Can Cognitive Therapy – Trazadone Ease Dialysis Insomnia?

Trazadone or cognitive behavioral treatment for insomnia (CBT-I) did not significantly improve mild to moderate chronic insomnia in patients receiving hemodialysis. These results are significant since long-term dialysis patients frequently experience lack of sleep. The study findings were published in Annals of Internal Medicine (1^✔ ✔Trusted Source
Effectiveness of Existing Insomnia Therapies for Patients Undergoing Hemodialysis

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Trazadone’s Ineffectiveness in Dialysis Insomnia Therapy

Insomnia affects up to 50 percent of persons undergoing long-term dialysis. Because insomnia is associated with exacerbated fatigue, depression, pain perception, and poor quality of life, patients place a high priority on finding effective treatments for this condition.
CBT-I and trazodone are commonly used interventions to treat insomnia in the general population, but evidence for the efficacy and safety of insomnia treatments cannot be extrapolated to persons undergoing long-term dialysis.

A team led by researchers from the University of Washington randomly assigned 126 persons undergoing hemodialysis and experiencing chronic insomnia to 6 weeks of CBT-I, trazodone, or placebo to compare the effectiveness of the interventions.

Participants were assessed for severity of insomnia at 7 and 25 weeks using the Insomnia Severity Index (ISI) questionnaire. The authors found that the change in ISI scores was the same for patients regardless of the intervention used, but serious adverse events occurred more frequently in participants using trazodone.

According to the authors, given the high burden of insomnia in dialysis patients and the high priority placed by patients for symptom relief, more trials are needed to investigate additional therapies for this condition.

An accompanying editorial by Ronald B. Postuma, MD, MSc highlights how the different causes of insomnia impact its treatment. The author notes that the lack of efficacy observed with CBT-I in this study is remarkable, given the extremely strong evidence base for its utility in primary insomnia, suggesting that the typical psychophysiological drivers of insomnia in the general population may be simply less pertinent in hemodialysis patients.

The authors also highlight that future studies should explore medications specifically designed for insomnia and treatments that target restless legs and neuropathic pain.

1. Effectiveness of Existing Insomnia Therapies for Patients Undergoing Hemodialysis – (https://www.acpjournals.org/doi/10.7326/M23-1794)

Source-Eurekalert