Since many patients with arthritis report sleep disturbances (Louie et al., 2011), inquiring about sleep problems is important for identifying and subsequently treating sleep disturbances that could, in turn, improve other arthritis-related symptoms such as pain, fatigue, depression, and disability. As compared to pharmacotherapy, CBT-I is often preferred by patients (Morin, Gaulier, Barry, & Kowatch, 1992) and has been shown to have short-term and long-term efficacy (Irwin, Cole, & Nicassio, 2006). Preliminary evidence suggests that CBT-I can improve sleep quality and pain in those with OA (Vitiello et al., 2009, 2013, 2014). Given that arthritis can cause activity limitations and restrict patients’ ability to get around outside their homes (Verbrugge & Juarez, 2006), patients may be reluctant to undergo CBT-I which requires 6–8 weekly face-to-face individual sessions. Thus, alternative nonpharmacological insomnia treatment options that are less intensive may be more appealing to patients and have more widespread dissemination.

Brief behavioral treatment for insomnia (BBTI) is a manualized, behavioral treatment program involving two in-person sessions and two telephone booster sessions. BBTI can be delivered by healthcare professionals without specialized training. BBTI emphasizes the behavioral components of CBT-I, in particular sleep restriction and stimulus control, by modifying waking behaviors to increase and regulate the duration of wakefulness to increase homeostatic sleep drive and provide an individualized sleep and wake prescription to optimize the circadian sleep drive (Troxel, Germain, & Buysse, 2012). The intervention provides patients with four main “rules” for better sleep (Table 9.1): (1) reduce time in bed, (2) get up at the same time of day every day, regardless of sleep duration, (3) do not go to bed unless sleepy, and (4) do not stay in bed unless asleep. BBTI has been shown to have short-term efficacy in a sample of 79 older adults with insomnia and comorbid conditions (Buysse et al., 2011). In brief, participants were randomly assigned to either BBTI or an information control consisting of printed sleep education materials. As compared to the IC group, patients receiving BBTI reported significant improvements in sleep diary- and actigraphy-measured sleep outcomes and had greater rates of treatment response (defined as PSQI score of ≥3 points or change in sleep diary sleep efficiency of ≥10 %) at posttreatment. Of the 25 patients with a favorable treatment response, 64 % no longer met insomnia criteria at 6-month follow-up.

Only one study has directly tested the effects of a sleep intervention in patients with arthritis (Vitiello et al., 2013, 2014). The favorable effects of CBTI on sleep and pain in this study warrant future research to explore cognitive and behavioral treatments for insomnia in patients with arthritis. BBTI may be a viable treatment option due to its brief design requiring limited in-person sessions and the advantage of treatment delivery by nurses and other professionals with limited experience in sleep medicine or behavioral therapies.