Frequently Asked Questions for Healthcare Professionals

CBT-i is a non-pharmacological therapeutic intervention modality that seeks to resolve the causes of insomnia by changing dysfunctional behaviors and thoughts related to sleep. This therapy aims to combat the state of alertness in bed, based on adjusting sleep and wake times and exposure to stimuli that interfere with sleep onset and consolidation. In addition to stimulus control and sleep restriction, which seeks to equalize bed and sleep times, CBT-i focuses on psychoeducation. The program proposes training skills that facilitate physical and mental relaxation, providing cognitive restructuring and teaching strategies that promote sleep hygiene.

Sleep hygiene tips make up the content of the Vigilantes do Sono program based on CBT-i, but alone they are not effective in resolving insomnia. Scientific evidence demonstrates that, in the absence of behavioral and cognitive techniques, sleep hygiene has low potential to influence the state of hyperarousal and to reverse the conditioning of the sleeping environment as an aversive place. It has been shown that CBT-i techniques have a dramatic impact not only on sleep, but on well-being and quality of life of different populations. From young to old, among pregnant women, individuals with chronic pain or other medical conditions, CBT-i can prevent and alleviate anxiety and depression. Protocols generally last 4 to 12 weeks. CBT-i is considered today by health systems in the United States, England and European Union as the best solution for insomnia, with evidence spanning more than 30 years. About 4 out of 5 people who complete a CBT-i program significantly improve their sleep and quality of life.

A Chatbot - from English 'chat' (conversation) + 'bot' (robot) - is a computer program developed using artificial intelligence to find answers and perform tasks automatically.

Artificial intelligence (AI) is a field of computer science that investigates and develops mathematical algorithms to train machines to perform tasks that mimic the functioning of the human mind, such as learning and reasoning, through pattern recognition in sets of information. With the use of AI at Vigilantes do Sono, our robot Sônia can personalize the user experience based on the types of sleep complaints each person has, also depending on biological characteristics and medical conditions that interfere with sleep patterns, or the possibilities of putting certain trainings and techniques into practice.

The program has a total of 7 weekly modules. The first module focuses on presenting the program, mapping complaints and collecting baseline information that will feed the sleep restriction algorithm. From the second module, the restriction begins, when Sônia proposes adjusting the sleep opportunity window, which will be reviewed at the beginning of each of the following modules. The remaining content consists of teaching a relaxation training, a cognitive technique and some sleep hygiene guidelines in each module. Sônia's recommendation is that during the interval of days between modules, patients put into practice the trainings and techniques they have learned and record in the diary whether they are practicing. Thus, throughout the evolution of the program, they can have a comparison of which trainings and techniques they like best and are most effective in improving their sleep pattern.
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It depends on each person's pace and dedication. The program is divided into 7 modules of approximately 6 sessions each (45 in total), lasting about 5-10 minutes, between reading the content about trainings and techniques and filling out the sleep diary. The idea is that the patient does one session a day, but it is possible to do more, which can speed up the completion of the entire program. In addition, some people, even after completing all sessions, choose to continue filling out the diary and continue with the weekly sleep restriction reviews.

Vigilantes do Sono is recommended for people who have difficulty sleeping, or who are interested in improving their sleep. Despite being based on CBT-i - which is an intervention protocol originally developed for clinical populations of individuals with chronic insomnia - all the psychoeducational content of the Vigilantes do Sono program can be beneficial for anyone interested in improving the quality of sleep, life and productivity. The program involves the systematic teaching of life skills. These are relaxation trainings, cognitive techniques and guided sleep hygiene guidelines. In this sense, the Vigilantes do Sono program has a preventive character, as it can reduce the chances of developing or worsening chronic insomnia.

Research in the area suggests that the sooner insomnia is treated, the better, as this prevents it from becoming a chronic problem and can even trigger other health conditions, such as hormonal changes, high blood pressure, depression, among others. CBT-i, in this case, which is based on changing behaviors and beliefs related to sleep, is the gold-standard therapeutic intervention, as only it addresses the root causes of insomnia, associated with perpetuating conditioning of a dysfunctional relationship with the sleeping environment. The use of medication may be indicated and should be done with medical supervision. However, without CBT-i, for most patients, insomnia returns when they stop medication. In addition, over time, sleep-inducing medications may lose their effect, cause tolerance and dependence not only physiological, but psychological, a complex and difficult condition to treat.

The Vigilantes do Sono program may be contraindicated, or may not work with the expected effectiveness, in the case of people who have or have had other sleep disorders, severe psychiatric and neurological conditions, or medical conditions that make it difficult to apply CBT-i techniques.

• Sleep apnea and other sleep disorders that can trigger insomnia
• Bipolar disorder, convulsive disorders and severe parasomnia

It's simple. You just need to be registered with a professional council (CRM, CRP, CRO, CRFA, CREFITO, CRN, CREF, etc.) and have a professional ID code. Health professionals who wish to monitor their patients' progress can register on our portal. Upon registration on the portal, each professional receives their partner code from their council registration number and this code can be used by patients to obtain discounts and benefits. Professionals who choose not to register on the portal can also recommend the program to their patients, advising them to use the professional council acronym, state of origin and registration number (e.g., CRMSP12345). Patients themselves enter the partner code within the app.

Telemedicine is regulated in Brazil by Federal Law 13.989/2020, on an emergency basis, while the COVID-19 pandemic lasts. Other current resolutions and regulations from CFM and CRMs also guide doctors and other health professionals about permitted conduct in telemedicine and telehealth, such as:

• Authorization of teleorientation and telemonitoring modalities (CojuR 1756/2020);
• Treatment of different diseases in the same patient characterizes a new professional act subject to new medical fees (Res. CFM 1958/2010, art. 1, §2);
• Consultations in prolonged treatments with reassessments and therapeutic modifications may be charged by the doctor (Res. CFM 1958/2010, art. 3);
• Telemonitoring and teleorientation fulfill different functions from a medical follow-up consultation, therefore medical fees may be paid (Opinion CRM-MG No. 120/2021);
• The form of medical remuneration in telemedicine must be agreed directly between doctor and patient, respecting the provisions of the Medical Code of Ethics (Opinion CRM-MG No. 29/2021).

The Vigilantes do Sono app is available for download in Portuguese in versions for iOS and Android, found in the Apple and Google stores.