Cognitive behavioral therapy for insomnia in fibromyalgia

Cognitive behavioral therapy (CBT) is a type of psychotherapy used to treat insomnia. I use it in my practice almost daily. Here is an article about a study of CBT vs sleep hygiene education in patients with fibromyalgia. The results showed that sleep hygiene education did improve subjective sleep quality, but that was it. CBT improved several sleep variables, fatigue, daily functioning, pain catastrophizing, anxiety and depression.

Nightmares and beliefs about sleep are related to suicidal thoughts

This article in the Journal of Clinical Sleep Medicine discusses the relationship between nightmares, beliefs about sleep and insomnia, and suicidal thoughts. Apparently, studies have shown that insomnia symptoms are related to near lethal suicide attempts. Nightmares are also linked to suicidal thoughts and completions.

This study gave questionnaires to patients that presented with suicidal thoughts or attempts. Insomnia symptoms were common in these patients. Nightmares were also present. These symptoms remained significant even after adjusting for the effects of depression - which can increase risk of suicide and insomnia. The researchers analyzed these patients thoughts and beliefs about sleep and insomnia - such as, "if I don't sleep well, I will not be able to function at all the next day."

The findings suggest that the insomnia symptoms themselves were not the determining factor for suicidal thoughts - it was the thoughts about the consequences and causes of insomnia that was related to suicidal thoughts. Nightmares also increased the risk of being suicidal. This makes sense. Many people wouldn't mind insomnia as much if they felt it didn't impact their daytime functioning or possibly affect their health. The researchers noted a sense of hopelessness about insomnia - meaning these insomniacs did not think they ever would sleep better. And therefore, their daytime functioning and how they felt in the daytime would never improve. It reminds me of patients that deal with chronic, unrelenting pain - they can become hopeless about ever living a life without pain.

Unlike chronic pain, however, insomnia can get better with behavioral therapy. Recognizing this is important for physicians and mental health workers, so that they can refer their at risk patients with insomnia for appropriate treatment.

Sleeping pills do not always work for insomnia

This article discusses a survey done in the UK showing that 4 out of 10 people said sleeping pills do not help their insomnia.

Insomnia may be genetic

This article discusses how sleep research is beginning to demonstrate a genetic component to some insomnia. This really isn't brand new, as we always knew that only some people are prone to insomnia. However, it may one day help in treating this disorder. And it give some hope to insomnia suffers by quoting Dr. Espie, an insomnia expert across the pond. He mentions that psychological treatment for insomnia, even "genetic" insomnia is effective - I agree. If you're struggling with insomnia, find a sleep clinic that does cognitive behavioral therapy for insomnia.