L’objectif de notre étude est de comparer l’efficacité d’un programme de thérapie cognitive et comportementale (TCC) classique sur l’insomnie à un programme associant TCC et pleine conscience (PC).

Trente-trois patients atteints d’insomnie chronique ont été répartis en deux groupes en fonction de la psychothérapie suivie (TCC classique ou TCC+PC). Les paramètres du sommeil (latence d’endormissement, temps d’éveil intrasommeil, temps de sommeil total, temps passé au lit, efficacité de sommeil et nombre d’éveils nocturnes) ont été mesurés sur les agendas de sommeil recueillis avant la thérapie (T0) et 6 semaines après celle-ci (T1). Les caractéristiques de l’insomnie, la somnolence diurne, les symptômes anxio-dépressifs et la qualité de vie (SF36) ont également été évalués par auto-questionnaires.

Vingt-neuf patients ont suivi l’ensemble des sessions. La prise en charge en thérapie, quel que soit le protocole suivi, a permis une amélioration significative de tous les paramètres de l’agenda, de la qualité du sommeil, des symptômes anxieux (p=0,004) et de la vitalité sur l’échelle SF 36 (p=0,004). En comparant les deux groupes de thérapie, nous avons retrouvé un effet supérieur du nouveau protocole avec une diminution significativement plus marquée du temps d’éveil intrasommeil (p=0,009).

Cette étude confirme, d’une part, l’effet bénéfique des TCC de l’insomnie en groupe sur les paramètres sommeils, les symptômes anxieux et la qualité de vie des patients. D’autre part, elle semble, pour la première fois, montrer la supériorité d’une approche associant TCC classique et pleine conscience.

Insomnia is considered to be a serious public health issue affecting approximately 10% of adults. Chronic insomnia may increase the risk of health problem, psychological vulnerability and proneness to accidents. Cognitive behavioral therapy for insomnia (CBT-I) is recommended as the first line of treatment. Even though CBT-I is widely considered as an effective therapy, 20 to 30% of patients do not respond to this treatment. Mindfulness therapy, known to reduce rumination and stress, could be an interesting complement to enhance CBT-I. The aim of this study is to evaluate the efficacy of therapy combining mindfulness meditation and CBT-I for the treatment of chronic insomnia.

Thirty-three patients, diagnosed with chronic insomnia, aged 18 to 75 years (51±15 years) were recruited between October 2015 and June 2016 at the Sleep Center of Marseille. The patients were then divided into two groups according to their psychotherapy method: group CBT-I alone (17 patients) or a group therapy combining CBT-I and Mindfulness (16 patients). All participants were given five sessions of standard CBT during eight weeks. The patient-reported outcome measures were sleep onset latency, wake after sleep onset (WASO), total wake time, total sleep time, time in bed, sleep efficiency and number of awakening from sleep diaries before treatment (T0) and six weeks later (T1). Assessments were done using Pittsburgh Sleep quality index (PSQI), Insomnia severity Index (ISI), the Epworth sleepiness scale, the hospital anxiety and depression scale (HAD), the dysfunctional beliefs and attitude about sleep (DBAS-16); further, the use of sleeping pills was also recorded at T0 and T1.

Out of the 33 participants who began the treatment, 29 completed all sessions and were included in the analyses (4 dropouts in the group CBT-I alone). The data shows that each treatment yielded significant improvements over time in sleep variables from the diary, PSQI, ISI, anxiety (P=0.004), DBAS 16, sleeping pill use and vitality measured by SF36 health survey (P=0.004). Comparing the results of the two therapy groups, the meditation associated to CBT-I shows significantly greater rates of reduction in WASO relative to CBT-I group (P=0.009).

This study confirms the beneficial effects of CBT for patients suffering from insomnia on sleep parameters, anxiety symptoms and quality of life. Furthermore, this study suggests, for the first time, that combining CBT and mindfulness is a superior approach compared to that of only conventional CBT-I in improving sleep.