***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Forty-five adults with primary insomnia received cognitive-behavioral therapy ( CBT ) implemented in a group therapy format , in individual face-to-face therapy or through brief individual telephone consultations . The results indicate that CBT was effective in improving sleep parameters with all 3 methods of treatment implementation , and there was no significant difference across methods of implementation . All 3 treatment modalities produced improvements in sleep that were maintained for 6 months after treatment completion . These results suggest that group therapy and telephone consultations represent cost-effective alternatives to individual therapy for the management of insomnia Insomnia is a major health problem , with significant psychological , health , and economic consequences . Studies have demonstrated that cognitive-behavioural therapy can effectively treat insomnia ; however , treatment availability is limited by many factors , including a lack of trained clinicians . One potential way to overcome these barriers is to use the Internet to deliver treatment . Toward this aim , we developed a self-guided , interactive , tailored Internet intervention for adults with insomnia ( SHUTi : Sleep Healthy Using The Internet )  . The current paper provides a detailed description of SHUTi and examines users ' perceptions of the intervention 's usefulness and effectiveness . The study was part of a larger r and omised controlled trial ( RCT ) to test the efficacy of SHUTi , but findings in this paper are based only on the 21 participants who completed the post- assessment after using SHUTi . The overwhelming majority rated SHUTi as convenient , underst and able , and useful . Nearly all ( 95 % ) indicated that the program had at least somewhat improved their sleep , sleep efficiency , and overall quality of life . Ninety percent perceived the intervention as effective and predicted it would be effective in producing a long-term cure . Although these results were based on a small sample , they provide encouraging evidence of the potential for Internet interventions to be accepted by patients Sleep disturbance is common in patients with advanced cancer , and their family carers also may suffer from sleep problems . The aims of this study were to determine the prevalence of sleep-wake disturbances in patients with advanced cancer and their carers , to monitor the amount of daytime spent in activity and rest , and to examine the relationship between sleep , physical , and psychological symptoms . This was a prospect i ve , descriptive observational study in patients with advanced incurable cancer and their carers attending a regional cancer center , using subjective ( Short Form-36 ,  Epworth Sleepiness Score , Hospital Anxiety and Depression Scale , Memorial Symptom Assessment Scale  , and  sleep history and diary ) and objective ( Actiwatch ) assessment s over a seven-day period . Sixty patients with advanced cancer and their family carers completed the study .  Poor sleep was a frequent complaint : 47 % of the patients and 42 % of the carers reported that they did not sleep well , yet patients reported sleeping an average of 8.2 hours and carers 7.8 hours per night . The objective assessment s revealed that although sleep efficiency ( SE ) was greater than 90 % for most patients and carers , sleep fragmentation was high in both groups . Patients and carers who complained of poor sleep were significantly more anxious ( P<0.001 and < 0.05 ) compared with patients and carers who reported sleeping well . Patients who complained of poor sleep had significantly more pain ( P<0.05 ) . These results show that a substantial proportion of advanced cancer patients and their carers complained of poor sleep despite reporting " normal " duration of sleep . Objective measurements using Actiwatch revealed good SE but high levels of sleep fragmentation and movement , suggesting that sleep quality may be disturbed . Further work is required to investigate sleep quality and the consequences of poor sleep . In the meantime , health care professionals need to routinely inquire about sleep and consider possible reversible underlying factors , such as pain and anxiety , for those who report sleep disturbance BACKGROUND Chronic sleep-onset insomnia is a prevalent health complaint in adults . Although behavioral and pharmacological therapies have been shown to be effective for insomnia , no placebo-controlled trials have evaluated their separate and combined effects for sleep-onset insomnia . The objective of this study was to evaluate the clinical efficacy of behavioral and pharmacological therapy , singly and in combination , for chronic sleep-onset insomnia . METHODS This was a r and omized , placebo-controlled clinical trial that involved 63 young and middle-aged adults with chronic sleep-onset insomnia . Interventions included cognitive behavior therapy ( CBT ) , pharmacotherapy , or combination therapy compared with placebo . The main outcome measures were sleep-onset latency as measured by sleep diaries ; secondary measures included sleep diary measures of sleep efficiency and total sleep time , objective measures of sleep variables ( Nightcap sleep monitor recorder ) , and measures of daytime functioning . RESULTS In most measures , CBT was the most sleep effective intervention ; it produced the greatest changes in sleep-onset latency and sleep efficiency , yielded the largest number of normal sleepers after treatment , and maintained therapeutic gains at long-term follow-up . The combined treatment provided no advantage over CBT alone , whereas pharmacotherapy produced only moderate improvements during drug administration and returned measures toward baseline after drug use discontinuation . CONCLUSIONS These findings suggest that young and middle-age patients with sleep-onset insomnia can derive significantly greater benefit from CBT than pharmacotherapy and that CBT should be considered a first-line intervention for chronic insomnia . Increased recognition of the efficacy of CBT and more widespread recommendations for its use could improve the quality of life of a large numbers of patients with insomnia Sleep disturbance is a very common problem for cancer patients that has largely not been addressed in the clinical intervention literature . Mindfulness meditation has demonstrated clinical benefits for a variety of patient population s in other areas of functioning . This study examined the effects of an 8-week Mindfulness-Based Stress Reduction ( MBSR ) program on the sleep quality of a heterogeneous sample of 63 cancer patients . Overall sleep disturbance was significantly reduced ( p < .001 ) and participants reported that their sleep quality had improved ( p < .001 ) . There was also a significant reduction in stress ( p < .001 ) , mood disturbance ( p = .001 ) , and fatigue ( p < .001 ) . The associations among these changes and implication s for improving quality of life of cancer patients are discussed OBJECTIVE The aim of this study was to investigate the potential of mindfulness-based stress reduction ( MBSR ) as a treatment for  chronic primary insomnia .  DESIGN A r and omized controlled trial was conducted . SETTING The study was conducted at a university health center . PATIENTS Thirty adults with primary chronic insomnia based on criteria of the Diagnostic and Statistical Manual of Mental Disorders , Text Revision , 4th Edition were r and omized 2:1 to MBSR or pharmacotherapy ( PCT ) . INTERVENTIONS Mindfulness-based stress reduction , a program of mindfulness meditation training consisting of eight weekly 2.5 hour classes and a daylong retreat , was provided , with ongoing home meditation practice expectations during three-month follow-up ; PCT , consisting of three milligrams of eszopiclone ( LUNESTA ) nightly for eight weeks , followed by three months of use as needed . A 10-minute sleep hygiene presentation was included in both interventions . MAIN OUTCOMES The Insomnia Severity Index ( ISI ) , Pittsburgh Sleep Quality Index ( PSQI ) , sleep diaries , and wrist actigraphy were collected pretreatment , posttreatment ( eight weeks ) , and at five months ( self-reports only ) . RESULTS Between baseline and eight weeks , sleep onset latency ( SOL ) measured by actigraphy decreased 8.9 minutes in the MBSR arm ( P < .05 ) . Large , significant improvements were found on the ISI , PSQI , and diary-measured total sleep time , SOL , and sleep efficiency ( P < .01 , all ) from baseline to five-month follow-up in the MBSR arm . Changes of comparable magnitude were found in the PCT arm . Twenty-seven of 30 patients completed their assigned treatment . This study provides initial evidence for the efficacy of MBSR as a viable treatment for chronic insomnia as measured by sleep diary , actigraphy , well-vali date d sleep scales , and measures of remission and clinical recovery Purpose This study aims to provide recommendations on the optimal strategies and interventions for the prevention , screening , assessment , and management of  cancer-related sleep disturbance ( insomnia and insomnia syndrome ) in adult cancer population s. Methods A systematic search of the published health literature was conducted to identify r and omized controlled trials , clinical practice guidelines , systematic review s , and other guidance documents . The Sleep Disturbance Expert Panel [ comprised of nurses , psychologists , primary care physicians , oncologists , physicians specialized in sleep disturbances , research ers , and guideline method ologists ] review ed , discussed , and approved the final version of the guideline . Health care professionals across Canada were asked to provide feedback through an external review process . Results Three clinical practice guidelines and 12 r and omized controlled trials were identified as the evidence base . Overall , despite the paucity