Background/Objective: Cognitive-behavioral therapy (CBT) is one of the first-line treatments in the management of fibromyalgia (FM) and it has been applied with considerable success to treat the psychological processes associated with pain and insomnia. We hypothesized that treating sleep and pain jointly with new combined modalities of CBT may offer greater sleep-related benefits to patients. Method: Thirty-nine female patients with FM and insomnia were randomly allocated to receive CBT centered on pain (CBT-P) or combined CBT focused on pain and insomnia (CBT-C). Participants were assessed at baseline and post-treatment with the Pittsburgh Sleep Quality Index and an ambulatory polysomnography.Results: Participants who received CBT-P showed increases in time in bed and total sleep time and decreases in light sleep, but there was no improvement in perceived sleep quality. Participants who received combined CBT-C showed more meaningful improvements related to refreshing sleep (i.e., higher sleep efficiency and less time awake and longer time in Stage 4 sleep), and these changes were concordant with a significant improvement in self-perceived sleep quality. Conclusions: This study suggests that new CBT-C approaches can improve insomnia-related clinical aspects.

背景/目的：认知行为疗法（CBT）是管理纤维肌痛（FM）的一线治疗方法之一，并且已成功地用于治疗与疼痛和失眠有关的心理过程。我们假设，结合新的CBT组合疗法来治疗睡眠和疼痛可能会为患者带来更多与睡眠相关的益处。方法：将39名患有FM和失眠的女性患者随机分配至以疼痛为中心的CBT（CBT-P）或以疼痛和失眠为中心的CBT组合（CBT-C）。在基线和治疗后用匹兹堡睡眠质量指数和动态多导睡眠图对参与者进行评估。结果：接受CBT-P治疗的参与者的卧床时间和总睡眠时间增加，而轻度睡眠减少，但觉察到的睡眠质量没有改善。接受CBT-C联合治疗的参与者表现出与刷新睡眠有关的更有意义的改善（即，更高的睡眠效率，更少的清醒时间和更长的第四阶段睡眠时间），这些变化与自我感觉到的睡眠质量有了显着改善。结论：这项研究表明，新的CBT-C方法可以改善失眠相关的临床方面。