Can CBT-I Help Your Insomnia? A Guide To Effectiveness Across Different Conditions & Life Stages
Quick Summary
Cognitive Behavioral Therapy for Insomnia (CBT-I) is highly effective not just for primary insomnia, but also when sleep problems occur alongside other medical or psychiatric conditions.
CBT-I can be successfully adapted to treat sleep problems in individuals dealing with sleep apnea, chronic pain, cancer, and mental health disorders like depression.
The core components of CBT-I are frequently modified by experienced behavioural sleep medicine clinicians to maintain safety and effectiveness for different age groups, from adolescents to older adults.
Working with a board certified specialist, such as a Diplomate in Behavioral Sleep Medicine (DBSM), provides the personalized modifications necessary to safely treat complex insomnia with co-occurring conditions.
What is CBT-I and How Effective Is It For Chronic Insomnia Without Other Conditions?
What is CBT-I?
Cognitive Behavioral Therapy for Insomnia (CBT-I) is a structured, evidence-based program that treats chronic sleep problems by changing the behaviours and beliefs, and emotions that keep you awake. Instead of relying on medication, this therapy targets the underlying imbalances in the physical sleep/wake system and skills to manage difficult nights, to prevent vicious cycles of sleeplessness and provide long-term relief.
Standard CBT-I is typically delivered over six to eight sessions across two to three months and relies on a few core components that retrain your brain and body to sleep soundly.
How Effective Is CBT-I For Chronic Insomnia Without Other Conditions?
CBT-I is highly effective for treating chronic primary insomnia, producing results that equal or beat prescription sleep medications.
Because of its high success rate and low risk of side effects, both the American College of Physicians and the American Academy of Sleep Medicine recommends it as the absolute first-line treatment for the disorder (Qaseem et al., 2016).
Research shows that 70% to 80% of patients experience a significant therapeutic response during treatment, typically cutting their sleep latency, the amount of time it takes to fall asleep, and the time spent awake during the night by about half (Morin et al., 1999).
While the therapy works just as well as sedative-hypnotics (sleeping pills) in the short term, CBT-I actually outperforms medication in the long run (Smith et al., 2002). Because the program teaches you lasting behavioural skills rather than relying on a pill, clinical gains are remarkably stable, with studies showing patients maintain their improved sleep for months or even years after finishing their sessions (Castronovo et al., 2018).
Okay, so that’s primary insomnia. But in the real world, people have all kinds of other conditions.
So how effective is CBT-I when someone has another condition? The short answer is it’s always quite effective. But let’s take a closer look.
Can CBT-I Help if You Have Other Sleep Disorders?
How is CBT-I Adapted for Sleep Apnea?
CBT-I is highly effective for insomnia that occurs with obstructive sleep apnea (OSA), helping patients tolerate their breathing devices better and sleep more soundly.
It is very common for people to suffer from comorbid insomnia and sleep apnea (COMISA), a condition where you experience both chronic sleeplessness (especially falling asleep) and interrupted breathing during the night. In fact, up to 38% of patients with obstructive sleep apnea also meet the criteria for insomnia (Zhang et al., 2019).
When a person has both conditions, it can be incredibly difficult to tolerate continuous positive airway pressure (CPAP), the primary medical treatment for sleep apnea, because the mask and air pressure give a person more things to focus on or struggle with while lying awake.
Studies show that completing a modified CBT-I program before starting CPAP therapy significantly reduces insomnia symptoms and actually increases how many hours a night patients use their CPAP machines (Ong et al., 2020; Sweetman et al., 2019).
Furthermore, research confirms that CBT-I improves sleep outcomes for patients with sleep apnea regardless of the severity of their breathing issues (Fung et al., 2016; Sweetman, Lack, Lambert, Gradisar, & Harris, 2017).
While sleep apnea involves breathing, what if your sleep struggles are tied to your internal body clock?
Can CBT-I Help Fix Circadian Rhythm Disorders?
Yes, CBT-I can help fix circadian rhythm disorders by incorporating it alongside chronotherapy to physically shift your internal body clock.
For individuals with delayed sleep-wake phase disorder, a condition where your internal body clock is shifted much later than societal norms, standard CBT-I is adapted to include the specific timed interventions of chronotherapy. Chronotherapy involves strategically timing your exposure to bright light in the morning and timing the intake of melatonin, a hormone that regulates sleep-wake cycles, in the evening to physically pull your internal clock backward.
Clinical trials demonstrate that combining cognitive behavioral techniques with chronotherapy successfully advances sleep times and reduces the time it takes to fall asleep (Danielsson, Jansson-Fröjmark, Broman, & Markström, 2016; Gradisar et al., 2011).
But what if your schedule is dictated by your job rather than your biology?
