Introduction Cognitive Behavioural Therapy for Insomnia (CBT-I) is the first line therapy for insomnia, a common risk factor in psychiatry. We investigated whether piloting a CBT-I programme within a Community Mental Health Team (CMHT) improves insomnia symptoms. Our programme consisted mainly of Sleep Restriction Therapy (SRT) determined by individual chronotypes. CBT-I is currently under-resourced in the UK. To our knowledge, this was the first NHS programme in Bristol secondary mental health.
Methods 10 participants were recruited. Participants underwent a therapist guided initiation on (a) Sleep education (b) Sleep hygiene (c) Stimulus Control. Individual sleep windows were determined by the participants’ chronotype: whether they were a ‘morning lark’ or ‘evening owl’. Participants then underwent a 6-week course of Sleep Restriction Therapy (SRT). Weekly follow up focussed around motivation and explanation was either by phone or face-to-face due to the COVID-19 pandemic. Outcome measurements used pre- and post-intervention sleep diaries; as well as insomnia, depression (PHQ-9) and general health questionnaires (SF-36).
Results There was little improvement in Total Sleep Time (TST) (d= -0.84 hours) and patient-reported sleep quality (d= -0.67) following a 6-week course of modified CBT-I. Despite this, average number of mid-sleep awakenings roughly halved (47.9%). ISI, PHQ-9 and SF-36 questionnaires demonstrated no difference between pre-intervention and post-intervention scores. Unstructured interviews revealed that patients’ thoughts and anxieties at night-time interfered with SRT.
Conclusions Our study suggests that modified CBT-I is a challenge for mental health populations. Solely SRT may not be sufficient to treat insomnia secondary to mental illness. Treating co-morbid insomnia may therefore require multi-component CBT-I to address sleep-related mental health issues, such as panic attacks, flashbacks and nightmares. CBT-I in secondary mental health services requires further development, with long-term follow up of patients to evaluate adherence to the programme and the behavioural changes needed.
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