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Misperception of Sleep and Cognitive Behavioral Therapy: emphasizing the importance


Insomnia is the most common sleep disorder in the general population. Patients report difficulty initiating, maintaining, or returning to sleep. Insomniacs have a longer latency time to sleep and rumination of thoughts. The mechanism by which sleep reactivity initiates and perpetuates the insomnia disorder may involve cognitive-emotional processes.


To report the good response to Cognitive Behavioral Therapy of an insomniac with poor sleep perception.


Application of Cognitive-Behavioral Therapy techniques to treat insomnia (CBT-I). We identified behavioral and thought patterns that were contributing to the maintenance of insomnia. We applied the Dysfunctional Sleep Beliefs and Attitudes Scale (DBSDS), sleep hygiene and diary, stimulus control, progressive muscle relaxation, and cognitive restructuring.


A 38-year-old woman with no comorbidities reported difficulty falling asleep. She said she had gone several days without sleep. Her symptoms of insomnia started after her mother’s treatment for breast cancer 3 years ago. She sought medical attention many times and used several medications, but without success. She was dependent use of clonazepam. In the evaluation with actigraphy and sleep diary, we found that she had an average of 06 hours of sleep per night and poor sleep perception. We applied some CBT-I techniques and obtained positive results in her sleep pattern. We reduced her clonazepam dosage gradually from 5.0 drops/day to 2.0 to 3.0 drops/week, resulting in an average of < 0.5 drops/day. Sleep quality could be measured through verbal reports and sleep diary entries that indicated a 100% improvement in sleep quality. Latency time was reduced to 5 minutes and arousals during sleep were eliminated. In the ECADS we analyzed that the patient scored maximum (50/50) on the factor indicating beliefs about immediate negative consequences regarding sleep, and 28/30 possible points on the indicator about long-term negative consequences. In the factor assessing the need for control over insomnia, she scored 8/20. We proposed a cognitive restructuring by identifying and recording dysfunctional thoughts and working on cognitive flexibility.


CBT-I shows efficacy in the treatment of moderate chronic insomnia. Its advantages are low risk, low cost, possible association with medication, and maintenance of long-term results.


Insomnia, Sleep, Cognitive Behavioral Therapy


Relato de Caso


Danielle Mesquita Torres, Janequeli Simão Nascimento, Janine de Carvalho Bonfadini, Alissa Ellen Formiga, Manoel Alves Sobreira Neto, Emmanuelle Silva Tavares Sobreira