Sleep Disorders

Behavioral Sleep Medicine

The Behavioral Sleep Medicine (BSM) Program at Cleveland Clinic's Sleep Disorders Center provides nonpharmacological treatments for adults, adolescents, and children who suffer from sleep disorders. During the assessment phase, patients and their provider collaboratively develop a comprehensive treatment plan that will identify specific goals for treatment. Depending upon the presenting problem, treatment typically involves cognitive-behavioral therapy (CBT), a form of brief therapy that has extensive research support as an effective way to help people with chronic insomnia, circadian rhythm disorders, nightmare disorder, and difficulty acclimating to positive airway pressure (PAP) therapy for obstructive sleep apnea. The BSM program is also active in research investigating clinical care models for insomnia and outcome data from center clinics, in addition to collaborating with several researchers in the Sleep Disorders Center and with outside academic medical centers across the country. In addition to patient care and research, the BSM program is committed to training and education by sponsoring an accredited postdoctoral fellowship in behavioral sleep medicine.

Insomnia Outcomes in BSM Program

May 2019 – February 2020

SOL = sleep onset latency, WASO = wake after sleep onset

Data represents patients seen for treatment of insomnia in the BSM Psychology Fellow’s clinic (1 Fellow) from May 2019 through February 2020. Patients were selected if they (1) had at least 1 session of cognitive behavioral therapy for insomnia (CBTI); (2) completed sleep diaries as part of treatment; (3) were not currently in treatment; and (4) were aged 18 or older. Patients were also identified as either treatment completers and/or treatment responders based on criteria explained in a study of health care utilization following CBTI.¹ Treatment completers attended ≥ 3 sessions of CBTI; if they attended 1 to 2 sessions they were classified as noncompleters. Among treatment completers, patients were further classified as treatment responders if their sleep diaries indicated (1) either sleep onset latency (SOL) or wakefulness after sleep onset (WASO) reduction of 50% from baseline; or (2) if baseline sleep efficiency (SE)% is < 85%, SE% increased by ≥ 10% by the end of treatment. If neither of these conditions were met, they were classified as nonresponders.

Analysis of wake variables reflect the treatment responder data. SOL significantly decreased from 43.65 min to 21.07 min (P < 0.001). WASO also significantly decreased from 58.26 min to 45.89 min (P = 0.02).

References
  1. McCrae CS, Bramoweth AD, Williams J, Roth A, Mosti C. Impact of brief cognitive behavioral treatment for insomnia on health care utilization and costs. J Clin Sleep Med. 2014 Feb 15;10(2):127-135.