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Why not a Brief Behavioral Treatment of Insomnia (BBTI), why not? Case report description


Chronic insomnia is one of the most prevalent sleep disorders in the general population, with an incidence ranging from 4% to 48%. The gold standard and recommended treatment for chronic insomnia is the Cognitive Behavioral Therapy of Insomnia (CBT-I). The American Academy of Sleep Medicine suggests that clinicians use multi-component brief therapies for chronic insomnia in adults. BBTI, as CBT-I, uses stimulus control and sleep restriction techniques to improve sleep quality (SQ), sleep latency (SL), and wake after sleep onset (WASO). This is a unique and efficient intervention for a majority of patients seen in primary care settings.


To describe the efficiency of a BBTI intervention in a Sleep Center.


Anamnesis and physical examination were performed, followed by five BBTI sessions.


We describe a case of a 55-yearold female patient, referred to our ambulatory sleep center (ASONO – HCFMUSP) with a chronic insomnia diagnosis. Comorbidities: fibromyalgia and De Quervain’s tenosynovitis. Using: olanzapine 5mg at night and gabapentin 400mg twice a day. After anamnesis and clinical evaluation, we decided to use BBTI sessions every two weeks. The patient answered the following questionnaires in the first and last session: Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI) and Epworth Sleep Scale (ESS). Sleep diaries were used in all sessions.The first session is psychoeducation of sleep in addition to the stimulus control technique, followed by a session of sleep restriction and reinforcement of sleep hygiene. The third and fourth sessions focused on sleep restriction and one more session to follow up the results obtained.


The use of BBTI was satisfactory to insomnia complaint remission in this case. Questionaries showed improvement in all scores comparing pre and pos-treatment: ISI (from 9 to 1), PSQI (from 11 to 2) and ESS (from 2 to 1). The parameters evaluated with sleep diaries also presented positive outcomes comparing the first with the last, SE increased 28% (ranging from 64% to 92%) and total sleep time by 135 minutes (from 4h30min to 6h45min) and decreased WASO by 120 minutes (from 2h04min to 5 minutes). These results bring to light a very important tool for insomnia treatment in adults, BBTI.


Insomnia; behavioral therapy, BBTI


Relato de Caso


IPQ HC USP - São Paulo - Brasil


João Victor Valinho de Moraes, Eddy Alberto Betancourt Flores, Flávia Zuccolotto dos Reis Requena, Camila Munaro Monteiro, Gracielly Porte de Oliveira, Hugo Gustavo Vega Alcivar, Thaina Rocha Braga Machado, Rosa Hasan, Andrea Cecilia Toscanini