The effectiveness of short-term cognitive behavioral therapy in the complex treatment of idiopathic restless legs syndrome with chronic insomnia

Aim. To investigate the effectiveness of the short-term protocol of cognitive behavioral therapy RELEGS M. Hornyak et al. in complex treatment to improve the quality of sleep, reduce the symptoms of depression, anxiety, suicidal thoughts in patients with primary SBN comorbid with chronic insomnia.

Methods. Study participants: 68 patients with primary restless legs syndrome with comorbid chronic insomnia. Women — 56 (average age 52.1±10.3 years), men — 12 (average age 50.3±9.4 years). The severity of restless legs syndrome is moderate to severe. The average age of the onset of the disease is 18–48 years, the duration of the course of the disease is on average 14–15 years. Taking various medications for the management of SBN for an average of 4–5 years. Study design: a randomized controlled trial, after screening — 26 patients were assigned to the main group, underwent combined treatment, took a prolonged form of Pramipexole (Mirapex-PD, 1.5 mg.) and underwent the RELEGS CBT protocol (Restless Legs Skills program, Hornyak, Grossmann, 2018), which integrates the cognitive behavioral insomnia protocol (Morin, 2007) and Mindfulness-Based Stress therapy (Mindfulness-Based Stress Reduction, Bablas, 2016). The control group consisted of 24 people who received only general recommendations on sleep hygiene once. Both groups were treated with dopaminergic agonists under the supervision of a neurologist. Research methods: IRLS, ISI, DBAS-16, sleep diary analysis, actigraphy, BDI, SBQ-R, BAI.

Results. The use of the CBT protocol in combination therapy with prolonged-acting dopaminergic agonists in patients with primary restless leg syndrome (mild and moderate severity) with comorbid chronic insomnia, in contrast to simple one-time general recommendations on sleep hygiene, is more effective for reducing dysfunctional behaviors, the spectrum of reinsurance and avoidance behavior both in relation to sleep and symptoms of restless legs. In patients with primary restless legs syndrome who underwent CBT, greater mental well-being was observed, which was expressed in a decrease in the severity of symptoms of insomnia, anxiety, and suicidal behavior after completion and persisted after 3 months of follow-up.

Conclusion. As part of a personalized comprehensive approach, along with a drug-based approach and general recommendations for sleep hygiene, the use of short-term CBT (4 sessions, 60 minutes each) can significantly improve mental well-being, improve the quality of sleep of patients with restless legs syndrome with comorbid chronic insomnia.