Cognitive Behavioral Therapy for Insomnia in the Context of Cardiovascular Conditions

Cardiovascular disease (CVD) is the leading cause of death worldwide and is associated with high levels of morbidity, disability and poor quality of life. The prevalence of insomnia symptoms and diagnosis of insomnia are high among those with CVD. Although insomnia appears to be important to CVD, less is known about the effects of insomnia treatment on important biological, sleep, symptom, quality of life, functional and morbidity or mortality outcomes in people with or at-risk for CVD. The purposes of this paper are to review the literature on the effects of CBT-I on insomnia, sleep, daytime symptoms, function, and biological outcomes in the context of CVD and to suggest implications for future research and practice. Limited available evidence suggests that CBT-I improves biomarkers that may contribute to CVD risk. CBT-I shows promise as a way to improve cardiovascular morbidity associated with the negative biological consequences of chronic insomnia, as well as symptom burden, functional performance and quality of life in the large population of people who are living with chronic CVD and insomnia. Additional research is needed to answer basic questions about short and long term outcomes, the role of biomarkers, and optimal delivery methods of CBT-I in cardiac conditions.