Combined Insomnia and Poor CPAP Compliance

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.