Does CBT-I Work for Shift Work Disorder?
CBT-I works for shift work disorder by making adaptations to ensure safe fatigue management, as well as enhanced sleep quality and quantity.
When working with shift work disorder, a condition caused by working during normal sleeping hours, standard CBT-I rules are heavily modified. Because shift workers are often already severely sleep-deprived, CBT-I is adapted to ensure treatment manages potentially dangerous levels of daytime sleepiness.
Treatment is very individualised to the shift-worker’s specific shift schedule, and sleeping conditions. Research indicates that when these specific adaptations are made, CBT-I can effectively treat chronic insomnia in shift workers (Järnefelt et al., 2012).
Beyond other sleep disorders, is CBT-I effective for people managing mental health conditions?
Is CBT-I Effective for People with Mental Health Conditions?
How Does CBT-I Help with Depression?
Treating insomnia directly with CBT-I significantly improves sleep in depressed patients and can actually double the response rate to antidepressant medications (Manber et al., 2008).
It is probably no surprise that depression and insomnia are linked, but research shows that insomnia often precedes a depressive episode and makes it harder to recover. A large meta-analysis of 17 randomized trials confirmed that CBT-I produces large, significant reductions in insomnia severity for patients with major depressive disorder (Feng, Han, Li, Geng, & Miao, 2020).
Furthermore, the largest study to date on this topic found that adding CBT-I to antidepressant therapy resulted in a 54% insomnia remission rate, compared to just 29% for those who only received standard care (Manber et al., 2016).
But that’s standard depression, does CBT-I work with bipolar disorder?
Is CBT-I Safe for Bipolar Disorder?
Some adjustments to sleep schedules that are made in CBT-I are thought to be risky in bipolar disorder because sleep disruption is a known trigger for manic episodes (Wehr, Sack, & Rosenthal, 1987).
However, when safety modifications are applied, a specialized protocol known as CBT-I-BP has been shown to successfully reduce insomnia severity while also significantly lowering the rate of hypomania and mania relapses (Harvey et al., 2015).
If CBT-I can be modified for a complex condition like bipolar, can it also work for more severe psychiatric conditions?
Can CBT-I Treat Insomnia in Schizophrenia?
Yes, CBT-I can effectively treat insomnia in schizophrenia, often by incorporating specific techniques to address severe nightmares. Patients with schizophrenia or other psychotic disorders suffer from profound sleep disturbances, including unstable sleep-wake rhythms and frequent awakenings.
Clinical trials show that CBT-I substantially improves insomnia in patients with persistent delusions and hallucinations (Freeman et al., 2015; Hwang, Nam, & Lee, 2019). Because these patients often suffer from severe nightmares that make them afraid to go to sleep, therapists may incorporate imagery rehearsal therapy, a behavioral treatment for treating recurring nightmares.
What about sleep problems triggered by withdrawal from drugs or alcohol - substance use disorders?
Does CBT-I Help During Substance Use Recovery?
CBT-I helps individuals recovering from alcohol or cannabis use disorders by providing behavioral tools to replace the habit of using substances to fall asleep. While alcohol and cannabis might initially reduce the time it takes to fall asleep, they severely disrupt the natural structure of your sleep (the normal cycling between light, deep, and REM sleep) in the second half of the night.
When patients stop using these substances, they often experience a temporary spike in sleeplessness due to withdrawal. Multiple randomized controlled trials have demonstrated that CBT-I effectively improves both insomnia and daytime functioning in adults recovering from alcohol dependence (Arnedt, Conroy, Armitage, & Brower, 2011; Chakravorty et al., 2019; Currie, Clark, Hodgins, & El-Guebaly, 2004).
Mental health is clearly linked to sleep, but what about physical health conditions?
Does CBT-I work when you have chronic physical medical issues?
Does CBT-I Work When You Have Chronic Medical Issues?
How Effective Is CBT-I for Chronic Pain?
CBT-I improves sleep for chronic pain patients by adjusting standard rules to accommodate physical limitations and mobility issues.
Chronic pain and sleep are a two-way street; poor sleep actually lowers your pain threshold, making you feel pain more intensely the next day (Smith et al., 2007). This happens because sleep loss impairs conditioned pain modulation, the body's natural ability to block or reduce pain signals.
While extensive research shows that unmodified CBT-I produces large, long-term improvements in insomnia for chronic pain patients (Currie, Wilson, Pontefract, & DeLaplante, 2000; Edinger, Wohlgemuth, Krystal, & Rice, 2005), standard rules must often be adjusted for safety.
If a patient has mobility issues or is a fall risk, clinicians need to adjust elements of treatment in ways that maintain treatment effectiveness while overcoming risks (Davies, Lacks, Storandt, & Bertelson, 1986).
