Development and evaluation of a cognitive behavioural intervention for post-stroke insomnia

Background: CBT for insomnia (CBTI) has been successfully applied to those with long term medical illness as an alternative to sleep medication. Such treatments have not yet been experimentally trialled in with stroke, nor has attention been paid to tailoring CBTI for those living with the challenges of stroke. The present study aimed to modify the standard CBTI protocol for post-stroke insomnia and to test the efficacy. Method: The first phase of the study comprised development of the protocol and consultation with a service user feedback group. The second phase involved a Single Case Experimental Design whereby 5 community dwelling persons with stroke, who met the DSM-IV criteria for insomnia, underwent the modified CBTI protocol. Efficacy of the protocol was determined by measuring sleep, beliefs about sleep, daytime functioning, mood, quality of life and whether participants met the criteria for insomnia. A content analysis was also carried out to elicit qualitative findings from participant feedback and therapist clinical notes. Results: The modified CBTI protocol showed both subjective and objective improvements on one or more sleep parameter for all participants. Three participants no longer met the criteria for insomnia at post-treatment. CBTI was associated with improvements in daytime sleepiness, quality of life and belief change about sleep. The content analysis suggested that behavioural techniques were preferred by participants over cognitive strategies. 3 I I ~ Conclusion: This study has shown that the modified CBTI protocol was beneficial for reversing insomnia symptoms in those with stroke. 4