Screening
It is recommended that patients in various treatment settings are screened for insomnia disorder using the Insomnia Severity Index (ISI). A total score of ≥ 8 on the ISI indicates clinically relevant insomnia symptoms and suggests the need for further clinical assessment. Deviations from strict adherence to the cut-off score may be possible based on clinical judgment.
Indication
Physicians should be involved in the indication for participation in the treatment program to ensure an appropriate diagnostic process.
Inclusion criteria
- The patient reports difficulties falling asleep, maintaining sleep or poor sleep quality along with impaired sleep-related quality of life.
- Typically, diagnostic criteria for insomnia disorder are met—i.e., reports of several poor nights per week for a period of at least 3 months. Deviations from strict criteria may be possible based on clinical judgment.
Exclusion criteria
- A symptom severity that makes participation in the program impossible, such as severe cognitive impairment or acute intoxication.
SLEEPexpert intentionally uses minimal exclusion criteria; in particular, comorbid conditions or the use of medication are not exclusion criteria per se.
The three phases of the treatment program
1. Introduction (kick-off session)
After the indication has been established, patients participate in a kick-off session (kick-off presentation). In this session—usually conducted in a group format by a healthcare professional (e.g., physician, psychologist, and/or member of the nursing team)—patients are informed about basic behavioral principles of sleep.
Together with each patient, an individual sleep window is discussed and prescribed during the kick-off session. This involves adjusting the time in bed to match the currently reported sleep duration. The sleep window is prescribed and documented in the medical record.
Patients are then asked to implement their sleep window and fill out a sleep diary.
2. Self-management with support of the treatment team
Patients are supported by the treatment team in implementing their individual sleep window. The coaching protocol can be used.
Time in bed should be adjusted to the reported sleep duration. If sleep quality improves, the sleep window can be maintained. If patients experience prolonged wakefulness in bed, the sleep window should be further reduced. Over time, patients learn to gain more control over their sleep. During this process, the use of sleep-inducing or sedating medication should be reviewed and, if possible, reduced and discontinued (sleep medication).
3. Self-management
Patients continue to adhere to their sleep window. Based on sleep diary data or direct experience, patients can adjust their sleep window independently (extend or reduce). The aim is to align time in bed to the perceived sleep duration.
Patients experience increased control over their own sleep with positive effects on self-efficacy, as well as cognitive and emotional factors.
How can I support patients as a healthcare professional?
At the start of the program, patients participate in a kick-off session. During the kick-off session an individual sleep window—the key element of the program—is discussed together with the patient and prescribed. The aim is that patients learn to gain more control over their sleep.
The following interventions can help to support patients:
- Ask about their prescribed sleep window.
- Ask about their current bedtime and sleep duration, including daytime sleep.
- Ask about their subjective experience of sleep and wakefulness.
- Motivate and support continuous implementation of the individual sleep window.
- If patients report unpleasantly long periods of wakefulness, the sleep window can be reduced (minimum 5 hours).
- If sleep quality is sufficient but daytime fatigue persists, the sleep window can be extended.
- A sleep diary can be used to guide the adaptation of the sleep window.
- Engage patients in a discussion on how to meaningfully utilize the additional time resulting from restriction of time in bed.
- Regularly review any sleep-inducing medication and reduce and discontinue if possible.
For questions or further information: contact@sleepexpert.ch