Behavioral Insomnia Therapy With Chronic Fatigue Syndrome

This study has been completed.
Sponsor:
Collaborator:
Information provided by (Responsible Party):
Duke University
ClinicalTrials.gov Identifier:
NCT00540254
First received: October 3, 2007
Last updated: February 28, 2013
Last verified: March 2010
  Purpose

The purpose of this study is to determine how best to manage the sleep problems of people with Chronic Fatigue Syndrome. This study is being conducted to determine how improvements in sleep affect other Chronic Fatigue symptoms including pain, fatigue, and mood as well as a person's sense of general well-being.


Condition Intervention Phase
Chronic Fatigue Syndrome
Behavioral Therapy Targeted to Sleep Problems
Behavioral: Cognitive Behavioral Therapy
Other: Usual Care for Chronic Fatigue Syndrome (Active Control Group)
Phase 1
Phase 2

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Single Blind (Caregiver)
Primary Purpose: Treatment
Official Title: Behavioral Insomnia Therapy With Chronic Fatigue Syndrome

Resource links provided by NLM:


Further study details as provided by Duke University:

Primary Outcome Measures:
  • total wake time [ Time Frame: Measures taken at baseline, mid-treatment, immediate post-treatment, one-month follow-up ] [ Designated as safety issue: No ]
  • total sleep time [ Time Frame: Measures taken at baseline, mid-treatment, immediate post-treatment, one-month follow-up ] [ Designated as safety issue: No ]
  • sleep efficiency [ Time Frame: Measures taken at baseline, mid-treatment, immediate post-treatment, one-month follow-up ] [ Designated as safety issue: No ]
  • beliefs about sleep [ Time Frame: Measures taken at baseline, mid-treatment, immediate post-treatment, one-month follow-up ] [ Designated as safety issue: No ]
  • sleep habits [ Time Frame: Measures taken at baseline, mid-treatment, immediate post-treatment, one-month follow-up ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • actigraphy (measurement of activity) [ Time Frame: Measures taken at baseline, mid-treatment, immediate post-treatment, one-month follow-up ] [ Designated as safety issue: No ]
  • scores on measures of fatigue, mood, anxiety, quality of life, chronic fatigue syndrome symptoms, fibromyalgia symptoms, medication usage [ Time Frame: Measures taken at baseline, mid-treatment, immediate post-treatment, one-month follow-up ] [ Designated as safety issue: No ]

Enrollment: 24
Study Start Date: September 2007
Study Completion Date: July 2010
Primary Completion Date: July 2010 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: Arm 1
Cognitive Behavioral Therapy (CBT) + Insomnia plus Usual Care for Chronic Fatigue Syndrome -continues standard care for Chronic Fatigue Syndrome plus 4 sessions of CBT targeted for insomnia/sleep problems
Behavioral: Cognitive Behavioral Therapy
Cognitive Behavioral Therapy (CBT) + Insomnia plus Usual Care for Chronic Fatigue Syndrome -continues standard care for Chronic Fatigue Syndrome plus 4 sessions of CBT targeted for insomnia/sleep problems
Active Comparator: Arm 2
Usual Care for Chronic Fatigue Syndrome (Active Control Group) - continues standard care for Chronic Fatigue Syndrome and comes to the sleep lab for bi-weekly sessions to discuss sleep problems and to review weekly sleep logs
Other: Usual Care for Chronic Fatigue Syndrome (Active Control Group)
Usual Care for Chronic Fatigue Syndrome (Active Control Group) - continues standard care for Chronic Fatigue Syndrome and comes to the sleep lab for bi-weekly sessions to discuss sleep problems and to review weekly sleep logs

Detailed Description:

Chronic Fatigue Syndrome (CFS) is a prevalent, debilitating, and poorly understood condition that contributes to impaired functioning and increased health care utilization. The vast majority of CFS patients complain of unrelenting sleep disturbances (e.g., sleep onset insomnia and/or sleep maintenance insomnia) that could exacerbate symptoms such as fatigue, mood disturbance, and reduced quality of life. Research with normal sleepers and insomnia sufferers has demonstrated that sleep disruption adversely affects those systems hypothesized to be important in CFS (e.g., neuroendocrine and autonomic systems). Insomnia appears to be a perpetuating factor in CFS, as insomnia appears to develop as a comorbid condition that interacts with and worsens CFS. Perhaps because the insomnia of CFS patients traditionally has been viewed as a secondary symptom rather than as a comorbid disorder, the sleep-specific treatment needs of CFS patients have been largely ignored. In fact, there have been few studies conducted to test sleep-focused therapies with CFS patients. Both our clinical observations and our preliminary studies suggest that those with CFS display sleep targets (i.e., increased time-in-bed, decreased daytime activity) that are common to those with Primary and other comorbid insomnias. These phenomena are known to perpetuate sleep problems, and likely account for the chronic insomnia among CFS patients. Given the high prevalence and cost associated with CFS, as well as its complex clinical picture, interventions that directly address perpetuating mechanisms would likely improve the sleep and general prognosis for these patients.

