Therapy curbs insomnia in dialysis patients

By Megan Rauscher

NEW YORK (Reuters Health) - A type of psychotherapy called cognitive-behavior therapy, or CBT, seems to reduce insomnia and fatigue and improve the overall quality of sleep in patients undergoing dialysis treatment, a study shows. CBT can be an effective non-drug therapy for dialysis patients with sleep problems, the investigators say.

Dialysis is a procedure that people with failing kidneys must undergo in order to remove toxins from the bloodstream. More than half of people with advanced kidney disease receiving dialysis treatment suffer from insomnia and other sleep disturbances.

Sleep disturbance in dialysis patients is a "puzzling and prevalent complaint," study chief Dr. Hung-Yuan Chen from National Taiwan University Hospital, Taipei, told Reuters Health. "However, only hypnotics are available for clinicians to solve this problem at present."

Given that CBT has been proven effective for chronic insomnia in the elderly and in patients with cancer or chronic pain, Chen's team investigated the effect of CBT on sleep disturbance in patients with insomnia who were on dialysis for longer than 90 days.

All 24 study patients received "sleep hygiene" education before the 4-week study, and 13 of them were randomized to an intervention group that also received four 1-hour-weekly psychiatrist-led CBT treatment sessions. Participants who were on low-dose hypnotics long-term before entering the study were maintained at the same dose during the study.

After 4 weeks, there was an "impressive" trend toward improvement in sleep based on standard tests, although the results were not statistically significant, the team reports in the American Journal of Kidney Diseases.

Nearly 80 percent of patients in the CBT group experienced favorable changes in their sleep habits. Fatigue was also less of a problem for the CBT patients.

The CBT group but not the control group also saw declines in levels of a blood protein linked to inflammation called interleukin-1-beta.

The current study, Chen and colleagues say, provides "novel evidence" that treating dialysis patients with insomnia with CBT, in addition to an extreme low dose of hypnotics, "may not only improve sleep quality and daytime fatigue, but also alter levels of circulating biomarkers of inflammation in this population."

SOURCE: American Journal of Kidney Diseases, August 2008.