Cognitive behavioral therapy for insomnia associated with traumatic brain injury: a single-case study

Arch Phys Med Rehabil. 2004 Aug;85(8):1298-302. doi: 10.1016/j.apmr.2003.11.036.


Objective: To test the efficacy of a cognitive behavioral therapy (CBT) for insomnia with a patient with traumatic brain injury (TBI).

Design: Single-case study.

Setting: Outpatient rehabilitation center.

Participant: A man in his late thirties who sustained a moderate TBI in a motor vehicle crash and who developed insomnia. He complained of difficulties falling asleep and staying asleep, despite pharmacotherapy with zopiclone.

Interventions: Eight weekly individual CBT sessions. Treatment included stimulus control, sleep restriction, cognitive therapy, and sleep hygiene education.

Main outcome measures: Sleep diary and polysomnography data.

Results: Sleep onset decreased from 47 to 18 minutes, and nocturnal awakenings dropped from 85 to 28 minutes on average at posttreatment. Sleep efficiency also increased substantially (58% to 83%). Polysomnography evaluations corroborated the diary data by showing a decrease in total time awake (63.2 to 26.3 min) and in the number of awakenings (21 to 7.5). The majority of gains were well maintained at 1- and 3-month follow-up assessments.

Conclusions: These preliminary results suggest that sleep disturbances after TBI can be alleviated with a nonpharmacologic intervention. CBT for post-TBI insomnia is a promising therapeutic avenue deserving more scientific and clinical attention.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Affect
  • Attitude to Health
  • Brain Injuries / complications*
  • Cognitive Behavioral Therapy / methods*
  • Fatigue / diagnosis
  • Fatigue / etiology
  • Follow-Up Studies
  • Glasgow Coma Scale
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Male
  • Neuropsychological Tests
  • Polysomnography
  • Self Care / methods
  • Self Care / psychology
  • Severity of Illness Index
  • Sleep Initiation and Maintenance Disorders / diagnosis
  • Sleep Initiation and Maintenance Disorders / etiology
  • Sleep Initiation and Maintenance Disorders / psychology
  • Sleep Initiation and Maintenance Disorders / therapy*
  • Treatment Outcome
  • Wechsler Scales