We have found that making a decision to start CBT-I can be
challenging for many patients. As you already know, you can
expect that your patients might present with skepticism when you
bring up this referral suggestion. This is perfectly acceptable
in our book! We expect patients to be skeptical. Here are some
common examples of skepticism you likely hear:
- Patients want the quick-fix of a sleep medication, despite
understanding that CBT-I is the first-line recommendation.
- Others fear the dependency and side effects, and while they do
not want to stay on a sleeping pill, they also fear not taking
- Patients feel they “know themselves” and have “tried
everything” so are resistant to the idea that someone can
- They do not feel comfortable having a licensed psychologist or
counselor help them, given that it's just a sleep issue
From what we understand from theoretical principles pertaining to Stages of Change[Learn More about Stages of Change (Prochaska & DiClemente, 1970's)], resisting change, or contemplating change are very common parts of the cycle leading into readiness for change, and change behaviors.
My ask of you, is that you let us help your patient through
their skepticism, validate their resistance, and join with them
where they are in their cycle of readiness for change. You can
do this by letting your patient know that this is quite typical
to have this resistance, and that our team is very skilled in
talking through this. They are not obligated to complete the
treatment, but if they can “put their foot in the door” and
schedule the appointment, they are one step closer to having
We have seen consistently that patient’s motivation to change is
highest when face-to-face with their doctor. Therefore, if you
can also help your patient by encouraging your clinical staff or
front staff to use our Referral Team Scheduling Form, the
probability that they stay in the Stages of Change cycle,
instead of losing them altogether, is highest.
We recognize that asking your staff to make sure that patients
have their Referral Team Scheduling Form completed that day, is
challenging, and can feel like a burden. That said, this
compared to having this patient return with sleep medication
refill requests, or follow-up consultation about insomnia
frustrations, can also be burdensome. Our goal for providing
sleep centers with BSM support is to free up clinic slots and
admin time for you, by taking care of any and all BSM needs.
While I know this added task of requesting your team to help
ensure that Referral Team Scheduling Form is filled out that
day, is imperfect, in the long-run, this small task will open up
more time and bigger changes for optimization of your clinics.
We will continue working closely with each of you to learn
exactly what new referral options will best serve the needs for
your clinic. We look forward to moving more deeply into
providing CPAP adherence support, and addressing COMISA needs.
As always, please reach out with any questions. We are excited
to continue working with your insomnia patients, sleep
medication tapers, and the varied BSM referrals you have sent
Thank you for your support!