Clinical Research Studies

Insomnia and Neuropathy Neuropathic pain and chronic pain is associated with sleep disturbances suggesting that increased pain sensitivity and sleep disturbance have a complex relationship. Importantly, insomnia is modifiable with targeted psychological interventions. Thus, strategies to identify and modify sleep may improve neuropathic pain symptoms, quality of life, and sleep duration. This may be especially necessary in diabetic populations with a high incidence of peripheral neuropathy and older patients for which pharmacologic treatments are sub-optimal or intolerable. Insomnia is a disturbance of sleep continuity associated with daytime complaints related to sleepiness, fatigue, somatic symptoms (e.g., headaches or body aches), mood and cognitive changes, impaired occupational function, concerns about sleep, or dissatisfaction with sleep. Insomnia is estimated to occur in up to a third of the adult population worldwide and primary care practices report upwards of 50% prevalence of insomnia in outpatients. Insomnia is often comorbid with other medical conditions (e.g., cardiometabolic diseases and depression), and is often reported as a symptom associated with peripheral neuropathy. Insomnia and MG Insomnia and difficulty sleeping has been reported in patients with Myasthenia Gravis (MG) and as a contributing factor to the fatigue that is often reported in this immune mediated neuromuscular disease.29 Chronic use of corticosteroids for immunosuppression has been associated with insomnia in patients with MG.29,30 In one study that examined sleep outcomes, in 54 patients with MG, 60% of participants had a Pittsburgh Sleep Quality Index (PSQI) score that was pathological (PSQI > 5).30 When these patients were further stratified those with more severe clinical MG had worse scores compared to those in clinical remission (pathological PSQI score was found in 82.6% of patients in the generalized category, 50% in the ocular category and 40% in the remission category) suggesting that disease severity may also be a factor related to impaired sleep in MG.30 In a larger population-based study out of Denmark, participants who responded to an online survey regarding fatigue and level of physical activity had elevated insomnia severity index (ISI) scores.31 In addition to insomnia excessive daytime sleepiness has been reported in MG.30,32,33 Excessive daytime sleepiness and clinically worse MG is associated with obstructive sleep apnea (OSA) with the population prevalence of OSA in MG being greater than in the general population (36% compared to an expected prevalence of 15 to 20% in the general population).32 However excessive daytime sleepiness as measured by the ESS is also reported in people with MG in clinical remission.30 As mentioned above, insomnia is highly prevalent in the United States and regardless of whether insomnia is a primary medical condition or associated with another co-morbid disease, the American College of Physicians (ACP) recommends that treatment for insomnia with cognitive behavioral therapy-insomnia (CBT-I) to improve sleep health should be provided regardless of the presence or absence of any comorbid illnesses that could have precipitated the insomnia.10 CBT-I may also help reduce insomnia symptoms even when co-morbid with other sleep disorders.16 It is unclear if an intervention like CBT-I could improve MG symptoms and fatigue associated with MG. People with neuropathy sometimes can also utilize complimentary and integrative therapies (CIT). Since the global pandemic, there has been a proliferation of mindfulness-based applications and virtual psychotherapy along with vitamins and supplements that some people with neuropathy may be utilizing. Some people have also been receiving acupuncture and massage and physical therapy to compliment their treatments as well. Our goal is to assess what types of CIT our patients are utilizing in addition to pharmacological therapies that we prescribe for patients with peripheral neuropathy.