Referral to a Psychologist
Patients with complex insomnia (insomnia with comorbidities) who require more specialised support, those who do not experience improvement of their insomnia disorder with BBTi or digital CBTi, or those who prefer not to use digital CBTi, can be referred to a psychologist specialising in sleep health for CBTi.
Patients suitable for CBTi from a ‘sleep’ psychologist, instead of an online program or BBTi:
- Epilepsy or muscle spasm disorders
- Co-morbid sleep disorder (e.g., obstructive sleep apnoea, restless legs syndrome, circadian rhythm disorder)
- Shift workers
- People who drive or operate heavy machinery for work
- Previous motor vehicle accident
- Severe or uncontrolled psychiatric condition (e.g., Bi-polar disorder, Schizophrenia disorder)
- Currently pregnant or caring for very young children
- Epworth Sleepiness Scale score > 15
- Significant or very strongly held maladaptive or dysfunctional sleep-related cognitions (e.g., on the Dysfunctional Beliefs and Attitudes about Sleep Scale)
- Previously tried BBTi or online program which was not effective
Consider additional referral to sleep physician for those who are/those with:
- People who drive for work
- Severe daytime sleepiness
- Suspected co-morbid sleep disorder (e.g. insomnia and obstructive sleep apnoea)
CBTi by a psychologist may however be limited due to lack of trained therapists, cost of treatment or time.
The Australian Psychological Society and Australian Association of Psychologists websites includes a 'Find a Psychologist' search tool, to find a local Psychologist who specialises in the management of sleep disorders:
> ‘Search by Issue’
> ‘General Health’
> ‘Sleeping Disorders’
A Mental Health Treatment Plan can be used to refer patients to a psychologist for CBTi.1
Patients who have a current GP Management Plan or a Team Care Arrangement are eligible for Medicare rebates for up to five allied health services on referral from their GP.
AHI - Apnoea-Hypopnoea Index
BBTi - Brief Behavioural Therapy for Insomnia
BMI - Body Mass Index (kg/m2)
BQ - Berlin Questionnaire
CBTi - Cognitive Behavioural Therapy for Insomnia
CELL - Coblation Endoscopic Lingual Lightening
COPD - Chronic Obstructive Pulmonary Disease
CVA - Cerebrovascular Accident
CPAP - Continuous Positive Airway Pressure
CSA - Central Sleep Apnoea
DASS - Depression Anxiety Stress Scale
DBAS - Dysfunctional Beliefs and Attitudes about Sleep
DBP - Diastolic Blood Pressure
DIMS - Difficulties Initiating and/or Maintaining Sleep
DISE - Drug-Induced Sleep Endoscopy
DISS - Daytime Insomnia Symptom Scale
ENT - Ear Nose and Throat
ESS - Epworth Sleepiness Scale
FOSQ - Functional Outcomes of Sleep Questionnaire
FSH - Follicle-Stimulating Hormone
FTP - Friedman Tong Position
GP - General Practitioner
HANDI - RACGP Handbook of Non-Drug Interventions
HGNS - Hypoglossal Herve Htimulation
ISI - Insomnia Severity Index
K10 - Kessler Psychological Distress Scale
MAD - Mandibular Advancement Device
MAS - Mandibular Advancement Rplint
MBS - Medicare Benefits Schedule
MMA - Maxillomandibular Advancement Surgery
MRA - Mandibular Repositioning Appliance
ODI - Oxygenation Desaturation Index
OSA - Obstructive Sleep Apnoea
PLMD - Periodic Limb Movement Disorder
PT - Positional Therapy
PTSD - Post-Traumatic Stress Disorder
PSG - Polysomnography
QSQ - Quebec Sleep Questionnaire
REM - Rapid Eye Movement
RFTB - Radiofrequency Thermotherapy of the Tongue Base
SBP - Systolic Blood Pressure
SCI - Sleep Condition Indicator
SE - Sleep Efficiency
SF36 - Short-Form (36) Health Survey
SMILE - Submucosal Minimally Invasive Lingual Excision
SNRIs - Serotonin-Norepinephrine Reuptake Inhibitors
SOL - Sleep Onset Latency
SSRI - Selective Serotonin Reuptake Inhibitors
TFTs - Thyroid Function Tests
TIB - Time In Bed
TORS - Transoral Robotic Surgery
TST - Total Sleep Time
UPPP - Uvulopalatopharyngoplasty
WASO - Wake After Sleep Onset