Ruth Amadi nearly abandoned treatment in week three, along with, historically, about a third of everyone else on the service.
Shift patterns cannot be treated around. Where the pattern is the cause, the conversation has to be about the pattern, and it is usually the least welcome conversation in the clinic.
The diary runs for two weeks before anything is changed. Retrospective estimates of sleep are unreliable in both directions, and the diary is the correction.
Almost all abandonment happens in the first month. So almost all our contact is in the first month now.
Illustrative composite
Sleep hygiene alone has a poor evidence base as a standalone treatment, which is awkward, because it is the most widely distributed sleep advice in existence.
Twelve-month continuation on the redesigned pathway runs twenty-one points higher. “Week three,” she says. “It’s all about week three.”
