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

Publication Type:

Journal Article

Authors:

Ouellet, Marie-Christine; Charles M Morin

Source:

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

Keywords:

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

Abstract:

OBJECTIVE: To test the efficacy of a cognitive behavioral therapy (CBT) for insomnia with a patient with traumatic brain injury (TBI).DESIGN: Single-case study.SETTING: Outpatient rehabilitation center.PARTICIPANT: 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.INTERVENTIONS: Eight weekly individual CBT sessions. Treatment included stimulus control, sleep restriction, cognitive therapy, and sleep hygiene education.MAIN OUTCOME MEASURES: Sleep diary and polysomnography data.RESULTS: 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.CONCLUSIONS: 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.