Case presentations from the SLEEP-HD trial: Extension of CBT-I to people with kidney failure treating with hemodialysis

Abstract

People with kidney failure treated with hemodialysis are at higher risk for insomnia due an array of biological, treatment, and behavioral factors. The Short and Long-term Effectiveness of Existing insomnia therapies for Patients undergoing HemoDialysis (SLEEP-HD) trial was a parallel-group, multicenter, placebo-controlled, randomized clinical trial that found no significant difference in the effectiveness of Cognitive Behavior Therapy for Insomnia (CBT-I) or trazodone versus medication placebo in patients undergoing in-center hemodialysis. We now provide case reports from two of the participants treated in the trial, to highlight both the challenges and successes of this approach in this population. Beyond the typical challenges with CBT-I implementation, we observed some unique difficulties faced by people with kidney failure trying to follow standard CBT-I recommendations and we also found evidence that for some, the intervention was quite impactful.