When applied correctly, CBT-I not only fixes sleep but can also lead to clinically significant reductions in pain severity (Tang et al., 2015).
Beyond chronic pain, can CBT-I also support patients battling or recovering from life-threatening illnesses?
Can CBT-I Improve Sleep for Cancer Survivors?
CBT-I is highly successful at treating insomnia in cancer survivors and significantly reduces cancer-related fatigue and depression. Cancer survivors experience insomnia at rates two to six times higher than the general population (Savard et al., 2011). This is driven by the emotional distress of the diagnosis, the physical pain of the disease, and the side effects of treatments like chemotherapy and corticosteroids.
A meta-analysis of eight studies involving over 750 cancer survivors confirmed that CBT-I produces clinically significant and durable improvements in sleep efficiency and insomnia severity (Johnson et al., 2016). Further randomized trials show that CBT-I in this population also reduces depression (Peoples et al., 2019), decreases cancer-related fatigue (Heckler et al., 2016), and improves overall quality of life (Peoples et al., 2017).
In cancer patients, specific adaptions are made to allow the body to heal while improving sleep. Cognitive therapy is heavily utilized to address specific fears, such as the common but unhelpful belief that a lack of sleep will cause the cancer to return.
Does CBT-I Work After a Traumatic Brain Injury?
CBT-I works well for patients recovering from a traumatic brain injury (TBI) when therapists adapt the program to include cognitive support. Insomnia is one of the most common and debilitating post-concussive symptoms (lingering health issues after a head injury) following a TBI.
Case reports and pilot trials indicate that CBT-I and its core elements show great promise for treating sleep disturbances in patients with mild to severe TBI (Nguyen et al., 2017; Ouellet & Morin, 2007). Because TBI often causes memory, processing, and attention deficits, standard CBT-I delivery can be overwhelming. Treatment can be adapted by providing simplifications, repetitions where needed, and workarounds where paperwork is too difficult for the patient.
Medical conditions can happen at any age, but what about age itself? How effective is CBT-I at different stages of life?
How Effective Is CBT-I At Different Stages of Life?
How Effective Is CBT-I for Adolescents?
CBT-I is highly effective for treating insomnia in adolescents, producing significant improvements in sleep whether delivered in person, in groups, or online. Clinical trials show that the therapy successfully reduces insomnia symptoms and improves overall sleep efficiency for teenagers, with medium to large effect sizes (de Bruin et al., 2015a).
Because teens often juggle busy schedules and prefer digital communication, internet-delivered CBT-I has proven to be an especially accessible, cost-effective, and successful option.
Beyond just fixing sleep, CBT-I offers huge secondary benefits for the developing brain. Research demonstrates that treating a teen's insomnia with CBT-I leads to noticeable improvements in executive functioning, the mental skills needed for paying attention and managing working memory (de Bruin et al., 2015b).
Furthermore, successfully completing the program reduces symptoms of other common adolescent struggles, including anxiety, depression, and even attention-deficit/hyperactivity disorder (ADHD) (de Bruin et al., 2018).
As we move into adulthood, how does CBT-I handle the massive physical changes of pregnancy?
Is CBT-I Safe And Effective During Pregnancy?
CBT-I is completely safe during pregnancy and is the preferred treatment over sleep medications. Pregnancy brings a host of physical changes, from hormonal fluctuations to bladder pressure, that disrupt sleep.
A meta-analysis found that nearly 40% of pregnant women experience clinical insomnia symptoms (Sedov, Anderson, Dhillon, & Tomfohr-Madsen, 2021). Because severe sleep deprivation is linked to a higher risk of preterm birth, specific adaptations are made to ensure treatment protocols do not increase sleep deprivation (Micheli et al., 2011).
Clinical trials confirm that CBT-I delivered during pregnancy leads to significantly greater reductions in insomnia severity, with 62% of women attaining full remission (Manber et al., 2019; Tomfohr-Madsen et al., 2017).
Therapy also focuses on preparing the mother for postpartum sleep disruptions and challenging unrealistic expectations about how much sleep is required for a healthy pregnancy.
Can CBT-I Help with Menopause Insomnia?
CBT-I effectively treats menopause insomnia by incorporating specific coping strategies for temperature regulation and hot flushes. During the menopausal transition, up to 60% of women experience insomnia, largely driven by nocturnal hot flushes (Kravitz et al., 2008).
Multiple randomized clinical trials have demonstrated that CBT-I produces significant reductions in insomnia symptoms and improves overall sleep quality for perimenopausal and postmenopausal women (Drake et al., 2019; McCurry et al., 2016).
CBT-I for menopause incorporates environmental adjustments to help with hot flushes. Cognitive therapy is used to help women manage their reactions to hot flushes, which prevents the heart rate from spiking and makes it easier to return to sleep (Nowakowski et al., 2017).
