Cognitive behavioral therapy for insomnia associated with traumatic brain injury: a single-case study.

Publication Type:

Journal Article


Arch Phys Med Rehabil, Volume 85, Issue 8, p.1298-302 (2004)


Adult, Affect, Attitude to Health, Brain Injuries, Cognitive Therapy, Fatigue, Follow-Up Studies, Glasgow Coma Scale, Health Knowledge, Attitudes, Practice, Humans, Male, Neuropsychological Tests, Polysomnography, Self Care, Severity of Illness Index, Sleep Initiation and Maintenance Disorders, Treatment Outcome, Wechsler Scales


<p><b>OBJECTIVE: </b>To test the efficacy of a cognitive behavioral therapy (CBT) for insomnia with a patient with traumatic brain injury (TBI).</p><p><b>DESIGN: </b>Single-case study.</p><p><b>SETTING: </b>Outpatient rehabilitation center.</p><p><b>PARTICIPANT: </b>A man in his late thirties who sustained a moderate TBI in a motor vehicle crash and who developed insomnia. He complained of difficulties falling asleep and staying asleep, despite pharmacotherapy with zopiclone.</p><p><b>INTERVENTIONS: </b>Eight weekly individual CBT sessions. Treatment included stimulus control, sleep restriction, cognitive therapy, and sleep hygiene education.</p><p><b>MAIN OUTCOME MEASURES: </b>Sleep diary and polysomnography data.</p><p><b>RESULTS: </b>Sleep onset decreased from 47 to 18 minutes, and nocturnal awakenings dropped from 85 to 28 minutes on average at posttreatment. Sleep efficiency also increased substantially (58% to 83%). Polysomnography evaluations corroborated the diary data by showing a decrease in total time awake (63.2 to 26.3 min) and in the number of awakenings (21 to 7.5). The majority of gains were well maintained at 1- and 3-month follow-up assessments.</p><p><b>CONCLUSIONS: </b>These preliminary results suggest that sleep disturbances after TBI can be alleviated with a nonpharmacologic intervention. CBT for post-TBI insomnia is a promising therapeutic avenue deserving more scientific and clinical attention.</p>

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