The Sleep Study
We’re customizing a cognitive behavioural therapy for insomnia (CBTi) program for people with arthritis who are struggling with sleep.
Up to 70% of people living with arthritis report sleep issues, including difficulty falling asleep, staying asleep, and/or waking up early in the morning. These sleep problems, also known as insomnia, can worsen arthritis symptoms like fatigue, pain, and depression and impact overall quality of life.
For most people living with arthritis, insomnia goes unidentified and untreated. When it is treated, hypnotics are typically prescribed to induce sleep. This medication is not intended for daily, prolonged use and can lead to side effects and tolerance, which means it can stop working.
CBTi for Arthritis
Cognitive behavioural therapy for insomnia involves learning new strategies and behaviours to promote sleep and has worked for people living with other diseases like cancer. We’re creating and testing the first CBTi program to help people with arthritis sleep.
About CBTi for Arthritis
When people lay awake in bed, they start to have ruminating thoughts that negatively impact their ability to fall asleep. They worry that they’re not going to fall asleep, won’t be able to function, and will struggle at work the next day. These types of thoughts don’t help to induce sleep. CBTi involves assisting people in improving their self-talk by replacing automatic, negative thoughts with positive, realistic thoughts.
People living with chronic insomnia often develop coping behaviours that worsen sleep. For example, they will take naps for too long or too late in the day. A long nap at 4pm will impact a person’s night sleep. Or they will lay awake in bed for hours rather than getting up and doing something else or look at their phones in bed. CBTi helps people identify behaviours that negatively affect sleep and replace them with positives ones.
No study has ever looked at whether CBTi works for people living with arthritis who are struggling with insomnia. This research and program fills an important gap in arthritis care. It will provide new knowledge on the benefits of a non-drug method for managing insomnia in people who have different types of arthritis. If found helpful, the program will be available online, improving access to insomnia treatment.
“This is the first program, to our knowledge, that is not only specifically tailored to patients with arthritis for sleep, but will be delivered over the internet. Patients will be able to access it 24/7 from their homes rather than waiting to see a professional who is trained in CBTi.”
Research for Better Sleep
Insomnia is something that is difficult to cope with and has a negative impact on a person’s ability to function, concentrate and focus. When a person has arthritis, lack of sleep can also exacerbate symptoms such as pain, increased fatigue, depressed mood and difficulty tolerating stressors.
While it has become increasingly recognized that insomnia is something physicians should be screening for and treating in the context of arthritis care, it tends to go unrecognized and untreated. Cognitive behavioural therapy for insomnia is the first line of treatment for chronic sleep problems. However, it is not widely available in Canada and waitlists are long.
Our research is seeking to develop a better solution to deliver CBTi specifically to people with arthritis and involves two phases.
Phase 1: A Canada-wide survey with a large sample of people living with arthritis will identify sleep needs and treatment preferences. The goal is to better customize the online CBTi program for arthritis using the results of this survey.
Phase 2: Revise and test the customized arthritis CBTi program with patient partners to see initial evidence of its potential to improve sleep and other commonly experienced symptoms, including 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. We also expect that they will maintain these improvements at the three-month follow-up.
Dr. Deborah Da Costa, PhD
Research Scientist, Arthritis Research Canada
Dr. Deborah Da Costa is a scientist at the Research Institute, McGill University Health Centre and an associate professor in the Department of Medicine, Faculty of Medicine at McGill University.
Her research focuses on the interplay between modifiable psychosocial and behavioural (e.g. exercise) factors and health status in various chronic illnesses and in relation to depression in populations at risk. This has laid the foundation for the knowledge-transfer phase of her program which focuses on tailoring and evaluating evidence-based e-health interventions to empower individuals with the knowledge and skills needed to optimize their health and wellness.
Dr. Da Costa’s research activities focus on: 1) maternal and paternal mental health during the transition to parenthood – identifying predictors and developing e-health psychoeducational interventions; 2) delineating the role of behavioural and psychosocial variables on health outcomes and quality of life in patients with chronic conditions; and 3) developing and testing gender-tailored tools to help individuals initiate and sustain healthy lifestyle behaviours over the lifespan.