Assessment
- Goals of assessment
- Clinical tools for assessing insomnia
- Screen for other sleep disorders
- When to make a referral to a sleep clinic
- Contraindications for CBT-I
- Normal sleep architecture
- Two-process model of sleep: Circadian rhythm and sleep drive
- The arousal system
- What causes chronic insomnia?
- Key perpetuating factors for chronic insomnia
- Behaviors that interfere with “buildup” of sleep drive
- Behaviors that interfere with the optimal timing of sleep
- Conditioned arousal and physiological/cognitive hyperarousal
- Perpetuating factors and CBT-I
- Stimulus Control (SC): Addressing conditioned arousal
- Rules for reassociating the bed with sleep
- Sleep Restriction Therapy (SRT): Restoring the sleep drive
- How to present rationale
- Calculate time-in-bed prescription
- Placing the time-in-bed window
- Identify and overcome potential obstacles to adherence
- Sleep extension
- Combining SC and SRT
- The myth of sleep hygiene
- Counterarousal strategies: Quieting an active mind
- Establishing a buffer zone
- Processing strategies (including constructive worry and rumination strategies)
- Mindfulness and relaxation therapies
- Cognitive therapy: Identify and change distorted thoughts about sleep
- Thought Records
- Behavioral Experiments
- Socratic Questioning
- Models of Delivery
- Four session individual therapy format
- Seven session group therapy format
- