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Cognitive behavioral therapy for insomnia associated with traumatic brain injury: a single-case study
Marie-Christine Ouellet1, Charles M Morin
1Ecole de Psychologie, Centre d'Etude des Troubles du Sommeil, Université Laval, Québec City, QC, Canada. mcouellet@psy.ulaval.ca
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.