Insomnia is one of the more common sleep–wake disorders from which people suffer. This is particularly true among individuals who have experienced neurological insult via conditions such as multiple sclerosis, stroke, and other neurodegenerative disorders. While cognitive-behavioral therapy for insomnia (CBT-I) is one of the most effective behavioral interventions for insomnia, there is a dearth of empirical literature on its application to patients who have a history of neurological disorders. The present case study illustrates a largely successful course of CBT-I to treat a persistent and severe case of insomnia for Eric, a 55-year-old Caucasian man with multiple sclerosis and a self-reported history of restless leg syndrome and stroke. His treatment course is described in detail, and the implications of this approach to care are discussed.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing.
2.
BastiemC. H.VallièresA.MorinC. M. (2001). Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Medicine, 2, 297–307.
3.
BazilC. W. (2003). Effects of antiepileptic drugs on sleep structure. CNS Drugs, 17, 719–728.
4.
BraleyT. J.BoudreauE. A. (2016). Sleep disorders in multiple sclerosis. Current Neurology and Neuroscience Reports, 16, Article 50. https://doi.org/10.1007/s11910-016-0649-2
5.
ChengP.LuikA. I.Fellman-CoutureC.PetersonE.JosephC. L. M.TallentG.. . . DrakeC. L. (2019). Efficacy of digital CBT for insomnia to reduce depression across demographic groups: A randomized trial. Psychological Medicine, 49, 491–500. https://doi.org/10.1017/S0033291718001113
6.
ClancyM.DrerupM.SullivanA. B. (2015). Outcomes of cognitive-behavioral treatments for insomnia on insomnia, depression, and fatigue for individuals with multiple sclerosis: A case series. International Journal of MS Care, 17, 261–267.
7.
DykenM. E.AfifiA. K.Lin-DykenD. C. (2012). Sleep-related problems in neurologic diseases. Chest, 141, 528–544. https://doi.org/10.1378/chest.11-0773
8.
EdingerJ. D.WohlgemuthW. K.RadtkeR. A.CoffmanC. J.CarneyC. E. (2007). Dose-response effects of cognitive-behavioral insomnia therapy: A randomized clinical trial. Sleep, 30, 203–212. https://doi.org/10.1093/sleep/30.2.203
9.
GrewalR. G.DoghramjiK. (2016). Epidemiology of insomnia. In AttarianH. P. (Ed.), Clinical handbook of insomnia (pp. 13–25). Springer.
10.
JohnsM. W. (1991). A new method for measuring daytime sleepiness: The Epworth Sleepiness Scale. Sleep, 14, 540–545.
11.
JohnsM. W.HockingB. (2004). Daytime sleepiness and sleep habits of Australian workers. Sleep, 20, 844–849.
12.
LapinB. R.BenaJ. F.WaliaH. K.MoulD. E. (2018). The Epworth Sleepiness Scale: Validation of one-dimensional factor structure in a large clinical sample. Journal of Clinical Sleep Medicine, 14, 1293–1301.
13.
LundeH. M. B.AaeT. F.IndrevågW.AarsethJ.BjorvatnB.MyhrK. M.BøL. (2012). Poor sleep in patients with multiple sclerosis. PLOS ONE, 7(11), e49996. https://doi.org/10.1371/journal.pone.0049996
14.
MajendieC. M.DyschL.CarriganN. (2017). Cognitive Behavioral Therapy for Insomnia (CBT-I) for an adult with multiple sclerosis. Clinical Case Studies, 16, 115–131.
15.
MignognaJ.MartinL. A.HarikJ.HundtN. E.KauthM.NaikA. D.. . . CullyJ. (2018). “I had to somehow still be flexible”: Exploring adaptations during implementation of brief cognitive behavioral therapy in primary care. Implementation Science, 13, Article 76.
16.
MorinC. M. (1993). Insomnia: Psychological assessment and management. New York, NY: Guilford Press.
17.
OhayonM.WickwireE. M.HirshkowitzM.AlbertS. M.AvidanA.DalyF. J.. . . VitielloM. V. (2017). National Sleep Foundation’s sleep quality recommendations: First report. Sleep Health, 3, 3–19.
18.
PillaiJ. A.LeverenzJ. B. (2017). Sleep and neurodegeneration: A critical appraisal. Chest, 151, 1375–1386.
19.
SalamO. A. A.GhonimiN. A.IsmailM. H. (2019). Risk of obstructive sleep apnea in multiple sclerosis: Frequency, clinical and radiological correlates. Multiple Sclerosis and Related Disorders, 28, 184–188.
20.
SiebernA. T.ManberR. (2011). New developments in cognitive behavioral therapy as the first-line treatment of insomnia. Psychology Research and Behavior Management, 4, 21–28.
21.
TruijensF.Zuhlke-van HulzenL.VanheuleS. (2019). To manualize, or not to manualize: Is that still the question? A systematic review of empirical evidence for manual superiority in psychological treatment. Journal of Clinical Psychology, 75, 329–343.
22.
Van StratenA.Van der ZweerdeT.KleiboerA.CuijpersP.MorinC. M.LanceeJ. (2018). Cognitive and behavioral therapies in the treatment of insomnia: A meta-analysis. Sleep Medicine Reviews, 38, 3–16.
23.
WebbC. A.DeRubeisR. J.BarberJ. P. (2010). Therapist adherence/competence and treatment outcome: A meta-analytic review. Journal of Consulting and Clinical Psychology, 78, 200–211.
24.
WinkelmanJ. W. (2015). Insomnia disorder. The New England Journal of Medicine, 373, 1437–1444.
25.
WongM. L.LauK. N. T.EspieC. A.LuikA. I.KyleS. D.LauE. Y. Y. (2017). Psychometric properties of the sleep condition indicator and Insomnia Severity Index in the evaluation of insomnia disorder. Sleep Medicine, 33, 76–81.
26.
WuJ. Q.ApplemanE. R.SalazarR. D.OngJ. C. (2015). Cognitive behavioral therapy for insomnia comorbid with psychiatric and medical conditions: A meta-analysis. JAMA Internal Medicine, 175, 1461–1472. https://doi.org/10.1001/jamainternmed.2015.3006
27.
YoungstedtS. D.KripkeD. F.JamesS. (2017). Sleep duration, morbidity, and mortality. In ChokrovertyS. (Ed.), Sleep disorders medicine (pp. 559–566). Springer.
28.
ZhangH.LiY.LiX.LiuG.WangB.LiC. (2014). Effect of sodium valproate on the sleep structures of epileptic patients. Experimental and Therapeutic Medicine, 7, 1227–1232.
