Evaluation of the efficacy of a new insomnia service providing cognitive behavioural therapy for insomnia

Louise Berger

Abstract

Background: The Royal Surrey County Hospital Sleep Clinic has been providing respiratory sleep services for around 7 years. A gap in service provision was identified when patients referred for sleep apnoea assessments, were frequently found to have symptoms more suggestive of insomnia. Staff found they had inadequate knowledge to treat this condition and requested the specialist skills of an Occupational Therapist to establish and run a new insomnia service.Methods: An Occupational Therapist lead programme, providing one to one Cognitive Behavioural Therapy for Insomnia (CBT-I) was introduced and outcomes were measured using the Insomnia Severity Index (ISI). This is a widely used, standardised, self-report instrument designed to assess the severity of both night-time and daytime components of insomnia. Data is available from 38 patients who have completed treatment so far. Sixty-three percent of referrals came from the Sleep Clinic, the remainder were mainly from General Practitioners (GPs). Patient ages range between 30 and 81 years old and insomnia chronicity was between 3 months and 20+ years. Co-morbidities were common and included unmanaged sleep apnoea.
Results: The Insomnia Severity Index provides an indication of the severity of the insomnia, according to the overall score which is out of 27 (‘no insomnia’, ‘subthreshold insomnia’, ‘moderate insomnia’ and ‘severe insomnia’). The mean pre-treatment score was 19, vs. a mean post-treatment score of 8. Ninety percent of patients made an improvement significant enough to reduce their insomnia severity by at least one category. Only 10% of patients made no improvement. Forty five percent of patients were found to have ‘no insomnia’ after treatment.
Conclusions: An improvement in 90% of patients suggests this insomnia service is effectively treating patients with chronic insomnia. The author would speculate that offering an Insomnia Service as an integral part of the respiratory sleep service is key to providing a comprehensive treatment programme for patients and for enhancing the skills and knowledge base of clinicians. This review of service is limited by data being restricted to before and immediately after treatment. Follow up data is currently being gathered to measure longer term treatment outcomes.