Finally, how does the therapy adapt as we enter our senior years?
Does CBT-I Help for Older Adults?
CBT-I is highly effective for older adults, with research confirming that healthy seniors can successfully participate in and benefit from the standard therapy (Irwin, Cole, & Nicassio, 2006; Rybarczyk, Lund, Garroway, & Mack, 2013).
Treating insomnia in this population often leads to significant improvements in overall health, daytime functioning, mood, and quality of life. Even for older adults with mild cognitive impairments, clinical experience suggests they can participate fully and achieve similar improvements in their sleep.
While the standard therapy works well, a qualified professional will often make patient-centered adaptations to accommodate the unique medical complexity, sensory impairments, or functional limitations common in this age group, ensuring the treatment is both safe and successful.
What if you fall into a special category, such as having tried CBT-I before without success, or currently taking sleep medication?
What if You Have Tried CBT-I Before or Take Sleep Medication?
Why Might CBT-I Fail the First Time?
CBT-I might fail the first time if you only tried basic sleep hygiene not true CBT-I, or used an automated online program that lacked personalization. Many patients come to our sleep clinic feeling defeated because they previously tried what they think is CBT-I and it did not work. Often, what they actually tried was just sleep hygiene - rules like avoiding caffeine or keeping the room cool - which is not a cure for chronic insomnia.
In other cases, they weren’t provided careful explanation of how the sleep/wake system works and close support from an experienced clinician to ensure they understood what to do once sleep improves, what to expect post-treatment, and relapse prevention skills.
But what if you’ve never tried CBT-I and you’ve just relied on sleeping pills instead of therapy? Can CBT-I help you break that sleep medication habit?
Can CBT-I Help You Stop Taking Sleeping Pills?
Yes, a modified CBT-I approach is an excellent tool to help you safely taper off prescription sleep medications. If you are currently taking prescription sleep aids, clinicians can collaborate with your prescribing doctor to create a gradual reduction schedule.
The key to a successful taper is timing: an experienced clinician will usually wait to start reducing your medication until after you have started sleep consolidation therapy. Sleep consolidation therapy increases natural sleep drive, which replaces the reduction in sleepiness from taking a lower dose of your medication (Belleville et al., 2007).
Long-term studies show that patients who receive CBT-I alongside a tapering plan are significantly more likely to remain medication-free years later compared to those who only taper their medication (Blom, Jernelov, Ruck, Lindefors, & Kaldo, 2016).
So with all these different conditions, and treatment modifications and nuances across different conditions, how do you make sure you get the right treatment?
Why Should You Work With a Qualified Behavioural Sleep Professional?
To get the most out of CBT-I, you should work with a qualified professional, such as a Diplomate in Behavioral Sleep Medicine (DBSM), a board-certified specialist in treating behavioural sleep disorders without medication, because they have the specialized training to adapt the therapy to your specific medical needs.
While many general therapists, counselors, of even GPs may be familiar with basic cognitive behavioral techniques, treating chronic insomnia requires a deep understanding of sleep architecture, circadian biology, and how sleep interacts with other medical conditions. A DBSM or similarly qualified behavioral sleep medicine expert understands that CBT-I is not a rigid, one-size-fits-all manual.
If you have chronic pain, sleep apnea, or take psychiatric medications, a qualified behavioral sleep medicine specialist knows exactly how to safely modify CBT-I so it does not trigger a manic episode, worsen your pain sensitivity, or leave you dangerously sleepy during the day.
They can collaborate directly with your prescribing physicians to manage medication tapers and adjust your treatment plan dynamically based on your weekly sleep data.
By seeking out a specialist with dedicated training in behavioral sleep medicine, you ensure that your treatment is safe, personalized, and highly effective for your unique situation.
Concerned about your sleep? We always advocate talking to your primary care health provider in the first instance.
You can also talk to a NZ behavioural sleep medicine clinic like The Better Sleep Clinic for sleep help. Whether it’s an Auckland sleep clinic, Wellington sleep clinic, Christchurch sleep clinic, Hamilton sleep clinic, New Plymouth sleep clinic or anywhere in NZ, we can help. We specialise in the recommended insomnia treatment - CBT for insomnia. We also have expertise in treating other sleep disorders such as treatments for circadian rhythm disorders such as delayed sleep phase disorder, nightmare disorder, and co-occuring mental health conditions.
Book an assessment (no referral required) or, if you have a specific question, enquire about treatment and get started addressing your sleep problems today.
Frequently Asked Questions About The Effectiveness Of CBT-I Across Conditions
Q1: Does CBT-I work if I have sleep apnea and insomnia?
