Effects of Cognitive Behavioral Therapy on Insomnia of Maintenance Hemodialysis Patients

The objective of the study was to evaluate the effects of cognitive behavioral therapy [sleep-related behavior modification and progressive muscle relaxation on insomnia of maintenance hemodialysis (MHD) patients] on improving insomnia of MHD patients. 103 MHD patients complicated with insomnia were randomly assigned to treatment (n = 52) and control (n = 51) groups. The control group was treated with conventional hemodialysis, and the treatment group was additionally treated with cognitive behavioral therapy for 3 months (sleep-related behavior modification and progressive muscle relaxation). All cases were assessed by Symptom Checklist 90 (SCL-90) and Pittsburgh Sleep Quality Index (PSQI) before and 2, 4, 6, 8, 10, and 12 weeks after treatment. Fifty-one patients in the treatment group and 47 patients in the control group completed the experiments. After treatment, the total mean scores were (1.94 +/- A 0.50/2.29 +/- A 0.31); scores of somatization, depression, anxiety, hostility, and additional items were (1.87 +/- A 0.58/2.56 +/- A 0.26), (2.25 +/- A 0.80/2.79 +/- A 0.50), (1.79 +/- A 0.26/2.37 +/- A 0.34), (1.71 +/- A 0.46/2.25 +/- A 0.43), and (1.91 +/- A 0.67/2.26 +/- A 0.59) in SCL-90, respectively. The total scores for PSQI were (12.63 +/- A 2.27/16.40 +/- A 2.16); scores of subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbance, hypnotics, and daytime dysfunction which were (1.98 +/- A 0.76/2.57 +/- A 0.58), (1.75 +/- A 0.59/2.60 +/- A 0.50), (2.10 +/- A 0.50/2.62 +/- A 0.53), (2.06 +/- A 0.47/2.57 +/- A 0.54), (2.04 +/- A 0.69/2.45 +/- A 0.72), (1.02 +/- A 0.79/1.51 +/- A 0.98), and (1.69 +/- A 0.55/2.09 +/- A 0.58), respectively, were significantly lower in the treatment group compared with the control group. However, there were no significant differences in the scores of factors of obsessive-compulsive (2.26 +/- A 0.62/2.32 +/- A 0.38), interpersonal sensitivity (2.23 +/- A 0.64/2.43 +/- A 0.47), phobic anxiety (1.98 +/- A 0.62/2.01 +/- A 0.67), paranoid ideation (1.55 +/- A 0.43/1.69 +/- A 0.39), and psychoticism (1.57 +/- A 0.46/1.66 +/- A 0.49). The conclusion is that sleep-related behavior modification in combination with progressive muscle relaxation effectively improved the mental state and sleep quality of MHD patients with insomnia.