Insomnia Treatment Preferences and Barriers of Individuals With Arthritis

Sleep disturbances, including difficulty initiating sleep, maintaining sleep or early morning awakenings, are prevalent in arthritis, contributing to fatigue, pain, and reducing quality of life. Cognitive-behavioral therapy for insomnia (CBTi) is the first-line treatment. Accessibility remains challenging. Internet-delivered CBTi (ICBTi) increases accessibility. To tailor ICBTi to arthritis, a needs assessment survey was conducted.

Individuals with arthritis, recruited through social media and patient organizations, completed an online survey assessing insomnia, help-seeking behaviors or barriers, management strategies, and treatment preferences.

Of the 248 participants, 55% discussed sleep with health care providers, and 35% did not in the past year despite perceiving the need. Common barriers to seeking treatment despite the need were having their own ways of coping (54% in inflammatory arthritis [IA] and 46% in osteoarthritis [OA]), and believing sleep problems are normal stress responses (53% in IA and 38% in OA). In IA, 54% and in OA, 43% used relaxation techniques for sleep, and 37% in IA and OA used over-the-counter medication at least once. In IA, 44%, and in OA, 39% rated medication as somewhat or very acceptable, 74% with IA and 66% in OA were willing to see health care providers for insomnia regularly, and 91% with IA and 86% with OA were likely or very likely to try an online arthritis-specific approach.

Given the prevalence, chronicity, and consequences of insomnia, better insomnia management is needed for individuals with arthritis. ICBTi is an acceptable approach for this population. These findings will guide the evaluation of an arthritis-specific ICBTi.