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Cognitive behavioral therapy for insomnia (CBT-I) and trazodone had the same effect as doing nothing for mild to moderate insomnia in people on dialysis, a new study finds. 

Researchers reported Monday on a clinical trial of more than 120 persons undergoing hemodialysis in Annals of Internal Medicine.

About 50% of people who are undergoing long-term dialysis report insomnia. The sleeping difficulty is linked to depression, pain perception, poor quality of life, and fatigue. Because of this people often seek treatment. CBT-I and trazodone are commonly used interventions to treat insomnia in the general population, but there wasn’t much evidence on how well they worked for people on long-term dialysis.

A team led by researchers from the University of Washington randomly assigned 126 individuals who were undergoing hemodialysis and experiencing chronic insomnia to try six weeks of CBT-I, trazodone, or placebo. At seven and 25 weeks, the people underwent an assessment using the Index (ISI) questionnaire. 

The change in ISI scores were the same for people regardless of the intervention used. Serious adverse events occurred more frequently in participants using trazodone, the authors reported. 

Because of the high burden of insomnia in this population of people on dialysis, more studies should look at additional insomnia treatments, the authors said.

Ronald B. Postuma, MD, a clinical researcher and movement disorders neurologist at McGill University, wrote an accompanying editorial detailing how the different causes of insomnia affect its treatment. Postuma wrote that the lack of efficacy the study found with CBT-I was remarkable, especially because there’s such strong evidence for using it in primary insomnia.

The usual psychophysiological drivers of insomnia in the general population may be less pertinent in hemodialysis patients. Future studies should explore medications specifically designed for insomnia and treatments that target restless legs and neuropathic pain that people on dialysis experience, Postuma wrote.