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Development and Evaluation of a Cognitive Behavioural Intervention for Chronic Post-Stroke Insomnia

Published online by Cambridge University Press:  26 February 2018

Katie Herron ,
Lorna Farquharson ,
Abigail Wroe  and
Annette Sterr
Katie Herron*
Affiliation:
Pain Management Centre, National Hospital For Neurology and Neurosurgery, University College London Hospitals, London, UK Department of Psychology, Royal Holloway, University of London, Surrey, UK
Lorna Farquharson
Affiliation:
Department of Psychology, Royal Holloway, University of London, Surrey, UK
Abigail Wroe
Affiliation:
Clinical Health Psychology Service, Berkshire Healthcare NHS Foundation Trust, Reading, UK
Annette Sterr
Affiliation:
School of Psychology, University of Surrey, Guildford, Surrey, UK
*
Correspondence to Katie Herron, Pain Management Centre, National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, UK. E-mail: katie.herron@nhs.net
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Abstract

Background: Cognitive behavioural therapy for insomnia (CBTI) has been successfully applied to those with chronic illness. However, despite the high prevalence of post-stroke insomnia, the applicability of CBTI for this population has not been substantially researched or routinely used in clinical practice. Aims: The present study developed a ‘CBTI+’ protocol for those with post-stroke insomnia and tested its efficacy. The protocol also incorporated additional management strategies that considered the consequences of stroke. Method: A single-case experimental design was used with five community-dwelling individuals with post-stroke insomnia. Daily sleep diaries were collected over 11 weeks, including a 2-week baseline, 7-week intervention and 2-week follow-up. The Insomnia Severity Index, Dysfunctional Attitudes and Beliefs About Sleep Scale, Epworth Sleepiness Scale, Fatigue Severity Scale and Stroke Impact Scale were administered pre- and post-treatment, as well as at 2-week follow-up. Results: At post-treatment, three participants no longer met diagnostic criteria for insomnia and all participants showed improvements on two or more sleep parameters, including sleep duration and sleep onset latency. Three participants showed a reduction in daytime sleepiness, increased quality of life and reduction in unhelpful beliefs about sleep. Conclusions: This study provides initial evidence that CBTI+ is a feasible and acceptable intervention for post-stroke insomnia. Furthermore, it indicates that sleep difficulties in community-dwelling stroke populations are at least partly maintained by unhelpful beliefs and behaviours. The development and delivery of the CBTI+ protocol has important clinical implications for managing post-stroke insomnia and highlights directions for future research.

Keywords

strokeinsomniacognitive behavioural therapy
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 46 , Issue 6 , November 2018 , pp. 641 - 660
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2018 

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