Epstein, D. R., & Dirksen, S. R. (2007). Randomized trial of a cognitive-behavioral intervention for insomnia in breast cancer survivors. Oncology Nursing Forum, 34, E51–E59.

To determine the efficacy of a cognitive-behavioral intervention for treating insomnia in survivors of breast cancer.

Participants were assigned to either a multicomponent intervention with stimulus control, sleep restriction, and sleep education and hygiene or a control intervention with sleep education and hygiene. Participants attended four weekly treatment group sessions (the first session was two hours and the other three were one hour) followed by two weekly 15- to 30-minute individual telephone sessions. Outcomes measures were sleep-onset latency, wake-after-sleep onset, total sleep time, time in bed, sleep efficiency, and sleep quality.

• The study was comprised of 34 participants in the multicomponent intervention and 38 in the control group.
• Participants were women older than 18 years with a diagnosis of stage I, II, or III breast cancer and with insomnia of at least three months' duration.

The study was conducted in university and medical center classrooms.

Patients were undergoing the follow-up phase of care.

This was a randomized, controlled trial.

• Daily sleep diary
• Actiwatch®

After the intervention, based on daily sleep diaries, both groups improved in sleep-onset latency, wake-after-sleep onset, total sleep time, time in bed, sleep efficiency, and sleep quality. A between-group difference existed for time in bed. Wrist actigraph data showed significant pre- to postintervention changes for sleep-onset latency, wake-after-sleep onset, total sleep time, and time in bed. When compared to the control group, the multicomponent intervention group rated overall sleep as more improved.
 

A nonpharmacologic intervention is effective in the treatment of insomnia in survivors of breast cancer.

• The study used a selective sample:  the women were primarily white, well educated, and, on average, were diagnosed with cancer six years previously.
• Recruitment was via an advertisement and support groups; therefore, participants were more motivated to receive treatment.
• Space was required for group meetings.
• Actigraphs incurred a cost.
• The study required a Master’s level clinical nurse specialist in psychiatric-mental health nursing trained in the delivery of the intervention.