A1: Yes, CBT-I is highly effective for people who suffer from both insomnia and sleep apnea. In fact, studies show that completing a modified CBT-I program before starting CPAP therapy significantly reduces insomnia symptoms and actually increases how many hours a night patients use their CPAP machines (Ong et al., 2020; Sweetman et al., 2019).
Q2: Can CBT-I help with depression?
A2: Yes, treating insomnia directly with CBT-I significantly improves sleep in depressed patients and can actually double the response rate to antidepressant medications (Manber et al., 2008). Because depression often causes low motivation, therapists frequently add behavioral activation, a technique of scheduling enjoyable daytime activities, to help patients find the energy to get out of bed in the morning.
Q3: Is CBT-I safe during pregnancy?
A3: CBT-I is completely safe during pregnancy and is the preferred treatment over sleep medications. Clinical trials confirm that CBT-I delivered during pregnancy leads to significantly greater reductions in insomnia severity, with 62% of women attaining full remission (Manber et al., 2019; Tomfohr-Madsen et al., 2017).
Q4: Can CBT-I help me stop taking sleeping pills?
A4: Yes, a modified CBT-I approach is an excellent tool to help you safely taper off prescription sleep medications with minimal “rebound insomnia”. A behavioural sleep medicine specialist will collaborate with your prescribing doctor to create a gradual reduction schedule. By using CBT-I to boost natural sleep drive, your body's biological pressure to sleep, treatment helps override the reduction in medication-induced sleepiness from taking lower doses of your medication (Belleville et al., 2007).
Q5: Why didn't CBT-I work for me the first time?
A5: CBT-I might fail the first time if you only tried basic sleep hygiene or used an automated online program that lacked personalization. Basic sleep hygiene rules like avoiding caffeine and devices, or keeping the room cool and a bedtime routine - is not a cure for chronic insomnia. Working with a qualified professional, such as a Diplomate in Behavioral Sleep Medicine (DBSM), means the therapy is properly adapted to your specific medical needs, lifestyle, and challenges.
References
Afolalu, E. F., Moore, C., Ramlee, F., Goodchild, C. E., & Tang, N. K. Y. (2016). Development of the pain-related beliefs and attitudes about sleep (PBAS) scale for the assessment and treatment of insomnia comorbid with chronic pain. Journal of Clinical Sleep Medicine, 12(9), 1269–1277.
Alföldi, P., Dragioti, E., Wiklund, T., & Gerdle, B. (2017). Spreading of pain and insomnia in patients with chronic pain: Results from a national quality registry (SQRP). Journal of Rehabilitation Medicine, 49(1), 63–70.
Anderson, W. S., Sheth, R. N., Bencherif, B., Frost, J. J., & Campbell, J. N. (2002). Naloxone increases pain induced by topical capsaicin in healthy human volunteers. Pain, 99(1–2), 207–216.
Baglioni, C., Altena, E., Bjorvatn, B., Blom, K., Bothelius, K., Devoto, A., & Riemann, D. (2020). The European Academy for Cognitive Behavioural Therapy for Insomnia: An initiative of the European Insomnia Network to promote implementation and dissemination of treatment. Journal of Sleep Research, 29(2), Article e12967.
Bair, M. J., Robinson, R. L., Katon, W., & Kroenke, K. (2003). Depression and pain comorbidity: A literature review. Archives of Internal Medicine, 163(20), 2433–2445.
Bastien, C. H., Vallières, A., & Morin, C. M. (2001). Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Medicine, 2(4), 297–307.
Beckham, J. C., Crawford, A. L., Feldman, M. E., Kirby, A. C., Hertzberg, M. A., Davidson, J. R. T., & Moore, S. D. (1997). Chronic posttraumatic stress disorder and chronic pain in Vietnam combat veterans. Journal of Psychosomatic Research, 43(4), 379–389.
Burgess, H. J., Rizvydeen, M., Kimura, M., Pollack, M. H., Hobfoll, S. E., Rajan, K. B., & Burns, J. W. (2019). An open trial of morning bright light treatment among US military veterans with chronic low back pain: A pilot study. Pain Medicine, 20(4), 770–778.
Campbell, P., Tang, N. K. Y., McBeth, J., Lewis, M., Main, C. J., Croft, P. R., Morphy, H., & Dunn, K. M. (2013). The role of sleep problems in the development of depression in those with persistent pain: A prospective cohort study. Sleep, 36(11), 1693–1698.
