Tai Chi an Effective Treatment for Insomnia in Breast Cancer Survivors

A new study suggests that tai chi may be as effective as traditional therapies at reducing insomnia in breast cancer survivors.

Survivors of breast cancer are nearly twice as likely as the general population to experience insomnia, with symptoms like difficulty falling asleep, frequent waking, or inability to fall back asleep, which can result in impaired functioning during the day. The “gold standard” treatment for the disorder is cognitive behavioral therapy for insomnia (CBT-I), which incorporates cognitive therapy, sleep hygiene, relaxation techniques, and other methods to improve sleep more effectively than pharmaceutical therapies.

Tai Chi Chih (TCC) is a form of the meditation exercise tai chi that has been successfully used to reduce insomnia in older adults, as well as depression and fatigue. However, no research existed on whether it would be effective for survivors of breast cancer, who commonly tend to experience these symptoms. Researchers from the University of California, Los Angeles, set out to fill this gap in the literature by conducting a noninferiority trial of TCC compared with CBT-I, and published their findings in the Journal of Clinical Oncology.

Ninety breast cancer survivors experiencing insomnia were randomly assigned to receive either CBT-I sessions or TCC classes for 3 months. The primary outcome was a decrease of at least 5 points on the Pittsburgh Sleep Quality Index (PSQI), indicating clinically meaningful improvement in insomnia symptoms. Secondary outcomes included sleep quality, fatigue symptoms, sleepiness, and symptoms of depression.

After the 3-month treatment period, participants were contacted for follow-up at months 6 and 15. At the 15-month endpoint, 43.6% of those receiving CBT-I and 46.7% of those receiving TCC showed meaningful response to treatment. The differences between the 2 groups in treatment response at 3, 6, and 15 months were not significant, meaning that the findings supported the noninferiority of TCC in the primary outcome.

Furthermore, patients undergoing CBT-I and TCC experienced similar rates of insomnia remission. Both study groups saw a significant improvement in PSQI scores and reported improvements in total sleep time, sleep onset latency, sleep efficiency, and wake after sleep onset. CBT-I and TCC resulted in similar improvements in fatigue, sleepiness, and depression measures. The only patient characteristic that affected the impact of treatment was race, as the sleep quality of nonwhite participants improved more with CBT-I than TCC.

“Both interventions yielded robust rates of insomnia treatment response, as indicated by marked clinical improvement, or complete or nearly complete remission of insomnia symptoms,” the study summarized. It noted that the findings demonstrated that TCC was noninferior to CBT-I and had durable effects over a year of follow-up, as opposed to mindfulness-based stress reduction, which was only noninferior to CBT-I for 5 months of follow-up.

The researchers suggested that TCC’s success could be attributed to its ability to reduce sympathetic arousal and inflammation, although the exact mechanisms by which it improves insomnia are not known. They wrote that their findings demonstrated the feasibility and effectiveness of TCC as an alternative to CBT-I in breast cancer survivors with insomnia.

“Given that standardized TCC is both scalable and community accessible compared with the limited availability of CBT in most medical centers, immediate access to TCC would address the need to reduce the morbidity associated with insomnia in survivors of breast and other cancers with treatment benefits commensurate with the status quo of clinical treatment approaches to insomnia,” the study concluded.