Does cognitive-behavioural therapy improve sleep outcomes in individuals with traumatic brain injury: a scoping review

ABSTRACT

Background

Insomnia symptoms are common after a traumatic brain injury (TBI). Cognitive-behavioural therapy (CBT) to treat sleep disturbances and insomnia (CBT-I) has been used to improve sleep outcomes. It is unclear if CBT/CBT-I is efficacious in individuals with a TBI. This review was performed to evaluate the use of CBT/CBT-I in individuals with a TBI who also endorse insomnia and concomitant symptoms.

Methods

Literature searches were conducted in June 2019. A total of 861 articles were found. The full text of 14 articles was reviewed for inclusion/exclusion criteria. Quality appraisal was conducted to assess the risk of bias.

Results

Five articles met the criteria. Two articles were pilot-randomized control trials and three were case studies. The review indicates that individuals participating in CBT/CBT-I reported increased sleep efficiency, sleep quality, and reduced insomnia symptoms and concomitant symptoms. The major source of bias is a limited number of participants across all studies.

Conclusion

This review provides evidence that CBT/CBT-I following a TBI can improve sleep outcomes and reduce concomitant symptoms. More robust studies are needed due to limited number of randomized control trials to determine if CBT/CBT-I is an effective treatment in individuals with TBI.

KEYWORDS:

• Sleep
• cognitive-behavioural therapy
• insomnia
• traumatic brain injury

Declaration of interest

Rebecca Ludwig has nothing to disclose.

Catherine Siengsukon is the owner and CEO of Sleep Health Education, LLC.

Prasanna Vaduvathiriyan has nothing to disclose.

Additional information

Notes on contributors

Rebecca Ludwig

Rebecca (Becca) Ludwig OTR/L is a practicing occupational therapist at the University of Kansas Medical Center.  Her area of research is focused on evaluating how sleep effects recovery and engagement in meaningful activities through non-pharmacological methods (CBT-I) in people who have had a concussion.  Becca Ludwig received her occupational therapy degree from Concordia University Wisconsin in 2015 and started PhD work in rehabilitation Science at the University of Kansas Medical center in 2018.

Prasanna Vaduvathiriyan

Prasanna Vaduvathiriyan, AHIP, a biomedical librarian has been focusing in the area of academic and clinical medicine since after she I started her education to pursue American Library Association accredited master’s degree in library & information science. Her research interest focuses on Investigating and embracing innovative approaches to facilitate best and effective educational strategies in health sciences. She is committed to function as an integral member of campus-wide educators and care team by maintaining collaborative relationships in scholarly research and facilitating the best evidence-based information in her journey as a medical librarian.

Catherine Siengsukon

Catherine (Katie) Siengsukon ,PT, PhD, is an Associate Professor in the Department of Physical Therapy and Rehabilitation Science and is the Director of the Sleep, Health & Wellness (SleepWell) Laboratory at the University of Kansas Medical Center. Dr. Siengsukon’s research agenda includes understanding the association between sleep and other health-related outcomes (ie. fatigue, cognitive function, pain) and investigating non-pharmacological interventions (ie. exercise, CBT-I) to improve sleep quality in adults, including those with multiple sclerosis. Dr. Siengsukon's research has been funded by the National Institutes of Health, the American Heart Association, and National Multiple Sclerosis Society. Dr. Siengsukon received her MPT from Rockhurst University in 2002 and her PhD in Rehabilitation Science from the University of Kansas Medical Center in 2008.