Chen, T.-Y., Lee, S., Schade, M. M., Saito, Y., Chan, A., & Buxton, O. M. (2019). Longitudinal relationship between sleep deficiency and pain symptoms among community-dwelling older adults in Japan and Singapore. Sleep, 42(2)
Collard, V. E. J., Moore, C., Nichols, V. P., Ellard, D. R., Patel, S., Sandhu, H., Parsons, H., Sharma, U., Underwood, M., Madan, J., & Tang, N. K. Y. (2021). Challenges and visions for managing pain-related insomnia in primary care using the hybrid CBT approach: A small-scale qualitative interview study with GPs, nurses, and practice managers. BMC Family Practice, 22, 210.
Cutrufello, N. J., Ianus, V. D., & Rowley, J. A. (2020). Opioids and sleep. Current Opinion in Pulmonary Medicine, 26(6), 634–641.
de Bruin, E. J., Bögels, S. M., Oort, F. J., & Meijer, A. M. (2015a). Efficacy of cognitive behavioral therapy for insomnia in adolescents: A randomized controlled trial with internet therapy, group therapy and a waiting list condition. Sleep, 38(12), 1913–1926.
de Bruin, E. J., van der Oord, S., Bögels, S. M., & Meijer, A. M. (2015b). Differential effects of online insomnia treatment on executive functions in adolescents. Sleep Medicine, 16(4), 510–520.
de Bruin, E. J., Bögels, S. M., Oort, F. J., & Meijer, A. M. (2018). Improvements of adolescent psychopathology after insomnia treatment: Results from a randomized controlled trial over 1 year. Journal of Child Psychology and Psychiatry, 59(5), 509–522.
de Zanette, S. A., Vercelino, R., Laste, G., Rozisky, J. R., Schwertner, A., Machado, C. B., Xavier, F., de Souza, I. C. C., Deitos, A., Torres, I. L. S., & Caumo, W. (2014). Melatonin analgesia is associated with improvement of the descending endogenous pain-modulating system in fibromyalgia: A phase II, randomized, double-dummy, controlled trial. BMC Pharmacology and Toxicology, 15, 40.
Filiatrault, M. L., Chauny, J. M., Daoust, R., Roy, M. P., Denis, R., & Lavigne, G. (2016). Medium increased risk for central sleep apnea but not obstructive sleep apnea in long-term opioid users: A systematic review and meta-analysis. Journal of Clinical Sleep Medicine, 12(4), 617–625.
Fishbain, D. A., Goldberg, M., Meagher, R. B., Steele, R., & Rosomoff, H. (1986). Male and female chronic pain patients categorized by DSM-III psychiatric diagnostic criteria. Pain, 26(2), 181–197.
Herrero Babiloni, A., Beetz, G., Tang, N. K. Y., Heinzer, R., Nijs, J., Martel, M. O., & Lavigne, G. J. (2021). Towards the endotyping of the sleep–pain interaction: A topical review on multitarget strategies based on phenotypic vulnerabilities and putative pathways. Pain, 162(5), 1281–1288.
Iacovides, S., George, K., Kamerman, P., & Baker, F. C. (2017). Sleep fragmentation hypersensitizes healthy young women to deep and superficial experimental pain. Journal of Pain, 18(7), 844–854.
Jansson-Fröjmark, M., Harvey, A. G., Lundh, L.-G., Norell-Clarke, A., & Linton, S. J. (2011). Psychometric properties of an insomnia-specific measure of worry: The Anxiety and Preoccupation about Sleep Questionnaire. Cognitive Behaviour Therapy, 40(1), 65–76.
Javaheri, S., Germany, R., & Greer, J. J. (2016). Novel therapies for the treatment of central sleep apnea. Sleep Medicine Clinics, 11(2), 227–239.
Julien, N., & Marchand, S. (2006). Endogenous pain inhibitory systems activated by spatial summation are opioid-mediated. Neuroscience Letters, 401(3), 256–260.
Jungquist, C. R., O'Brien, C., Matteson-Rusby, S., Smith, M. T., Pigeon, W. R., Xia, Y., Lu, N., & Perlis, M. L. (2010). The efficacy of cognitive-behavioral therapy for insomnia in patients with chronic pain. Sleep Medicine, 11(3), 302–309.
Kosek, E., & Hansson, P. (1997). Modulatory influence on somatosensory perception from vibration and heterotopic noxious conditioning stimulation (HNCS) in fibromyalgia patients and healthy subjects. Pain, 70(1), 41–51.
Lautenbacher, S., & Rollman, G. B. (1997). Possible deficiencies of pain modulation in fibromyalgia. Clinical Journal of Pain, 13(3), 189–196.
Lewandowski, A. S., Palermo, T. M., De la Motte, S., & Fu, R. (2010). Temporal daily associations between pain and sleep in adolescents with chronic pain versus healthy adolescents. Pain, 151(1), 220–225.
Lo, H. S., Yang, C. M., Lo, H. G., Lee, C. Y., Ting, H., & Tzang, B. S. (2010). Treatment effects of gabapentin for primary insomnia. Clinical Neuropharmacology, 33(2), 84–90.
