A case report of dyadic CBT-I treatment for post-stroke insomnia with severe impairment

Abstract

Sleep disorders, including insomnia and sleep apnea, are highly prevalent among stroke survivors and impact quality of life and mortality risk. Moreover, patient sleep disruptions contribute to poor sleep and burnout among caregivers. Although CBT-I is the first-line recommended treatment for chronic insomnia disorder, mobility and cognitive impairments increase barriers for stroke survivors to engage in CBT-I. This case report demonstrates a dyadic perspective on insomnia treatment in a patient who experienced a both stroke and cancer treatment. The description discusses the facilitating factors and barriers from his spouse/caregiver who experiences challenges to treatment related to the patient illness and caregiver sleep disruption/burden. The case demonstrates how the therapist and couple worked collaboratively using a dyadic perspective to problem solve barriers to CBT-I and demonstrates effects of sleep improvement on the patient and caregiver.

Keywords: Cancer; Cognitive behavioral therapy; Insomnia; Partner; Stroke.