Sleep Struggles: A New Approach to Treating Insomnia

After two years of pandemic stress, it’s no surprise that people around the globe are struggling to get the rest they need. For many with arthritis, sleep has always been a big problem and the pandemic is only making things worse. In fact, up to 70 per cent of Canadians living with arthritis report sleep issues, including difficulty falling asleep, staying asleep, or waking early in the morning. These sleep disturbances, also known as insomnia, can aggravate other arthritis symptoms – like fatigue, pain, and depression. For this reason, scientists at Arthritis Research Canada are looking to cognitive behavioural therapy for insomnia (CBTi) for answers.

What is cognitive behavioural therapy for insomnia?

CBTi is an evidence-based approach to manage symptoms of insomnia. It involves exploring the connection between how we think, what we do, and how we sleep. During treatment, a trained CBTi provider helps to identify thoughts, feelings, and behaviors that are contributing insomnia symptoms. A focus is on identifying unhelpful thoughts and behaviours that contribute to poor sleep and replacing them with ones that are more conducive to restful sleep.

While this approach has been shown to improve sleep in the general population and in individuals with chronic conditions such as cancer, no study to date has looked at using it to treat insomnia in arthritis patients.

“Insomnia goes unidentified and untreated for most people with arthritis,” said Dr. Deborah Da Costa, a scientist at Arthritis Research Canada and lead researcher behind this important sleep study. “Our work will provide new knowledge on the benefits of a non-drug method for managing insomnia in people living with arthritis.”

If found helpful, online cognitive behavioural therapy for insomnia will also help improve access to life-changing treatment.

Sleep and Pain: It’s a Two-Way Street

While many people with arthritis find chronic pain keeps them up at night, the relationship between pain and sleep works both ways. “We know that lifestyle factors, like amount of sleep and exercise, play a role in managing pain and inflammation,” Da Costa said. “Less sleep can impact how the brain processes pain and worsen inflammation.” Even more concerning, uncontrolled Inflammation in the body can result in serious, life-threatening complications like heart attacks, strokes, and diabetes. It can even shorten a person’s life.

Real World Research

“Sleep is important,” Da Costa said. “This research is about changing a person’s quality of life.” Her study includes two phases. Phase one is a Canada-wide survey of people living with different types of arthritis. The goal? To identify sleep needs and treatment preferences to better customize an online cognitive behavioural therapy for insomnia program. The second phase will revise and test a customized program with patients to see initial evidence of its potential to improve sleep and other symptoms like fatigue, pain, depression and anxiety. “We expect that patients assigned to the therapy will report improvements in insomnia and other related symptoms following completion of the program,” Da costa said. “We also expect that they will maintain these improvements at the three-month follow-up.”