies show a higher frequency than in the general population but it appears to be understudied and the treatment seems to be a neglected problem. There is a growing body of evidence about the efficacy of cognitive behavioral therapy for insomnia (CBT-I) in breast cancer survivors (BCS). The aim of this review is to examine the best available scientific evidence related to CBT-I and insomnia in patients with breast cancer and to assess the effect of CBT-I on their psychosocial functioning, sleep, quality of life, and mood.Methods: Empirical articles published in peer-reviewed journals from the earliest reports available until August 2015 were considered. The research on PubMed generated 18 papers, three of which did not meet the inclusion criteria. Another paper was retrieved by screening the reference list of the previously selected papers.Results: A total of 16 studies were found that evaluated the effects of CBT-I in breast cancer patients. CBT-I appears to be an effective therapy for insomnia in BCS, improving mood, general and physical fatigue, and global and cognitive dimensions of quality of life. CBT-I may also reduce menopausal symptoms, such as hot flushes and night sweat problems, frequency of medicated nights, level of depression, and anxiety.Conclusions: CBT-I seems to be an eligible intervention for improving sleep in BCS. Improvements concerning insomnia and sleep quality are durable (usually up to 12 months) and statistically significant.

Highlights

Insomnia is defined by the International Classification of Sleep Disorders, third edition (American Academy of Sleep Medicine, 2014) as “a persistent difficulty with sleep initiation, duration, consolidation, or quality that occurs despite adequate opportunity and circumstances for sleep, and results in some form of daytime impairment.”
Insomnia is characterized by subjective complaints about dissatisfaction with sleep quality or duration, difficulty falling asleep at bedtime, waking up too early in the morning or in the middle of the night, or non-restorative, or poor quality sleep
Predisposing factors can be several such as gender, older age, hyperarousability as a trait, personal or family history, mood or trait anxiety, predisposition to rumination; precipitating factors consist of diagnosis of cancer, severity of disease, cancer treatment that alter the levels of inflammatory cytokines or disrupt circadian rhythms or sleep-wake-cycles, side effects of cancer treatment, menopausal symptoms including pain or fatigue, and medications used to treat side effects such as corticosteroids

Summary

Introduction

Insomnia is defined by the International Classification of Sleep Disorders, third edition (American Academy of Sleep Medicine, 2014) as “a persistent difficulty with sleep initiation, duration, consolidation, or quality that occurs despite adequate opportunity and circumstances for sleep, and results in some form of daytime impairment.”Insomnia is characterized by subjective complaints about dissatisfaction with sleep quality or duration, difficulty falling asleep at bedtime, waking up too early in the morning or in the middle of the night, or non-restorative, or poor quality sleep. Insomnia involves subjective reports of daytime symptoms such as fatigue or low energy, difficulties with cognitive functions, CBT-I in BCS for instance attention, concentration, and memory, and mood disturbances including irritability and dysphoria, all of which can produce functional impairment and are often the primary concerns pushing patients to seek treatment. Notwithstanding the wide spread of the phenomenon in this population, insomnia is largely understudied It has a high prevalence in women with breast cancer for several reasons, such as a general increase in psychological distress after the cancer diagnosis and disruption of sleep due to increased frequency and severity of hot flushes caused by menopause, often induced by the chemotherapy (Fiorentino et al, 2010). The aim of this review is to examine the best available scientific evidence related to CBT-I and insomnia in patients with breast cancer and to assess the effect of CBT-I on their psychosocial functioning, sleep, quality of life, and mood

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Conclusion