Self-Monitoring More Effective Than Cognitive Behavioral Therapy for Insomnia in Epilepsy

Although cognitive behavioral therapy for insomnia did not improve sleep or related outcomes, self-monitoring behaviors may serve as a potential mediator of therapeutic change for patients with epilepsy, according to research published in Epilepsy and Behavior.

Researchers conducted a single-blind, randomized, controlled pilot study to evaluate both the feasibility and efficacy of cognitive behavioral therapy for insomnia in patients with epilepsy. A secondary exploratory analysis was conducted to assess which sleep parameters, including sleep quality, dysfunctional beliefs about sleep, total sleep time, and time spent in bed, might predict overall quality of life following treatment.

The total study cohort included 20 participants, 11 in the active treatment group and 9 in the control group. The participants attended four 2-hour sessions of weekly group-based cognitive behavioral therapy, and all participants, regardless of group, were required to complete a consensus sleep diary. The groups were similar in terms of age at epilepsy diagnosis, number of prescribed antiepileptic drugs, and seizure frequency. All patients were prescribed antiepileptic drugs.

Outcome change scores improved significantly from baseline scores, irrespective of group. A two-way repeated analysis of variance was carried out in order to assess between-group differences for both the sleep diary and standardized measures over the pre- to post-cognitive behavioral therapy time period.

Time related effects were noted for the Quality of Life in Epilepsy Inventory, the Pittsburgh Sleep Quality Index, the Sleep Hygiene Index, and the Dysfunctional Beliefs and Attitudes About Sleep Scale. Both the treatment and control groups demonstrated improvements for each of these measures following the cognitive behavioral therapy intervention. No main effects of either time or group were noted for EES scores, and similarly, no interactions between group and time were noted for the Quality of Life in Epilepsy Inventory, the Pittsburgh Sleep Quality Index, the Sleep Hygiene Index, the Dysfunctional Beliefs and Attitudes About Sleep Scale, or the Epworth Sleepiness Scale.

The investigators found no main effects of time or group for any sleep diary variable, including sleep efficacy, total sleep time, time in bed, sleep onset latency, or wake after sleep onset. Additionally, no Group x Time interaction effects were noted across the same variables.

Data from both the control and treatment groups were merged to increase statistical power. Results of a hierarchal regression analysis indicated that 86% of the variability in overall Quality of Life in Epilepsy Inventory scores were accounted for by the Pittsburgh Sleep Quality Index, the Dysfunctional Beliefs and Attitudes About Sleep Scale, total sleep time, and time in bed. According to researchers, this indicated that worse quality of life was associated with worse sleep quality, more dysfunctional beliefs about sleep, greater time in bed, and greater total sleep time. The results also suggest that both the Pittsburgh Sleep Quality Index and time in bed “made significant independent contributions to quality of life.”

Study limitations included a diminished ability to assess the efficacy of the intervention because the study only reached a minimum level of acceptable power. Moreover, there was no requirement for the participants to have a formal insomnia diagnosis. The follow-up period was short and did not collect data on depressive symptomatology, which may further affect patient quality of life. Finally, the lack of blinding for researchers may have further limited these findings.

“The results of the present research demonstrate that [cognitive behavioral therapy for insomnia] did not improve sleep or related quality of life outcomes significantly more than a control group,” the researchers concluded. “However, the significant improvements of both groups on overall sleep quality, sleep hygiene behaviors, beliefs about sleep, and quality of life outcomes indicates that the role of self-monitoring…may be a potential mediator of therapeutic change.”

Reference

Paardekooper D, Thayer Z, Miller L, Nikpour A, Gascoigne MB. Group-based cognitive behavioral therapy program for improving poor sleep quality and quality of life in people with epilepsy: A pilot study [published online January 23, 2020]. Epilepsy Behav. doi: 10.1016/j.yebeh.2019.106884