Session content for CBT-I
| Session number | Content |
| 1. Sleep education | Participants will be provided with education on sleep stages; sleep and fibromyalgia and circadian rhythms and sleep. This information is given to provide a heuristic background for the specific sleep techniques used. |
| 2. Sleep hygiene (SH) | SH will be discussed and participants are instructed to adhere to the following rules: (1) avoid caffeine after noon, (2) within 2 hours of bed, avoid exercise, nicotine, alcohol and heavy meals, (3) within 1 hour of bedtime, avoid screen time. The goal of SH is to eliminate sleep-interfering behaviours. |
| 3. Stimulus control (SC) and brief relaxation | SC will be discussed and participants will be asked to adhere to the following recommendations: (1) do not use bed/bedroom for anything but sleep (or sex), (2) if not asleep in 15–20 min, leave bed, do something non-arousing in another room. Return to bed when sleepy. If not asleep in 20 min, repeat., (3) if awake and not back asleep in 20 min, repeat #2, (4) avoid napping. The goal of SC is to break incompatible/build compatible sleep associations. In addition, a 10 min relaxation exercise will be recorded and given to participants for practice at bedtime and once during the day. The goal of this is to induce relaxation/reduce arousal. |
| 4. Sleep restriction | A time in bed prescription (Rx) will be set at baseline average diary reported total sleep time plus 30 min. If this value is <5 hours, Rx will be set at 5 hours. The therapist and participant will work together to set regular bed/wake times consistent with Rx. The goal of sleep restriction is to regulate sleep-wake cycle and reduce awake time in bed. |
| 5. Monitoring automatic thoughts | Thoughts, thought patterns and emotional reactions that interfere with getting good sleep (ie, “I will never sleep well again”.) will be identified and monitored. |
| 6. Challenging/Replacing dysfunctional thoughts | The validity of sleep-interfering thoughts will be challenged and replaced with sleep conducive ones (ie, “There are things I can do to improve my sleep”.) |
| 7. Practical recommendations | Established cognitive restructuring techniques (ie, reappraisal, reattribution and decatastrophising) will be taught. |
| 8. Review and maintenance | Learnt skills and importance of a regular sleep schedule and good sleep habits will be reviewed. Continued use of the techniques learnt will be discussed. |
| Booster sessions | In this brief (~20 min) telephone session, techniques from sessions 1 to 8 will be reviewed. The therapist will encourage continued practice of techniques. Problems will be trouble-shooted. |
CBT-I, cognitive behavioural treatment for insomnia.