Efficacy of Cognitive Behavioral Therapy Combined with Jacobson Progressive Muscle Relaxation in Improving Sleep Quality and Overall Well-Being in Hemodialysis Patients with Insomnia: A Randomized Controlled Trial

Abstract

This randomized controlled trial compared the efficacy of cognitive-behavioral therapy for insomnia (CBT-I) vs. CBT-I without Jacobson progressive muscle relaxation (JPMR) in maintenance hemodialysis (MHD) patients. A total of 160 MHD patients with insomnia were randomly assigned to either the CBT-I group, which received a 7-week CBT-I program combined with JPMR, or the CBT-I without JPMR group, which underwent the same CBT-I program without the inclusion of JPMR. The 7-week intervention incorporated sleep restriction, stimulus control, cognitive restructuring, and relaxation techniques. Outcomes were assessed at weeks 0, 4, 8, and 12 using the Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), Modified Fatigue Impact Scale (MFIS), Hospital Anxiety and Depression Scale (HADS), and SF-36 Health Survey. The CBT-I group showed significantly greater and sustained improvements in insomnia severity, sleep quality, fatigue, anxiety, depression, and overall quality of life compared to the CBT-I without JPMR group. Improvements in ISI and PSQI scores, as well as reductions in fatigue, anxiety, and depression, were observed as early as week 4 and became more pronounced by week 12. Additionally, quality of life improved significantly across all SF-36 dimensions in the CBT-I group. This study demonstrated that the CBT-I is more effective than CBT-I without JPMR in addressing insomnia, fatigue, anxiety, depression, and quality of life in MHD patients, offering a comprehensive approach to improving sleep and mental well-being in this population.