No Effect of a Self-Help Book for Insomnia in Patients With Obstructive Sleep Apnea and Comorbid Chronic Insomnia - A Randomized Controlled Trial.

Sverre Lehmann,Bjørn Bjorvatn,Ståle Pallesen,Ingvild W Saxvig,Thomas Berge

doi:10.3389/fpsyg.2018.02413

Sverre Lehmann, Bjørn Bjorvatn + Show 3 more

Open Access

https://doi.org/10.3389/fpsyg.2018.02413

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Abstract

Objective: To compare the effects of a self-help book for insomnia to that of sleep hygiene advice in a randomized controlled trial with follow-up after about 3 months among patients who were diagnosed with obstructive sleep apnea (OSA) and comorbid chronic insomnia, and who were concurrently initiating treatment with continuous positive airway pressure (CPAP).Methods: In all, 164 patients were included. OSA was diagnosed and categorized based on a standard respiratory polygraphic sleep study using a type 3 portable monitor. The self-help book focused on cognitive behavioral therapy for insomnia. The main outcome measure was insomnia severity assessed with the Bergen Insomnia Scale (BIS) and the Insomnia Severity Index (ISI).Results: The scores on the BIS improved significantly from pre-treatment to follow-up in the sleep hygiene advice group (26.8 vs. 21.8) and in the self-help book group (26.3 vs. 22.4). Similarly, the ISI scores were significantly improved in both conditions (sleep hygiene: 17.0 vs. 14.1; self-help book: 16.6 vs. 13.6). No time × condition interaction effects were detected, suggesting that the self-help book did not improve insomnia symptoms more than the sleep hygiene advice.Conclusion: In this randomized controlled trial among patients with OSA and comorbid insomnia who were initiating CPAP treatment, concurrently treating their insomnia with a self-help book did not improve sleep more than sleep hygiene advice. The statistically significant improved sleep at follow-up in both groups is most likely explained by the CPAP treatment.

Highlights

Obstructive sleep apnea (OSA) is a highly prevalent sleep disorder characterized by breathing pauses, oxygen desaturation, and arousals during sleep (American Academy of Sleep Medicine, 2014)
We have previously shown that a self-help book for insomnia, with focus on CBTi, significantly improved several sleep measures compared to sleep hygiene advice in a randomized controlled trial among patients with chronic insomnia (Bjorvatn et al, 2011)
There were no significant differences between the sleep hygiene advice and self-help book groups at pre-treatment on demographic and health variables (Table 2)

Summary

Introduction

Obstructive sleep apnea (OSA) is a highly prevalent sleep disorder characterized by breathing pauses, oxygen desaturation, and arousals during sleep (American Academy of Sleep Medicine, 2014). Non-restorative sleep (poor sleep quality) was previously a diagnostic criterion for chronic insomnia, but is no longer part of the diagnostic criteria according to the fifth and latest version of the Diagnostic and Statistical Manual for Mental disorders (DSM-5) (American Psychiatric Association, 2013) and the International Classification of Sleep Disorders-3 (ICSD-3) (American Academy of Sleep Medicine, 2014). As non-restorative sleep is commonly reported by OSA patients, these revised criteria will reduce the prevalence of insomnia among OSA patients. We recently reported that the prevalence of chronic insomnia disorder among OSA patients was reduced from 74–79% (depending on OSA severity) using the DSMIV/ICSD-2 criteria to 44–55% using the DSM-5/ICSD-3 criteria (Bjorvatn et al, 2015)

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