McCall, W. V., Blocker, J. N., D'Agostino, R., Jr., Kimball, J., Boggs, N., Lasater, B., & Rosenquist, P. B. (2010). Insomnia severity is an indicator of suicidal ideation during a depression clinical trial. Sleep Medicine, 11(9), 822–827.
McCracken, L. M., & Iverson, G. L. (2002). Disrupted sleep patterns and daily functioning in patients with chronic pain. Pain Research and Management, 7(2), 75–79.
McCurry, S. M., Shortreed, S. M., Von Korff, M., Balderson, B. H., Baker, L. D., Rybarczyk, B. D., & Vitiello, M. V. (2014). Who benefits from CBT for insomnia in primary care? Important patient selection and trial design lessons from longitudinal results of the Lifestyles trial. Sleep, 37(2), 299–308.
Melzack, R. (1999). Pain—An overview. Acta Anaesthesiologica Scandinavica, 43(9), 880–884.
Morin, C. M., LeBlanc, M., Daley, M., Gregoire, J. P., & Mérette, C. (2006). Epidemiology of insomnia: Prevalence, self-help treatments, consultations, and determinants of help-seeking behaviors. Sleep Medicine, 7(2), 123–130.
Morin, C. M., Vallières, A., & Ivers, H. (2007). Dysfunctional beliefs and attitudes about sleep (DBAS): Validation of a brief version (DBAS-16). Sleep, 30(11), 1547–1554.
Mork, P. J., & Nilsen, T. I. L. (2012). Sleep problems and risk of fibromyalgia: Longitudinal data on an adult female population in Norway. Arthritis & Rheumatism, 64(1), 281–284.
Pigeon, W. R., Moynihan, J., Matteson-Rusby, S., Jungquist, C. R., Xia, Y., Tu, X., & Perlis, M. L. (2012). Comparative effectiveness of CBT interventions for co-morbid chronic pain & insomnia: A pilot study. Behaviour Research and Therapy, 50(11), 685–689.
Pigeon, W. R., Pinquart, M., & Conner, K. (2012). Meta-analysis of sleep disturbance and suicidal thoughts and behaviors. Journal of Clinical Psychiatry, 73(9), e1160–e1167.
Prados, G., Miró, E., Martínez, M. P., Sánchez, A. I., Lami, M. J., & Cáliz, R. (2020). Combined cognitive-behavioral therapy for fibromyalgia: Effects on polysomnographic parameters and perceived sleep quality. International Journal of Clinical and Health Psychology, 20(3), 232–242.
Ramaswamy, S., & Wodehouse, T. (2021). Conditioned pain modulation—A comprehensive review. Neurophysiologie Clinique, 51(3), 197–208.
Roehrs, T., Hyde, M., Blaisdell, B., Greenwald, M., & Roth, T. (2006). Sleep loss and REM sleep loss are hyperalgesic. Sleep, 29(2), 145–151.
Roth, T., Van Seventer, R., & Murphy, T. K. (2010). The effect of pregabalin on pain-related sleep interference in diabetic peripheral neuropathy or postherpetic neuralgia: A review of nine clinical trials. Current Medical Research and Opinion, 26(10), 2411–2419.
Rybarczyk, B., Lund, H. G., Garroway, A. M., & Mack, L. J. (2013). Cognitive behavioral therapy for insomnia in older adults: Background, evidence, and overview of treatment protocol. Clinical Gerontologist, 36(2), 70–93.
Schwertner, A., Conceição Dos Santos, C. C., Costa, G. D., Deitos, A., de Souza, A., de Souza, I. C. C., Torres, I. L. S., da Cunha Filho, J. S. L., & Caumo, W. (2013). Efficacy of melatonin in the treatment of endometriosis: A phase II, randomized, double-blind, placebo-controlled trial. Pain, 154(6), 874–881.
Shear, T. C., Balachandran, J. S., Mokhlesi, B., Spampinato, L. M., Knutson, K. L., Meltzer, D. O., & Arora, V. M. (2014). Risk of sleep apnea in hospitalized older patients. Journal of Clinical Sleep Medicine, 10(10), 1061–1066.
Simpson, N. S., Scott-Sutherland, J., Gautam, S., Sethna, N., & Haack, M. (2018). Chronic exposure to insufficient sleep alters processes of pain habituation and sensitization. Pain, 159(1), 33–40.
Sivertsen, B., Lallukka, T., Petrie, K. J., Steingrímsdóttir, Ó. A., Stubhaug, A., & Nielsen, C. S. (2015). Sleep and pain sensitivity in adults. Pain, 156(8), 1433–1439.
