Combined Insomnia and Poor CPAP Compliance: A Case Study and Discussion
Abstract
This report describes the case of Samuel, a Caucasian man in his early sixties who self-referred to a behavioral insomnia clinic at a university medical center. Samuel had recently been diagnosed with obstructive sleep apnea and had been prescribed continuous positive air pressure (CPAP) therapy for this condition. At the time he presented for treatment, he was non-compliant with his CPAP prescription and maintained that the physician who diagnosed obstructive sleep apnea was mistaken. His presenting complaint to the insomnia clinic was a 25-year history of difficulty initiating sleep, which he believed was the sole cause of his problem with daytime sleepiness. In addition to his obstructive sleep apnea, Samuel was diagnosed with obstructive sleep apnea and psychophysiological insomnia. The treatments selected were a motivational enhancement treatment for CPAP compliance and a cognitive-behavioral intervention for insomnia. Treatments were presented in a combined, sequential fashion. At treatment follow-up, Samuel reported increased CPAP compliance, decreased daytime sleepiness, and decreased insomnia severity.
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In a middle-aged male with chronic insomnia and OSA, a nine session CBTi program resulted in a small increase in CPAP use.
“Wickwire and colleagues reported a case study in which a middle-aged male with chronic insomnia and OSA was treated with a nine session CBTi program, which resulted in a small increase in CPAP use [83].”
From Co-morbid insomnia and sleep apnea (COMISA): Prevalence, consequences, methodological considerations, and recent randomized controlled trials (2019) · cites this paper as [83]
Two early studies provided preliminary support for the combination of CBTi and CPAP therapy in COMISA patients.
“Two early studies provided preliminary support for the combination of CBTi and CPAP therapy in COMISA patients [76,83].”
From Co-morbid insomnia and sleep apnea (COMISA): Prevalence, consequences, methodological considerations, and recent randomized controlled trials (2019) · cites this paper as [83]
Cites
A New Method for Measuring Daytime Sleepiness: The Epworth Sleepiness Scale
Johns, M. W. (1991) · Sleep · doi:10.1093/sleep/14.6.540 · Cited by 17,364 · see citing works
Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation
Beck, A. T., Steer, R. A., & Carbin, M. G. (1988) · Clinical Psychology Review · doi:10.1016/0272-7358(88)90050-5 · Cited by 11,696 · see citing works
Validation of the Insomnia Severity Index as an outcome measure for insomnia research
Bastien, C. (2001) · Sleep Medicine · doi:10.1016/s1389-9457(00)00065-4 · Cited by 8,067 · see citing works
Principles and Practice of Sleep Medicine
Kryger, M. H., Roth, T. G., & Dement, W. C. (2011) · Elsevier eBooks · doi:10.1016/c2009-0-59875-3 · Cited by 5,118 · see citing works
(1993) · Medical Entomology and Zoology · Cited by 2,324 · see citing works
Epidemiologic Study of Sleep Disturbances and Psychiatric Disorders: An Opportunity for Prevention?
