Håvard Kallestad1, Henrik B Jacobsen2, Nils Inge Landrø3, Petter C Borchgrevink2, Tore C Stiles4. 1. Norwegian University of Science and Technology, Department of Neuroscience, Trondheim, Norway; St. Olav's University Hospital, Department of Østmarka, Trondheim, Norway. Electronic address: havard.kallestad@ntnu.no. 2. St. Olav's University Hospital, Hysnes Rehabilitation Center, Trondheim, Norway; St. Olav's University Hospital, National Competence Center for Pain and Complex Disorders, Trondheim, Norway; Norwegian University of Science and Technology, Department of Circulation and Medical Imaging, Trondheim, Norway. 3. St. Olav's University Hospital, Hysnes Rehabilitation Center, Trondheim, Norway; Norwegian University of Science and Technology, Department of Circulation and Medical Imaging, Trondheim, Norway; University of Oslo, Department of Psychology, Oslo, Norway. 4. St. Olav's University Hospital, National Competence Center for Pain and Complex Disorders, Trondheim, Norway; University of Oslo, Department of Psychology, Oslo, Norway; Norwegian University of Science and Technology, Department of Psychology, Trondheim, Norway.
Abstract
BACKGROUND: The definition of Chronic Fatigue Syndrome (CFS) overlaps with definitions of insomnia, but there is limited knowledge about the role of insomnia in the treatment of chronic fatigue. AIMS: To test if improvement of insomnia during treatment of chronic fatigue was associated with improved outcomes on 1) fatigue and 2) cortisol recovery span during a standardized stress exposure. METHODS: Patients (n = 122) with chronic fatigue received a 3.5-week inpatient return-to-work rehabilitation program based on Acceptance and Commitment Therapy, and had been on paid sick leave>8 weeks due their condition. A physician and a psychologist examined the patients, assessed medication use, and SCID-I diagnoses. Patients completed self-report questionnaires measuring fatigue, pain, depression, anxiety, and insomnia before and after treatment. A subgroup (n = 25) also completed the Trier Social Stress Test for Groups (TSST-G) before and after treatment. Seven cortisol samples were collected during each test and cortisol spans for the TSST-G were calculated. RESULTS: A hierarchical regression analysis in nine steps showed that insomnia improvement predicted improvement in fatigue, independently of age, gender, improvement in pain intensity, depression and anxiety. A second hierarchical regression analysis showed that improvement in insomnia significantly predicted the cortisol recovery span after the TSST-G independently of improvement in fatigue. CONCLUSION: Improvement in insomnia severity had a significant impact on both improvement in fatigue and the ability to recover from a stressful situation. Insomnia severity may be a maintaining factor in chronic fatigue and specifically targeting this in treatment could increase treatment response.
BACKGROUND: The definition of Chronic Fatigue Syndrome (CFS) overlaps with definitions of insomnia, but there is limited knowledge about the role of insomnia in the treatment of chronic fatigue. AIMS: To test if improvement of insomnia during treatment of chronic fatigue was associated with improved outcomes on 1) fatigue and 2) cortisol recovery span during a standardized stress exposure. METHODS:Patients (n = 122) with chronic fatigue received a 3.5-week inpatient return-to-work rehabilitation program based on Acceptance and Commitment Therapy, and had been on paid sick leave>8 weeks due their condition. A physician and a psychologist examined the patients, assessed medication use, and SCID-I diagnoses. Patients completed self-report questionnaires measuring fatigue, pain, depression, anxiety, and insomnia before and after treatment. A subgroup (n = 25) also completed the Trier Social Stress Test for Groups (TSST-G) before and after treatment. Seven cortisol samples were collected during each test and cortisol spans for the TSST-G were calculated. RESULTS: A hierarchical regression analysis in nine steps showed that insomnia improvement predicted improvement in fatigue, independently of age, gender, improvement in pain intensity, depression and anxiety. A second hierarchical regression analysis showed that improvement in insomnia significantly predicted the cortisol recovery span after the TSST-G independently of improvement in fatigue. CONCLUSION: Improvement in insomnia severity had a significant impact on both improvement in fatigue and the ability to recover from a stressful situation. Insomnia severity may be a maintaining factor in chronic fatigue and specifically targeting this in treatment could increase treatment response.
Authors: Daniel Vethe; Håvard Kallestad; Henrik B Jacobsen; Nils Inge Landrø; Petter C Borchgrevink; Tore C Stiles Journal: Front Psychol Date: 2018-09-21
Authors: Sigmund Ø Gismervik; Lene Aasdahl; Ottar Vasseljen; Egil A Fors; Marit B Rise; Roar Johnsen; Karen Hara; Henrik B Jacobsen; Kristine Pape; Nils Fleten; Chris Jensen; Marius S Fimland Journal: Scand J Work Environ Health Date: 2020-01-05 Impact factor: 5.024