Can people with poststroke insomnia benefit from blended cognitive behavioral therapy? A single case experimental design

Marthe E. Ford; Gert J. Geurtsen; Ben Schmand; Erny Groet; Coen A.M. Van Bennekom; Eus J.W. Van Someren

doi:10.1071/IB23036

RESEARCH ARTICLE (Open Access)

Previous Next Contents Vol 24(3)

Can people with poststroke insomnia benefit from blended cognitive behavioral therapy? A single case experimental design

Marthe E. Ford

^A ^B ^* , Gert J. Geurtsen ^C , Ben Schmand ^C , Erny Groet ^A , Coen A.M. Van Bennekom ^A ^D and Eus J.W. Van Someren ^B ^E

+ Author Affiliations

- Author Affiliations

^A Research and Development, Heliomare Rehabilitation, Wijk aan Zee, The Netherlands

^B Departments of Integrative Neurophysiology and Psychiatry, Amsterdam UMC, VU University, The Netherlands

^C Amsterdam UMC, University of Amsterdam, Department of Medical Psychology, The Netherlands

^D Coronel Institute for Labor and Health /Amsterdam UMC, Location AMC, Amsterdam, The Netherlands

^E Department of Sleep and Cognition, Netherlands Institute for Neuroscience, Amsterdam, The Netherlands

^* Correspondence to: m.ford@heliomare.nl

Brain Impairment 24(3) 696-720 https://doi.org/10.1017/BrImp.2022.12

Submitted: 28 June 2021 Accepted: 23 March 2022 Published: 31 May 2022

© The Author(s), 2022. Published by Cambridge University Press on behalf of Australasian Society for the Study of Brain Impairment. This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

Sleep is essential for our overall health and wellbeing. Unfortunately, stroke often induces insomnia, which has been shown to impede rehabilitation and recovery of function. Cognitive behavioral therapy for insomnia (CBT-I) is the treatment of choice for insomnia in the general population and is efficacious both when delivered face-to-face or online. The primary aim of this study was to evaluate efficacy of blended CBT-I (eCBT-I) in five poststroke participants with insomnia according to DSM-5 criteria.

Methods:

A randomized multiple baseline design was used to evaluate improvements in total sleep time, sleep onset latency, sleep efficiency, nocturnal awakenings and sleep quality. The intervention included six weeks of eCBT-I combined with two face-to-face sessions.

Results:

All participants completed the intervention. One participant stopped using the diary, while the other four completed it fully. All five sleep diary measures improved, significantly so for nocturnal awakenings. Moreover, after completion of the treatment, four out of five participants no longer fulfilled DSM-5 criteria for insomnia disorder

Conclusions:

This is the first study to show that blended CBT-I is potentially effective in participants with post-stroke insomnia. The findings justify extension to a randomized controlled trial.

Keywords: cognitive behavioral therapy, sleep, eHealth, acquired brain injury, rehabilitation, stroke, insomnia.

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