Ford, D. E. (1989) · JAMA · doi:10.1001/jama.1989.03430110069030 · Cited by 2,252 · see citing works
Harvey, A. G. (2002) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(01)00061-4 · Cited by 1,790 · see citing works
Psychological and behavioral treatment of insomnia: update of the recent evidence (1998-2004)
Morin, C. M., Bootzin, R. R., Buysse, D. J., Edinger, J. D., Espie, C. A., & Lichstein, K. L. (2006) · Sleep · doi:10.1093/sleep/29.11.1398 · Cited by 1,345 · see citing works
Objective Measurement of Patterns of Nasal CPAP Use by Patients with Obstructive Sleep Apnea
Kribbs, N. B., Pack, A. I., Kline, L. R., Smith, P. L., Schwartz, A. R., Schubert, N. M., Redline, S., Henry, J. N., Getsy, J. E., & Dinges, D. F. (1993) · American Review of Respiratory Disease · doi:10.1164/ajrccm/147.4.887 · Cited by 1,339 · see citing works
Recommendations for a standard research assessment of insomnia
Buysse, D. J., Ancoli-Israel, S., Edinger, J. D., Lichstein, K. L., & Morin, C. M. (2006) · Sleep · doi:10.1093/sleep/29.9.1155 · Cited by 1,206 · see citing works
Treatment of Chronic Insomnia by Restriction of Time in Bed
(1987) · Sleep · doi:10.1093/sleep/10.1.45 · Cited by 948 · see citing works
Nonpharmacologic Treatment of Chronic Insomnia
Morin, C. M., Hauri, P. J., Espie, C. A., Spielman, A. J., Buysse, D. J., & Bootzin, R. R. (1999) · Sleep · doi:10.1093/sleep/22.8.1134 · Cited by 888 · see citing works
Behaviour research and therapy
(1993) · Behaviour Research and Therapy · doi:10.1016/0005-7967(93)90091-8 · Cited by 877 · see citing works
Comparative Meta-Analysis of Pharmacotherapy and Behavior Therapy for Persistent Insomnia
Smith, M. T., Perlis, M. L., Park, A., Smith, M. S., Pennington, J., Giles, D. E., & Buysse, D. J. (2002) · American Journal of Psychiatry · doi:10.1176/appi.ajp.159.1.5 · Cited by 863 · cited 1× · see citing works
“CBT-I is at least as effective as pharmacotherapy for insomnia (e.g., M. T. Smith et al., 2002), if not more so (e.g., Sivertsen et al., 2006), and patients prefer CBT-I over pharmacotherapy (Morin, Gaulier, Barry, & Kowatch, 1992; Vincent & Lionberg, 2001).”
MethodAncoli‐Israel, S., & Roth, T. G. (1999) · PubMed · Cited by 776 · see citing works
National Institutes of Health State of the Science Conference Statement
(2005) · Sleep · doi:10.1093/sleep/28.9.1049 · Cited by 745 · see citing works
Sleepiness in Different Situations Measured by the Epworth Sleepiness Scale
Johns, M. W. (1994) · SLEEP · doi:10.1093/sleep/17.8.703 · Cited by 738 · see citing works
Sivertsen, B., Omvik, S., Pallesen, S., Bjorvatn, B., Havik, O. E., Kvale, G., Nielsen, G. H., & Nordhus, I. H. (2006) · JAMA · doi:10.1001/jama.295.24.2851 · Cited by 589 · cited 1× · see citing works
“CBT-I is at least as effective as pharmacotherapy for insomnia (e.g., M. T. Smith et al., 2002), if not more so (e.g., Sivertsen et al., 2006), and patients prefer CBT-I over pharmacotherapy (Morin, Gaulier, Barry, & Kowatch, 1992; Vincent & Lionberg, 2001).”
MethodPrinciples and Practice of Sleep Medicine
Awerbuch, G. I. (1990) · Neurology · doi:10.1212/wnl.40.4.731-a · Cited by 579 · see citing works
Quantitative criteria for insomnia
Lichstein, K. L., Durrence, H. H., Taylor, D. J., Bush, A. J., & Riedel, B. W. (2003) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(02)00023-2 · Cited by 531 · see citing works
Improving CPAP use by patients with the sleep apnoea/hypopnoea syndrome (SAHS)
Engleman, H. M., & Wild, M. R. (2003) · Sleep Medicine Reviews · doi:10.1053/smrv.2001.0197 · Cited by 473 · see citing works
Insomnia as a Health Risk Factor
Taylor, D. J., Lichstein, K. L., & Durrence, H. H. (2003) · Behavioral Sleep Medicine · doi:10.1207/s15402010bsm0104_5 · Cited by 450 · see citing works
Smith, M. T., Huang, M. I., & Manber, R. (2005) · Clinical Psychology Review · doi:10.1016/j.cpr.2005.04.004 · Cited by 449 · see citing works
Prevalence of Insomnia Symptoms in Patients With Sleep-Disordered Breathing
Krakow, B., Melendrez, D., Ferreira, E., Clark, J., Warner, T. D., Sisley, B., & Sklar, D. (2001) · Chest · doi:10.1378/chest.120.6.1923 · Cited by 313 · see citing works
Klink, M. E. (1992) · Archives of Internal Medicine · doi:10.1001/archinte.152.8.1634 · Cited by 273 · see citing works
Espie, C. A., Inglis, S. J., Harvey, L., & Tessier, S. (2000) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(99)00090-2 · Cited by 241 · see citing works
The direct economic costs of insomnia in the United States for 1995.