of evidence , the evidence and expert consensus suggest that it is important to screen and assess adult cancer patients for sleep disturbances using st and ardized screening tools on a routine basis . While prevention of sleep disturbance is the desired objective , cognitive behavioral therapies are effective in improving sleep outcomes . As part of the external review with 16 health care providers , 81 % indicated that they agreed with the recommendations as written . Conclusions Sleep difficulty is a prevalent problem in cancer population s that needs greater recognition by health professionals . Prevention , screening , assessment , and treatment strategies supported by the best available evidence are critical . Recommendations and care path algorithms for practice are offered CONTEXT Insomnia is a common condition in older adults and is associated with a number of adverse medical , social , and psychological consequences . Previous research has suggested beneficial outcomes of both psychological and pharmacological treatments , but blinded placebo-controlled trials comparing the effects of these treatments are lacking . OBJECTIVE To examine short- and long-term clinical efficacy of cognitive behavioral therapy ( CBT ) and pharmacological treatment in older adults experiencing chronic primary insomnia . DESIGN , SETTING , AND PARTICIPANTS A r and omized , double-blinded , placebo-controlled trial of 46 adults ( mean age , 60.8 y ; 22 women ) with chronic primary insomnia conducted between January 2004 and December 2005 in a single Norwegian university-based outpatient clinic for adults and elderly patients . INTERVENTION CBT ( sleep hygiene , sleep restriction , stimulus control , cognitive therapy , and relaxation ; n = 18 ) , sleep medication ( 7.5-mg zopiclone each night ; n = 16 ) , or placebo medication ( n = 12 ) . All treatment duration was 6 weeks , and the 2 active treatments were followed up at 6 months . MAIN OUTCOME MEASURES Ambulant clinical polysomnographic data and sleep diaries were used to determine total wake time , total sleep time , sleep efficiency , and slow-wave sleep ( only assessed using polysomnography ) on all 3 assessment points . RESULTS CBT result ed in improved short- and long-term outcomes compared with zopiclone on 3 out of 4 outcome measures . For most outcomes , zopiclone did not differ from placebo . Participants receiving CBT improved their sleep efficiency from 81.4 % at pretreatment to 90.1 % at 6-month follow-up compared with a decrease from 82.3 % to 81.9 % in the zopiclone group . Participants in the CBT group spent much more time in slow-wave sleep ( stages 3 and 4 ) compared with those in other groups , and spent less time awake during the night . Total sleep time was similar in all 3 groups ; at 6 months , patients receiving CBT had better sleep efficiency using polysomnography than those taking zopiclone . CONCLUSION These results suggest that interventions based on CBT are superior to zopiclone treatment both in short- and long-term management of insomnia in older adults . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00295386 PURPOSE To determine 1-year outcomes of a four-component behavioral therapy ( BT ) sleep intervention ( Individualized Sleep Promotion Plan [ ISPP ] ) versus a healthy eating control ( HEC ) on cancer-related fatigue in women receiving breast cancer adjuvant chemotherapy treatment ( CTX ) . PATIENTS AND METHODS A total of 219 participants from 12 oncology clinics were r and omly assigned in a clinical trial . Before CTX , research nurses coached intervention participants to develop a BT plan including stimulus control , modified sleep restriction , relaxation therapy , and sleep hygiene . BT plans were revised before each CTX and 30 , 60 , and 90 days after the last CTX and reinforced 7 to 9 days later . HEC participants received nutritional information and equal attention . Pittsburgh Sleep Quality Index ( PSQI ) , Daily Diary , Wrist Actigraph , and Piper Fatigue Scale measures and Repeated Linear Mixed Model analysis following the Intent to Treat paradigm were used . RESULTS Sleep quality differed over 1 years time ( F [ 4,162 ] = 7.7 , P < .001 ; by group , F [ 1,173 ] = 4.8 , P = .029 ; and over time by group , F [ 4,162 ] = 3.3 , P = .013 ) . Pairwise comparisons revealed significant differences between groups at 90 days ( P = .002 ) but not at 1 year ( P = .052 ) . Seven days of diary and actigraphy data did not corroborate with monthly reflections ( PSQI ) . The night awakenings ( Actigraph ) 
    Output:
    
Results suggest that CBT-I is associated with statistically and clinical ly significant improvements in subjective sleep outcomes in patients with cancer .
CBT-I may also improve mood , fatigue , and overall quality of life , and can be successfully delivered through a variety of treatment modalities , making it possible to reach a broader range of patients who may not have access to more traditional programs .