The proposed randomized clinical trial will allow us to test the effects of CBT for Insomnia on sleep and waking functions among CFS patients. Positive results could lead to enhanced CFS outcomes by treating the comorbid insomnia effectively.

The consent form for this study will provide participants with information about who will provide their care during the study, the purpose of the study, the number of participants expected in the study, what is required of participants in the study, information about random assignment to study groups, how long participation in the study will last, the risks associated with the study, possible benefits of participation, alternatives for treatment other than participation in this study, information about confidentiality, costs to the participants associated with the study, compensation for participation, and who to contact if there questions about the study or injuries related to the study, the right to stop participating and withdraw from the study.

  Eligibility

Ages Eligible for Study:   21 Years to 65 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Chronic Fatigue Syndrome and Insomnia
  • meet diagnostic criteria for insomnia
  • be diagnosed with CFS by the Study Physician using CDC criteria
  • must be in current treatment for CFS (we can provide referrals if needed).
  • under medical care for a minimum of 6 weeks with a stable medication regimen for > 1 month.

Study patients can have comorbid depression (as long as it is not bipolar, melancholic or psychotic) or fibromyalgia. They can be taking sleep medications.

Exclusion Criteria:

  • Those with untreated medical disorders that could account for the fatigue, or affect sleep. Medical conditions that would exclude a participant include:

    • organ failure resulting from conditions such as emphysema, cirrhosis, cardiac failure, chronic renal failure
    • chronic infections, including AIDS, and hepatitis B or C
    • rheumatic and chronic inflammatory diseases that could account for the fatigue: including systemic lupus erythematosis, Sjogren's syndrome, rheumatoid arthritis, inflammatory bowel disease, chronic pancreatitis
    • major neurologic diseases (e.g., multiple sclerosis, neuromuscular diseases, epilepsy or other diseases requiring ongoing medication that could cause fatigue, stroke, head injury with residual neurologic deficits)
    • diseases requiring systemic treatment (e.g., organ or bone marrow transplantation, systemic chemotherapy, radiation of brain, thorax, abdomen, or pelvis)
    • untreated major endocrine diseases (e.g., hypopituitarism, adrenal insufficiency)
    • being on medications with known fatigue side effects or medications that have not been stable for at least one month
    • inadequately-treated hypothyroidism
    • untreated or unstable diabetes mellitus
    • active infection
    • pregnancy, 1-3 months post-partum or breast feeding
    • within 6 months post-operation for a major surgical procedure
    • within 3 months post-operation of minor surgery
    • major infections, such as sepsis or pneumonia until 3 months post-resolution
    • major conditions whose resolution may be unclear for at least 5 years (e.g., myocardial infarction, heart failure)
    • terminal conditions
    • severe obesity as defined as a body mass index (weight in kilograms/height in meters)2 > 40
    • elective surgery planned during the trial
  • We will exclude those who meet DSM-IV criteria currently or in the past 5 years for psychotic or melancholic Major Depression, bipolar disorders, schizophrenia, or eating disorders, alcohol or substance abuse or dependence (e.g., dependence on benzodiazepines or any other substance)
  • We will exclude those meeting criteria for Narcolepsy, Restless Legs Syndrome, a Circadian Rhythm Disorder, or sleep apnea and/or hypopnea.
  • We will exclude those with a medication change within the last month to ensure participants are on a stable dose and regimen of medication. *Once potential patients have had a stable medication regimen for > 1 month, participants can enter the trial.
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00540254

Locations
United States, North Carolina
Duke University Medical Center - Insomnia and Sleep Disorders Lab
Durham, North Carolina, United States, 27710
Sponsors and Collaborators
Duke University
Investigators
Study Director: Andrew Krystal, M.D. Duke University
Principal Investigator: Mark Mayo Duke University
Principal Investigator: Pam Smith Duke Medical Center
  More Information

Publications:
Responsible Party: Duke University
ClinicalTrials.gov Identifier: NCT00540254     History of Changes
Other Study ID Numbers: Pro00002157, R21NR010539, NIH: 1 R21 NR010539-01A1
Study First Received: October 3, 2007
Last Updated: February 28, 2013
Health Authority: United States: Federal Government
United States: Institutional Review Board

Keywords provided by Duke University:
Chronic Fatigue
Insomnia
Cognitive Behavioral Therapy

Additional relevant MeSH terms:
Fatigue
Syndrome
Fatigue Syndrome, Chronic
Dyssomnias
Sleep Disorders
Parasomnias
Signs and Symptoms
Disease
Pathologic Processes
Virus Diseases
Muscular Diseases
Musculoskeletal Diseases
Encephalomyelitis
Central Nervous System Diseases
Nervous System Diseases
Neuromuscular Diseases
Mental Disorders
Neurologic Manifestations

ClinicalTrials.gov processed this record on October 19, 2014