Walsh, J. K., & Engelhardt, C. L. (1999) · PubMed · Cited by 229 · see citing works
Treatment preference and patient satisfaction in chronic insomnia
Vincent, N., & Lionberg, C. (2001) · SLEEP · doi:10.1093/sleep/24.4.411 · Cited by 221 · cited 1× · see citing works
“CBT-I is at least as effective as pharmacotherapy for insomnia (e.g., M. T. Smith et al., 2002), if not more so (e.g., Sivertsen et al., 2006), and patients prefer CBT-I over pharmacotherapy (Morin, Gaulier, Barry, & Kowatch, 1992; Vincent & Lionberg, 2001).”
MethodPatients' acceptance of psychological and pharmacological therapies for insomnia
Morin, C. M., Gaulier, B., Barry, T., & Kowatch, R. A. (1992) · SLEEP · doi:10.1093/sleep/15.4.302 · Cited by 211 · see citing works
Treatment of Late-Life Insomnia
Lichstein, K. L., & Morin, C. M. (2000) · Sage eBooks · doi:10.4135/9781452225555 · Cited by 206 · see citing works
Risk Factors Associated With Complaints of Insomnia in a General Adult Population
Klink, M. E. (1992) · Archives of Internal Medicine · doi:10.1001/archinte.1992.00400200070012 · Cited by 196 · see citing works
Frequency of insomnia report in patients with obstructive sleep apnoea hypopnea syndrome (OSAHS)
Smith, S. S., Sullivan, K. A., Hopkins, W., & Douglas, J. A. (2004) · Sleep Medicine · doi:10.1016/j.sleep.2004.03.005 · Cited by 187 · see citing works
A Comparison of Sleep Detection by Wrist Actigraphy, Behavioral Response, and Polysomnography
Blood, M. L., Sack, R. L., Percy, D. C., & Pen, J. C. (1997) · SLEEP · doi:10.1093/sleep/20.6.388 · Cited by 170 · see citing works
Relaxation therapy for insomnia: nighttime and day time effects
Means, M. K., Lichstein, K. L., Epperson, M. T., & Johnson, C. T. (2000) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(99)00091-1 · Cited by 163 · see citing works
Insomnia complaints in patients evaluated for obstructive sleep apnea
Krell, S. B., & Kapur, V. K. (2005) · Sleep And Breathing · doi:10.1007/s11325-005-0026-x · Cited by 163 · see citing works
Carlson, C. R., & Hoyle, R. H. (1993) · Journal of Consulting and Clinical Psychology · doi:10.1037//0022-006x.61.6.1059 · Cited by 161 · see citing works
Cognitive behaviour therapy for primary insomnia: Can we rest yet?
Harvey, A. G., & Tang, N. K. Y. (2003) · Sleep Medicine Reviews · doi:10.1053/smrv.2002.0266 · Cited by 158 · cited 1× · see citing works
“Yet the effect size for CBT-I, although moderate, is lower when compared to the treatments for other psychological disorders, suggesting that current CBT-I protocols are not yet maximally effective (Harvey & Tang, 2003).”
ResultBehavioral and cognitive treatments of geriatric insomnia.
