title: Outcomes of Cognitive-Behavioral Treatment for Insomnia on Insomnia, Depression, and Fatigue for Individuals with Multiple Sclerosis: A Case Series.
abstract: BACKGROUND
  This clinical case series examined outcomes of cognitive-behavioral therapy for insomnia (CBT-I) in individuals with multiple sclerosis (MS). Current literature links insomnia with higher rates of depression and fatigue in individuals with MS. However, no research to date evaluates a targeted psychotherapeutic intervention for insomnia in this population.
  
  
  METHODS
  Eleven individuals with a diagnosis of MS and insomnia participated in individual or group-based CBT-I sessions at the Cleveland Clinic Sleep Disorders Center between 2008 and 2013. A medical record review examined these individuals' self-reported experiences of insomnia, depression, and fatigue at the preintervention and postintervention levels using the Insomnia Severity Index, nine-item Patient Health Questionnaire, and Fatigue Severity Scale. Total sleep time was also reported at pretreatment and posttreatment intervals.
  
  
  RESULTS
  Overall, participants reported improvements regarding insomnia, fatigue, and depression after CBT-I. Total sleep time also increased by an average of 1.5 hours. Despite overall improvement, symptoms of fatigue, insomnia, and depression persisted, at varying levels, for most participants.
  
  
  CONCLUSIONS
  These results strongly suggest that CBT-I may serve as an effective clinical intervention for individuals with MS who report symptoms of insomnia. Given the considerable overlap of experiences of insomnia, depression, and fatigue in people with MS, CBT-I may also be helpful in identifying areas that may require additional clinical intervention for persistent symptoms of depression and fatigue. Further research is necessary.
authors.affiliation: Mellen Center for Multiple Sclerosis Treatment and Research (MC, ABS) and the Sleep Disorders Center (MD), Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Megan
authors.initials: M
authors.lastname: Clancy
authors.affiliation: Mellen Center for Multiple Sclerosis Treatment and Research (MC, ABS) and the Sleep Disorders Center (MD), Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Drerup
authors.affiliation: Mellen Center for Multiple Sclerosis Treatment and Research (MC, ABS) and the Sleep Disorders Center (MD), Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Amy Burleson
authors.initials: AB
authors.lastname: Sullivan