Clinical Case Studies

 

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Clinical Case Studies, Vol. 7, No. 4, 267-286 (2008)
DOI: 10.1177/1534650107309187

Combined Insomnia and Poor CPAP Compliance

A Case Study and Discussion

Emerson M. Wickwire, Jr

Johns Hopkins University School of Medicine

Julie A. Schumacher

University of Mississippi Medical Center

Alan C. Richert, Jr

University of Mississippi Medical Center

A. Sinan Baran

University of Mississippi Medical Center

Howard P. Roffwarg

University of Mississippi Medical Center

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.

Key Words: compliance • CPAP • insomnia • sleep • sleep apnea


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