Smith, M. T., Edwards, R. R., McCann, U. D., & Haythornthwaite, J. A. (2007). The effects of sleep deprivation on pain inhibition and spontaneous pain in women. Sleep, 30(4), 494–505.
Smith, M. T., & Haythornthwaite, J. A. (2004). How do sleep disturbance and chronic pain inter-relate? Insights from the longitudinal and cognitive-behavioral clinical trials literature. Sleep Medicine Reviews, 8, 119–132.
Simpson, N. S., Scott-Sutherland, J., Gautam, S., Sethna, N., & Haack, M. (2018). Chronic exposure to insufficient sleep alters processes of pain habituation and sensitization. Pain, 159(1), 33–40.
Sivertsen, B., Lallukka, T., Petrie, K. J., Steingrímsdóttir, Ó. A., Stubhaug, A., & Nielsen, C. S. (2015). Sleep and pain sensitivity in adults. Pain, 156(8), 1433–1439.
Smith, M. T., Edwards, R. R., McCann, U. D., & Haythornthwaite, J. A. (2007). The effects of sleep deprivation on pain inhibition and spontaneous pain in women. Sleep, 30(4), 494–505.
Smith, M. T., & Haythornthwaite, J. A. (2004). How do sleep disturbance and chronic pain inter-relate? Insights from the longitudinal and cognitive-behavioral clinical trials literature. Sleep Medicine Reviews, 8, 119–132.
Tang, N. K. Y., Goodchild, C. E., Sanborn, A. N., Howard, J., & Salkovskis, P. M. (2012). Deciphering the temporal link between pain and sleep in a heterogeneous chronic pain patient sample: A multilevel daily process study. Sleep, 35(5), 675–687.
Tang, N. K. Y., & Harvey, A. G. (2004). Correcting distorted perception of sleep in insomnia: A novel behavioural experiment? Behaviour Research and Therapy, 42(1), 27–39.
Tang, N. K. Y., & Sanborn, A. N. (2014). Better quality sleep promotes daytime physical activity in patients with chronic pain? A multilevel analysis of the within-person relationship. PLoS One, 9(3), e92158.
Tang, N. K. Y., Stella, M. T., Banks, P. D., Sandhu, H. K., & Berna, C. (2019). The effect of opioid therapy on sleep quality in patients with chronic non-malignant pain: A systematic review and exploratory meta-analysis. Sleep Medicine Reviews, 45, 105–126.
Taylor, D. J., Mallory, L. J., Lichstein, K. L., Durrence, H. H., Riedel, B. W., & Bush, A. J. (2007). Comorbidity of chronic insomnia with medical problems. Sleep, 30(2), 213–218.
Vinik, A., Emir, B., Parsons, B., & Cheung, R. (2014). Prediction of pregabalin-mediated pain response by severity of sleep disturbance in patients with painful diabetic neuropathy and post-herpetic neuralgia. Pain Medicine, 15(4), 661–670.
Vitiello, M. V., McCurry, S. M., Shortreed, S. M., Balderson, B. H., Baker, L. D., Keefe, F. J., Rybarczyk, B. D., & Von Korff, M. (2013). Cognitive-behavioral treatment for comorbid insomnia and osteoarthritis pain in primary care: The Lifestyles Randomized Controlled Trial. Journal of the American Geriatrics Society, 61(6), 947–956.
Vitiello, M. V., McCurry, S. M., Shortreed, S. M., Baker, L. D., Rybarczyk, B. D., Keefe, F. J., & Von Korff, M. (2014). Short-term improvement in insomnia symptoms predicts long-term improvements in sleep, pain, and fatigue in older adults with comorbid osteoarthritis and insomnia. Pain, 155(8), 1547–1554.
Wang, D., & Teichtahl, H. (2007). Opioids, sleep architecture and sleep-disordered breathing. Sleep Medicine Reviews, 11(1), 35–46. https://doi.org/10.1016/j.smrv.2006.03.006
Webster, L. R., Choi, Y., Desai, H., Webster, L., & Grant, B. J. B. (2008). Sleep-disordered breathing and chronic opioid therapy. Pain Medicine, 9(4), 425–432.
Whibley, D., AlKandari, N., Kristensen, K., Barnish, M., Rzewuska, M., Druce, K. L., & Tang, N. K. Y. (2019). Sleep and pain: A systematic review of studies of mediation. The Clinical Journal of Pain, 35(6), 544–558.
Willer, J. C., Le Bars, D., & De Broucker, T. (1990). Diffuse noxious inhibitory controls in man: Involvement of an opioidergic link. European Journal of Pharmacology, 182(2), 347–355. https://doi.org/10.1016/0014-2999(90)90293-F
Written By The Better Sleep Clinic
Reviewed By Dan Ford, Sleep Psychologist
