title: Intensive sleep deprivation and cognitive behavioral therapy for pharmacotherapy refractory insomnia in a hospitalized patient.
abstract: The case of a 59-year-old woman psychiatrically hospitalized with comorbid insomnia, suicidal ideation, and generalized anxiety disorder is presented. Pharmacologic therapies were unsuccessful for treating insomnia prior to and during hospitalization. Intensive sleep deprivation was initiated for 40 consecutive hours followed by a recovery sleep period of 8 hours. Traditional components of cognitive behavioral therapy for insomnia (CBTi), sleep restriction, and stimulus control therapies, were initiated on the ward. After two consecutive nights with improved sleep, anxiety, and absence of suicidal ideation, the patient was discharged. She was followed in the sleep clinic for two months engaging in CBTi. Treatment resulted in substantial improvement in her insomnia, daytime sleepiness, and anxiety about sleep. Sleep deprivation regimens followed by a restricted sleep recovery period have shown antidepressant effects in depressed patients. Similar treatment protocols have not been investigated in patients with pharmacotherapy refractory insomnia and generalized anxiety disorder.
authors.affiliation: Department of Behavioral Health, Madigan Army Medical Center, Tacoma, WA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Breitstein
authors.affiliation: Department of Neurology, Madigan Army Medical Center, Tacoma, WA.
authors.forename: Brandon
authors.initials: B
authors.lastname: Penix
authors.affiliation: Department of Pulmonary, Critical Care, Sleep Medicine, Madigan Army Medical Center, Tacoma, WA.
authors.forename: Bernard J
authors.initials: BJ
authors.lastname: Roth
authors.affiliation: Department of Pulmonary, Critical Care, Sleep Medicine, Madigan Army Medical Center, Tacoma, WA.
authors.forename: Tristin
authors.initials: T
authors.lastname: Baxter
authors.affiliation: Department of Pulmonary, Critical Care, Sleep Medicine, Madigan Army Medical Center, Tacoma, WA.
authors.forename: Vincent
authors.initials: V
authors.lastname: Mysliwiec
mesh_terms: D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D008875:Middle Aged; D012892:Sleep Deprivation; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy / Q000523:psychology / Q000628:therapy*; D059020:Suicidal Ideation; D017211:Treatment Failure
chemical_list: D006993:Hypnotics and Sedatives
keywords: anxiety; depression; hypnotics; insomnia; sleep deprivation; sleep restriction therapy