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Efficacy of dexmedetomidine with cognitive behavioral therapy for treating chronic insomnia related to conditioned arousal: a randomized controlled trial

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Abstract

To investigate the synergistic effect of dexmedetomidine and cognitive behavioral therapy (CBT) on chronic insomnia. Forty-six chronic insomnia patients were selected and randomly assigned to the CBT group (CBT-I) or the CBT combined with dexmedetomidine (CBT-I + DEX) group. The sleep indexes and polysomnographic parameters were assessed before treatment, 4 weeks after treatment, and 8 weeks after treatment. The daily sleep conditions were recorded during the entire treatment course. Eight patients in the CBT-I group quit treatment, with a success rate of 65.2 %, and two patients in the CBT-I + DEX group quit treatment, with a success rate of 91.3 %, revealing a significant difference between the two groups (P < 0.05). At 4 and 8 weeks after treatment, the soma-arousal level was significantly decreased in the CBT-I + DEX group compared with the CBT-I group (P < 0.01), but no significant difference in the cognitive arousal. Polysomnographic monitoring results show that the sleep time at non-REM stage 3 (N3) and the total sleep time in the CBT-I + DEX group was longer than the CBT-I group after 4 weeks of treatment (P < 0.05). The number of awakenings, sleep latency, REM sleep latency and sleep efficiency were significantly improved in both groups at the end of treatment (P < 0.05), but the total sleep time was not obviously increased in both groups. Dexmedetomidine hydrochloride-induced sleep effectively reduced the patients’ arousal level, prolonged deep sleep, reduced the degree of daytime sleepiness, and improved the success rate of CBT.

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Fig. 1

Abbreviations

CBT:

Cognitive behavioral therapy

DEX:

Dexmedetomidine

DIS:

Dexmedetomidine induced sleep

SCT:

Stimulus control therapy

CR:

Cognitive restructuring

RT:

Relaxation training

SHE:

Sleep hygiene education

SD:

Sleep diary

ISI:

Insomnia Severity Index

PSAS:

Pre-Sleep Arousal Scale

HAS:

The Hyperarousal Scale

PSQI:

The Pittsburgh Sleep Quality Index

ESS:

The Epworth Sleepiness Scale

References

  1. 1.

    National Institutes of Health State of the Science Conference Statement. Manifestations and management of chronic insomnia in adults. Sleep. 2005;28:1049–57.

  2. 2.

    Espiea CA, Broomfield NM, et al. The attention-intention-effort pathway in the development of psychophysiologic insomnia: a theoretical review. Sleep Med Rev. 2006;10:215–45.

  3. 3.

    Sivertsen B, Omvik S, Pallesen S, Bjorvatn B, Havik OE, Kvale G, et al. Cognitive behavioral therapy vs zopiclone for treatment of chronic primary insomnia in older adults: a randomized controlled trial. J Am Med Assoc. 2006;295:2851–8.

  4. 4.

    Ong JC, Kuo TF, Manber R. Who is at risk for dropout from group cognitive-behavior therapy for insomnia? J Psychosom Res. 2008;64(4):419–25.

  5. 5.

    Morin CM, Bonneau SB, Ivers H, et al. Speed and trajectory of changes of insomnia symptoms during acute treatment with cognitive–behavioral therapy, singly and combined with medication. Sleep Med. 2014;15:701–7.

  6. 6.

    Mantz J, Josserand J, Hamada S. Dexmedetomidine: new insights[J]. Eur J Anaesthesiol. 2001;28:3–6.

  7. 7.

    Venn RM, Bradshaw CJ, Spencer R, et al. Preliminary UK experience of dexmedetomidine, a novel agent for postoperative sedation in the intensive care unit[J]. Anesthesia. 1999;54:1136–42.

  8. 8.

    Guo-Zhong M, Xiao-Jiang J, Zhi-Qiang X. Effect of dexmedetomidine-induced sleep balance treatment on the chronic refractory primary insomnia patients. J Basic Appl Sci. 2014;10:102–9.

  9. 9.

    Dijk DJ. Slow-wave sleep deficiency and enhancement: implications for insomnia and its management. World J Biol Psychiatry. 2010;11:22–8.

  10. 10.

    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington: American Psychiatric Publishing; 2013.

  11. 11.

    Morgenthaler T, Kramer M, Alessi C, et al. Practice parameters for the psychological and behavioral treatment of insomnia: an update. An American Academy of Sleep Medicine report. Sleep. 2006;29:1415–19.

  12. 12.

    Morin CM, Bootzin RR, Buysse DJ, et al. Psychological and behavioral treatment of insomnia: update of the recent evidence (1998–2004). Sleep. 2006;29:1398–414.

  13. 13.

    Perlis ML, Jungquist C, Smith MT, et al. Cognitive behavioral treatment of insomnia: a session-by session guide. New York: Springer; 2005.

  14. 14.

    Buysse DJ, Ancoli-Israel S, Edinger JD, Lichstein KL, Morin CM. Recommendations for a standard research assessment of insomnia. Sleep. 2006;29:1155–73.

