Cognitive Behavioral Therapy for Insomnia to Address Insomnia Symptoms in Individuals with Multiple Sclerosis

Background: At least 40% of individuals with multiple sclerosis (MS) experience chronic insomnia defined as difficulty falling asleep, maintaining sleep, or waking up too early at least 3 nights/week for the past 3 months. Poor sleep quality has been associated with a reduction in physical function, psychological well-being, interpersonal relationships, and the ability to perform activities of daily living and occupational function, and an increase in perceived fatigue in individuals with MS. Cognitive behavioral therapy for insomnia (CBT-I) has been shown to be more effective long-term for treating insomnia compared to pharmacological interventions, but the use of CBT-I to treat insomnia in people with MS is less understood.

Objectives: The objective of this randomized controlled trial (RCT) is to assess the efficacy of using CBT-I to improve insomnia symptoms and fatigue in individuals with MS with symptoms of insomnia.

Methods: This is an ongoing RCT. To date, 13 individuals (11 female, 2 male; 11 relapsing-remitting; 2 secondary-progressive) have enrolled, and 7 have completed the study. Five individuals participated in a 6-week program of CBT-I, and 2 participated in a control condition. Participants completed a battery of surveys to assess insomnia severity (Insomnia Severity Index (ISI)), sleep quality (Pittsburgh Sleep Quality Index (PSQI)), fatigue (Modified Fatigue Impact Scale and (MFIS) Fatigue Severity Scale (FSS)). Due to the small sample size at this stage, change scores for each group are reported

Results: The CBT-I group showed a decrease in insomnia symptoms from 18.8 to 4.2 on the ISI (77.7% improvement) and the control group showed a decrease from 16 to 10 (37.5% improvement). The CBT-I group showed an improvement in sleep quality from 14.2 to 5.2 on the PSQI (63.3% improvement) and the control group showed an improvement from 9.5 to 6.5 (31.6% improvement). The CBT-I group showed an improvement in fatigue from 40 to 11.2 on the MFIS (70% improvement) and from 38.4 to 19 on the FSS (50.1% improvement), and the control group showed an improvement from 43 to 27 (37.2% improvement) on the MFIS but a worsening on the FSS from 32 to 38.5 (20.3% increase).

Conclusions: This study suggests the CBT-I may be an efficacious non-pharmacological treatment to improve insomnia symptoms, sleep quality, and fatigue in people with MS whereas the control condition appears to have less improvement. This RCT continues to enroll participants.