Brief behavioral treatment for patients with treatment-resistant insomnia

Abstract

ObjectiveTo evaluate the efficacy of brief behavioral treatment for insomnia (BBTI) in treating patients with treatment-resistant insomnia.MethodsSeventy-nine adults with treatment-resistant insomnia were randomly assigned to receive either individualized BBTI (delivered in two in-person sessions and two telephone “booster” sessions, n=40) or sleep hygiene education (n=39). The primary outcome was subjective (sleep diary) measures of self-report symptoms and questionnaire measures of Pittsburgh sleep quality index (PSQI), insomnia severity index (ISI), Epworth sleeping scale (ESS), and dysfunctional beliefs and attitudes about sleep scale (DBAS).ResultsThe repeated-measures analysis of variance showed significant time effects between pretreatment and posttreatment in the scale ratings of PSQI, ESS, DBAS, ISI, sleep latency (SL), time in bed (TIB), sleep efficiency (SE), and wake after sleep onset (WASO) in both groups and group × time interaction (FPSQI =3.893, FESS =4.500, FDBAS =5.530, FISI =15.070, FSL =8.909, FTIB =7.895, FSE =2.926, and FWASO =2.595). The results indicated significant differences between BBTI and sleep hygiene in change scores of PSQI, ESS, DBAS, ISI, SL, TIB, SE, and WASO. Effect sizes were moderate to large.ConclusionBBTI is a simple and efficacious intervention for chronic insomnia in adults.

The Development of a Sleep Intervention for Firefighters: The FIT-IN (Firefighter’s Therapy for Insomnia and Nightmares) Study

“…SOL decreased from 33 min to 21 min, and post-intervention average SOL was reported to be within normal limits [ 68 ]. This was consistent with previous studies that showed significant improvement in sleep indices following BBTi in various target groups such as the elderly and adult insomnia patients [ 23 , 24 , 28 ]. There were also improvements for insomnia severity and daytime sleepiness scores, suggesting that brief intervention is helpful in alleviating sleep disturbance in this population.…”

“…Brief behavior therapy for insomnia (BBTi) is a short-term sleep intervention that facilitates high patient compliance because of shorter delivery time compared to traditional cognitive-behavioral therapy for insomnia (CBTi) [ 23 , 24 ]. BBTi was developed to address common barriers, such as the duration of treatment sessions and the number of specialty-trained clinicians available that is encountered in the provision of evidence-based CBTi [ 25 ].…”

“…BBTi has the advantage of being effective with short-term sessions, and easier deliverability by a nurse or paraprofessional without a large amount of specialty training [ 26 ]. In addition, BBTi was developed to meet the needs for primary care settings, focusing on brief content and behavioral strategies, and comprised of stimulus control (an intervention that helps strengthen the association between the bed and sleep by instructing participants to use the bed for sleeping only), sleep restriction (an intervention that limits the time participants spent in bed awake), and some sleep-wake rules, such as limiting naps [ 24 ].…”

A step-by-step model for a brief behavioural treatment for insomnia in Australian general practice

“…The RACGP benzodiazepine guideline supports the use of BBTi, which can be delivered by general practitioners (GPs) and practice nurses with minimal training and without the need for costly overnight sleep studies. 7,15 Despite the shorter duration, BBTi is effective in a diverse group of patients with insomnia, including in older adults, 13 comorbid depression, 16 hypnotic-resistant insomnia 17 and individuals living with human immonodeficiency virus. 18 Furthermore, BBTi assists patients in withdrawing from sedative-hypnotic medications, by improving sleep and reducing withdrawal/ rebound insomnia symptoms.…”

“…18 Furthermore, BBTi assists patients in withdrawing from sedative-hypnotic medications, by improving sleep and reducing withdrawal/ rebound insomnia symptoms. 17 A step-by-step model for a brief behavioural treatment for insomnia in Australian general practice Importantly, several previous studies have shown the feasibility and efficacy of BBTi and other brief CBTi interventions in general practice settings, 19,20 and when administered by practice nurses. 14,20 Insomnia and depression/anxiety disorders commonly co-occur.…”