Combined cognitive-behavioral therapy for fibromyalgia: Effects on polysomnographic parameters and perceived sleep quality.

Abstract

Background/Objective: Cognitive-behavioral therapy (CBT) is one of the first-line treatments in the management of fibromyalgia (FM) and it has been applied with considerable success to treat the psychological processes associated with pain and insomnia. We hypothesized that treating sleep and pain jointly with new combined modalities of CBT may offer greater sleep-related benefits to patients. Method: Thirty-nine female patients with FM and insomnia were randomly allocated to receive CBT centered on pain (CBT-P) or combined CBT focused on pain and insomnia (CBT-C). Participants were assessed at baseline and post-treatment with the Pittsburgh Sleep Quality Index and an ambulatory polysomnography.Results: Participants who received CBT-P showed increases in time in bed and total sleep time and decreases in light sleep, but there was no improvement in perceived sleep quality. Participants who received combined CBT-C showed more meaningful improvements related to refreshing sleep (i.e., higher sleep efficiency and less time awake and longer time in Stage 4 sleep), and these changes were concordant with a significant improvement in self-perceived sleep quality. Conclusions: This study suggests that new CBT-C approaches can improve insomnia-related clinical aspects.