Brief Behavioral Therapy for Insomnia in Patients with Irritable Bowel Syndrome: A Pilot Study
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ORIGINAL ARTICLE
Brief Behavioral Therapy for Insomnia in Patients with Irritable Bowel Syndrome: A Pilot Study Sarah Ballou1 · Jesse Katon1 · Vikram Rangan1 · Vivian Cheng1 · Judy Nee1 · Johanna Iturrino1 · Anthony Lembo1 Received: 14 November 2019 / Accepted: 27 February 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Up to 60% of patients with irritable bowel syndrome (IBS) report fatigue and 50% meet criteria for clinical insomnia. Recent studies have demonstrated a relationship between poor sleep and next-day IBS symptoms. However, no study to-date has evaluated behavioral therapy to treat poor sleep in IBS. Aims The aim of the current pilot study is to test feasibility of behavioral therapy for insomnia among patients with IBS and poor sleep. Methods This randomized controlled pilot study tested the feasibility of administering brief behavioral therapy for insomnia (BBT-I) to patients with IBS who report poor sleep. Participants were randomized to BBT-I or self-monitoring control. Exploratory analyses evaluated group differences after 4 weeks of treatment. Results A total of 25 participants were randomized to the study, 13 to BBT-I and 12 to the control group. Three participants dropped out of the treatment group. Satisfaction with treatment was high. At follow-up, there were significant differences between groups in measures of sleep quality and insomnia severity. There were trends toward significance in IBS severity score, with 40% of the BBT-I sample reporting clinically meaningful drop in symptoms compared to 17% of the control group. Similar trends were observed with belly pain and global improvement scores. Conclusions This pilot study demonstrates feasibility/acceptability of a brief behavioral therapy for patients with IBS and poor sleep. Additionally, this study provides preliminary evidence to suggest that treatment of sleep difficulties in patients with IBS may improve IBS symptom outcomes. Future, larger randomized controlled studies are needed. Keywords Irritable bowel syndrome · Sleep · Insomnia · Behavioral therapy
Introduction Irritable bowel syndrome (IBS) is a chronic gastrointestinal disorder that is often associated with extra-intestinal comorbidities [1]. Mental health and chronic pain comorbidities have received the most attention in IBS research, but comorbid sleep issues are also prevalent and are associated with high levels of distress [2]. Approximately 30–60% of patients with irritable bowel syndrome (IBS) report fatigue, fragmented sleep, and/or poor sleep quality [3–6]. One recent survey reported that IBS patients in a tertiary care setting had higher rates of insomnia, poor sleep, and use of * Sarah Ballou [email protected] 1
Division of Gastroenterology, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
sleep medications when compared to patients with inflammatory bowel disease, GERD, and celiac disease [7]. In that survey, 51% of patients with IBS met criteria
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