Morin, C. M., & Azrin, N. (1988) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.56.5.748 · Cited by 154 · see citing works
Proceedings of the American Psychological Association
(1894) · PsycEXTRA Dataset · doi:10.1037/e530762009-001 · Cited by 153 · see citing works
Behavioral and cognitive treatments of geriatric insomnia.
Morin, C. M., & Azrin, N. H. (1988) · Journal of Consulting and Clinical Psychology · doi:10.1037//0022-006x.56.5.748 · Cited by 150 · see citing works
Popescu, G., Latham, M., Allgar, V. L., & Elliott, M. W. (2001) · Thorax · doi:10.1136/thorax.56.9.727 · Cited by 144 · see citing works
Carlson, C. R., & Hoyle, R. H. (1993) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.61.6.1059 · Cited by 144 · see citing works
Occult sleep apnea in a recruited sample of older adults with insomnia
Lichstein, K. L., Riedel, B. W., Lester, K. W., & Aguillard, R. N. (1999) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.67.3.405 · Cited by 143 · see citing works
Psychologic Correlates of Compliance with Continuous Positive Airway Pressure
Stepnowsky, C. J., Bardwell, W. A., Moore, P., Ancoli‐Israel, S., & Dimsdale, J. E. (2002) · SLEEP · doi:10.1093/sleep/25.7.758 · Cited by 136 · see citing works
Improving Compliance with Nasal CPAP and Vigilance in Older Adults with OSAHS
Aloia, M. S., Dio, L. D., Ilniczky, N., Perlis, M. L., Greenblatt, D. W., & Giles, D. E. (2001) · Sleep And Breathing · doi:10.1007/s11325-001-0013-9 · Cited by 133 · see citing works
Improving Compliance with Nasal CPAP and Vigilance in Older Adults with OSAHS
Aloia, M. S., Dio, L. D., Ilniczky, N., Perlis, M. L., Greenblatt, D. W., & Giles, D. E. (2001) · Sleep And Breathing · doi:10.1055/s-2001-12789 · Cited by 117 · see citing works
Prospective Data on Sleep Complaints and Associated Risk Factors in an Older Cohort
ROBERTS, R. E., Shema, S. J., & Kaplan, G. A. (1999) · Psychosomatic Medicine · doi:10.1097/00006842-199903000-00011 · Cited by 111 · see citing works
Clinical Management of Poor Adherence to CPAP: Motivational Enhancement
Aloia, M. S., Arnedt, J. T., Riggs, R. L., Hecht, J., & Borrelli, B. (2004) · Behavioral Sleep Medicine · doi:10.1207/s15402010bsm0204_3 · Cited by 110 · see citing works
Treating Sleep Disorders—Principles and Practice of Behavioral Sleep Medicine
Eghtedari-Namin, F. (2004) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2004.06.004 · Cited by 98 · see citing works
Nasal CPAP treatment for obstructive sleep apnea
Stepnowsky, C. J., & Moore, P. (2003) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(03)00038-2 · Cited by 79 · see citing works
Stimulus control and imagery training in treating sleep-maintenance insomnia.
Morin, C. M., & Azrin, N. H. (1987) · Journal of Consulting and Clinical Psychology · doi:10.1037//0022-006x.55.2.260 · Cited by 75 · see citing works
Social-cognitive correlates of CPAP adherence in experienced users
Stepnowsky, C. J., Marler, M., Palau, J. J., & Brooks, J. A. (2006) · Sleep Medicine · doi:10.1016/j.sleep.2005.11.004 · Cited by 75 · see citing works
Stimulus control and imagery training in treating sleep-maintenance insomnia.
