Dr Sheila Garland: CBT for Insomnia Improves Functioning in Patients With Cancer

Targeting insomnia with cognitive behavior therapy is almost like a frontline therapy, because by doing so, you’re able to improve a whole host of other symptoms that would coexist with insomnia, explained Sheila Garland, PhD, MSc, associate professor of psychology and oncology at Memorial University in Newfoundland, Canada.

At SLEEP 2023, Garland presented research on, “Effect of Virtual Cognitive Behavioral Therapy for Insomnia on Perceived Cognitive Functioning Among Cancer Survivors.”

Transcript

Can you discuss the principal findings of your investigation into insomnia in cancer survivors?

We investigated whether or not we could use an intervention for sleep, which was cognitive behavior therapy for insomnia, to improve perceived cognitive impairment in cancer survivors. Cognitive behavior therapy for insomnia, also called CBTI, I see as almost a frontline intervention to target insomnia. But by doing so, you're also able to improve a whole host of other symptoms that would coexist with insomnia.

This has been demonstrated for fatigue, it's been demonstrated for mood, but this is the first time that it's actually been demonstrated that if we target sleep—so we're not intervening on cognition directly, but just by getting these individuals sleeping better—we can improve to a clinically meaningful degree their perception of cognitive impairments and also their ability to function effectively during the day. We presented research showing that it improved presenteeism and absenteeism at work, so we're getting these people back to functioning in a way that is similar to they way were functioning prior to their cancer diagnosis.

Does virtual CBT offer superior benefits vs in-person sleep treatment, and how can concerns among hesitant patients regarding this care model be addressed?

One of the big challenges with an effective treatment like CBTI is the fact that it's not always accessible to everyone. So even though there might be a preference for in-person treatment, if the in-person treatment isn't available, perhaps there's the second-best thing, which would be a virtual-based treatment. When you're talking with people, that might be enough to convince them, well, it's either virtual treatment or it's nothing. But I think a lot of people, once they see that you can still have a real personal connection with the provider virtually, maybe the first session is a little awkward?

In our case specifically, we were dealing with people who were older, they were living in rural areas, and they didn't have a whole lot of comfort and familiarity with virtual care. But fortunately, I think COVID-19 made people more willing to try these things, and I think that it's only going to increase in comfort in using these virtual-based approaches. And they are very, very important because we know access is a huge issue. So whatever we can do, whether it be virtual care or mobile interventions, we really need to be exploring that because there's no reason that people need to suffer with insomnia and the consequences when we have a treatment that works so well.