Cognitive-Behavioral Therapy for Insomnia Co-Morbid with Hearing Impairment: A Randomized Controlled Trial

  • Markus Jansson-FröjmarkEmail author
  • Steven J. Linton
  • Ida K. Flink
  • Sarah Granberg
  • Berth Danermark
  • Annika Norell-Clarke


The purpose of the current study was to examine the effects of cognitive behavior therapy (CBT-I) for insomnia on patients with insomnia co-morbid with hearing impairment. A randomized controlled design was used with a 3-month follow-up. Thirty-two patients with insomnia co-morbid with hearing impairment were randomized to either CBT-I or a waitlist condition (WLC). The primary outcome was insomnia severity. Secondary outcomes were sleep diary parameters, dysfunction, anxiety, and depression. Compared to WLC, CBT-I resulted in lower insomnia severity at post-treatment and at follow-up (d = 1.18–1.56). Relative to WLC, CBT-I also led, at both assessment points, to reduced total wake time (d = 1.39) and increased sleep restoration (d = 1.03–1.07) and sleep quality (d = 0.91–1.16). Both groups increased their total sleep time, but no significant group difference emerged. Compared to WLC, CBT-I resulted in higher function (d = 0.81–0.96) and lower anxiety (d = 1.29–1.30) at both assessment points. Neither CBT-I nor WLC led to improvement on depression. Based on the Insomnia Severity Index, more CBT-I (53–77%) than WLC participants (0–7%) were treatment responders. Also, more CBT-I (24%) than WLC participants (0%) remitted. In patients with insomnia co-morbid with hearing impairment, CBT-I was effective in decreasing insomnia severity, subjective sleep parameters, dysfunction, and anxiety. These findings are in line with previous results on the effects of CBT-I in other medical conditions.


Insomnia Hearing impairment Tinnitus Cognitive behavior therapy Co-morbidity 



We would like to express our appreciation to Sparbankstiftelsen Nya for funding and to the two audiology clinics in Örebro and Karlstad for recruitment.


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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Markus Jansson-Fröjmark
    • 1
    Email author
  • Steven J. Linton
    • 1
  • Ida K. Flink
    • 1
  • Sarah Granberg
    • 2
    • 3
  • Berth Danermark
    • 2
    • 3
  • Annika Norell-Clarke
    • 1
  1. 1.School of Law, Psychology, and Social WorkÖrebro UniversityÖrebroSweden
  2. 2.The Swedish Institute for Disability ResearchÖrebro UniversityÖrebroSweden
  3. 3.Audiological Research CentreÖrebro University HospitalÖrebroSweden

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