Morin, C. M., & Azrin, N. H. (1987) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.55.2.260 · Cited by 65 · see citing works
Edinger, J., & Wohlgemuth, W. (2001) · Sleep Medicine · doi:10.1016/s1389-9457(01)00078-8 · Cited by 63 · see citing works
Treating sleep disorders : principles and practice of behavioral sleep medicine
Perlis, M. L., & Lichstein, K. L. (2003) · John Wiley & Sons, Inc. eBooks · Cited by 55 · see citing works
Smith, S. S., Lang, C. P., Sullivan, K. A., & Warren, J. (2004) · Sleep Medicine · doi:10.1016/j.sleep.2003.12.007 · Cited by 49 · see citing works
The role of behavioral sleep medicine in the assessment and treatment of sleep disordered breathing
Haynes, P. L. (2005) · Clinical Psychology Review · doi:10.1016/j.cpr.2005.04.009 · Cited by 44 · see citing works
Cognitive Behavioral Treatment of Insomnia
Perlis, M. L., Jungquist, C. R., Smith, M. T., & Posner, D. A. (2005) · Springer eBooks · doi:10.1007/0-387-29180-6 · Cited by 40 · see citing works
Riedel, B. W. (2000) · Sage eBooks · doi:10.4135/9781452225555.n5 · Cited by 28 · see citing works
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Sweetman, A., Lack, L., & Bastien, C. (2019) · Brain Sciences · doi:10.3390/brainsci9120371 · Cited by 253 · see citing works
“Alternatively, Wickwire and colleagues reported a case study in which a middle-aged male with chronic insomnia and OSA was treated with a nine session CBTi program, which resulted in a small increase in CPAP use [83].”
BackgroundResultDeveloping a successful treatment for co-morbid insomnia and sleep apnoea
Sweetman, A. M., Lack, L. C., Catcheside, P. G., Antic, N. A., Chai-Coetzer, C. L., Smith, S. S., Douglas, J. A., & McEvoy, R. D. (2017) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2016.04.004 · Cited by 185 · see citing works
Sleep maintenance insomnia complaints predict poor CPAP adherence: a clinical case series
Wickwire, E. M., Smith, M. T., Birnbaum, S., & Collop, N. A. (2010) · Sleep Medicine · doi:10.1016/j.sleep.2010.03.012 · Cited by 149 · see citing works
Self-citationSweetman, A., Lack, L., Lambert, S., Gradisar, M., & Harris, J. (2017) · Sleep Medicine · doi:10.1016/j.sleep.2017.09.003 · Cited by 84 · see citing works
Predictors and patterns of insomnia symptoms in OSA before and after PAP therapy
Glidewell, R. N., Renn, B. N., Roby, E., & Orr, W. C. (2014) · Sleep Medicine · doi:10.1016/j.sleep.2014.05.001 · Cited by 61 · see citing works
Diagnosis and treatment of insomnia comorbid with obstructive sleep apnea
Lack, L., & Sweetman, A. (2016) · Sleep Medicine Clinics · doi:10.1016/j.jsmc.2016.05.006 · Cited by 47 · see citing works
- Authors
- Wickwire, E. M., Schumacher, J. A., Richert, A. C., Sinan Baran, A., & Roffwarg, H. P.
- Affiliations
- Johns Hopkins University (US)
- University of Mississippi Medical Center (US)
- University of Mississippi Medical Center
- Venue
- Clinical Case Studies
- Publisher
- SAGE Publications
- Published
- 2008-08
- Volume
- 7
- Issue
- 4
- Pages
- 267-286
- ISSN
- 1534-6501 (ISSN-L)
- 1552-3802
- OpenAlex
- W2148362376
- Cited by
- 21
- References
- 59
- Citations by year
- 2025: 2 · 2023: 1 · 2022: 2 · 2020: 1 · 2019: 2 · 2018: 2 · 2017: 1 · 2016: 2 · 2014: 1 · 2013: 3
- FWCI
- 1.81
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Case Studies (publishedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Health Sciences › Health Professions › Complementary and Manual Therapy › Temporomandibular Joint Disorders
- Keywords
- insomnia, CPAP adherence, obstructive sleep apnea, psychophysiological insomnia, cognitive behavioral therapy for insomnia, daytime sleepiness, treatment-resistant insomnia
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