Follow-up after treatment
Behavioural therapy is measured in weeks, not days. The follow-up schedule, how to read a sleep diary, and a plan for the next bout of insomnia.
Key points
- Behavioural therapy produces results by the week. Judging it after two nights is far too early and leads people to give up at the wrong moment.
- The deciding measure is not hours of sleep but sleep efficiency, the ratio of time asleep to time in bed.
- The first week is usually worse before it is better. That is how the method is designed, not a sign of failure.
- Insomnia will return a few times in a lifetime, through illness, work or life events. The long-term goal is not never having insomnia but knowing what to do when it comes.
Who this is for
- You are partway through a CBT-I course and need weekly follow-up.
- You are reducing a sleep medication on a schedule.
- You have improved and want to hold the result.
- You are being treated for depression or anxiety and need the scale scores tracked over time.
Why follow-up matters as much as the treatment
Most people who abandon behavioural therapy do so in week one or week two, exactly the stage where sleep restriction deliberately creates a little sleep loss in order to concentrate sleep pressure. At the time it feels precisely like proof that the method is not working. Having someone read the data with you during that period is the single biggest difference between finishing and going back to medication.
The three numbers read each week
| Measure | How it is calculated | The deciding threshold |
|---|---|---|
| Sleep efficiency | Hours asleep ÷ hours in bed × 100 | Above 85% means widening the sleep window by 15 minutes |
| Time to fall asleep | From lying down to sleep, estimated | Under 30 minutes is the target |
| Total time awake in the night | The waking periods added up, estimated | Under 30 minutes is the target |
A plan for next time
The final session of the course is spent writing a short plan: which signs show insomnia is coming back, the three things to do in the first week, and the point at which to get back in touch. This plan matters because a relapse usually arrives during a busy or stressful period, exactly when people are least able to work out what to do.
How it works
- Send the diary before the appointment
A follow-up session starts from the data, not from memory. Sending the diary in advance means the whole session goes on adjusting rather than reconstructing.
- Read the three numbers
Sleep efficiency, time to fall asleep, total time awake in the night. These three decide whether the sleep window widens yet.
- Adjust
Widen or hold the sleep window, refine the behavioural techniques, work through whatever got in the way this week.
- Relapse prevention plan
The final session builds a plan for the next bout of insomnia. It will come, and having a way to handle it is what holds the result.
Frequently asked questions
- How long until the course ends?
- A full CBT-I course usually fits into 6 to 8 sessions over 6 to 10 weeks. For someone also tapering a medication it is longer, because a taper is measured in months.
- What if the insomnia comes back after the course?
- Get back in touch. A relapse usually needs only one or two sessions to restore the pattern, because you already have the skills. It is nothing like the first time.
References
- Behavioral and psychological treatments for chronic insomnia disorder in adults: an AASM clinical practice guideline - American Academy of Sleep Medicine, 2021 · DOI 10.5664/jcsm.8986
- Management of Chronic Insomnia Disorder in Adults: A Clinical Practice Guideline from the American College of Physicians - American College of Physicians, 2016 · DOI 10.7326/M15-2175
- The Consensus Sleep Diary: Standardizing Prospective Sleep Self-Monitoring - Sleep, 2012