  15. 15.

    Lichstein KL, Stone KC, Donaldson J, Nau SD, Soeffing JP, Murray D, Aguillard RN. Actigraphy validation with insomnia. Sleep. 2006;29:232–9.

  16. 16.

    Bastien C, Vallieres A, Morin C. Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med. 2001;2:297–307.

  17. 17.

    Buysse DJ, Reynolds CF III, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28:193–213.

  18. 18.

    Johns MW. A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale. Sleep. 1991;14:540–5.

  19. 19.

    Nicassio PM, Mendlowitz DR, Fussell JJ, Petras L. The phenomenology of the pre-sleep state: the development of the pre-sleep arousal scale. Behav Res Ther. 1985;23:263–71.

  20. 20.

    Pavlova M, Berg O, Gleason R, Walker F, Roberts S, Regestein Q. Self-reported hyperarousal traits among insomnia patients. J Psychosom Res. 2001;51:435–41.

  21. 21.

    Smith MT, Perlis ML, Park A, et al. Comparative meta-analysis of pharmacotherapy and behavior therapy for persistent insomnia. Am J Psychiatry. 2002;159(1):5–11.

  22. 22.

    Constantino MJ, Manber R, Ong J, et al. Patient expectations and therapeutic alliance as predictors of outcome in group cognitive-behavioral therapy for insomnia. Behav Sleep Med. 2007;5(3):210–28.

  23. 23.

    Ellis JG, Deary V, Troxel WM. The role of perceived partner alliance on the efficacy of CBT-I: preliminary findings from the partner alliance in insomnia research study (PAIRS). Behav Sleep Med. 2014:1–9 (ahead of print).

  24. 24.

    Matthews Ellyn E, Todd Arnedt J, Michaela S, et al. Adherence to cognitive behavioral therapy for insomnia: a systematic review. Sleep Med Rev. 2013;17(6):453–64.

  25. 25.

    Perlis ML, Smith MT, Orff H, Enright T, et al. The effects of modafinil and cognitive behavior therapy on sleep continuity in patients with primary insomnia. Sleep. 2004;27(4):715–25.

  26. 26.

    McChargue DE, Sankaranarayanan J, Visovsky CG, et al. Predictors of adherence to a behavioral therapy sleep intervention during breast cancer chemotherapy. Support Care Cancer. 2010;20:245–52.

  27. 27.

    Manber R, Bernert RA, Suh S, et al. CBT for insomnia in patients with high and low depressive symptom severity: adherence and clinical outcomes.[J] Clin. Sleep Med. 2011;7:645–52.

  28. 28.

    Hsu YW, Cortinez LI, Robertson KM, et al. Dexmedetomidine pharmacodynamics: part I crossover comparison of the respiratory effects of dexmedetomidine and remifentanil in heathy volunteers[J]. Anesthesiology. 2004;101:1066–76.

  29. 29.

    Shouse MN, Staba RJ, Saquib SF, Farber PR. Monoamines and sleep: microdialysis findings in pons and amygdala. Brain Res. 2000;860:181–9.

  30. 30.

    Park SP. In vivo microdialysis measures of extracellular norepinephrine in the rat amygdala during sleep–wakefulness. J Korean Med Sci. 2002;17:395–9.

  31. 31.

    Foster D, Wilson M. Reverse replay of behavioral sequences in hippocampal place cells during the awake state. Nature. 2006;440:680–3.

  32. 32.

    Belleville G, Guay C, Guay B, Morin CM. Hypnotic taper with or without self-help treatment of insomnia: a randomized clinical trial. J Consult Clin Psychol. 2007;75:325–35.

  33. 33.

    Dirksen SR, Epstein DR. Efficacy of an insomnia intervention on fatigue, mood and quality of life in breast cancer survivors. J Adv Nurs. 2008;61:664–75.

  34. 34.

    Jacobs GD, Pace-Schott EF, Stickgold R, Otto MW. Cognitive behavior therapy and pharmacotherapy for insomnia: a randomized controlled trial and direct comparison. Arch Intern Med. 2004;164:1888–96.

  35. 35.

    Rybarczyk B, Stepanski E, Fogg L, et al. A placebo-controlled test of cognitive behavioral therapy for comorbid insomnia in older adults. J Consult Clin Psychol. 2005;73:1164.

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Acknowledgments

The study was supported by the funding of new technology research about regulating center nerve hyperarousal state and correcting accumulated sleep debt (No. 12BJZ51).

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Correspondence to Xiaojiang Jiang.

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There is no conflict of interest declared.

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Li, X., Jiang, X., Liu, Y. et al. Efficacy of dexmedetomidine with cognitive behavioral therapy for treating chronic insomnia related to conditioned arousal: a randomized controlled trial. Sleep Biol. Rhythms 14, 75–85 (2016). https://doi.org/10.1007/s41105-015-0025-7

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Keywords

  • Conditioned arousal
  • Chronic insomnia
  • Cognitive behavioral therapy
  • Dexmedetomidine
  • Sleep induction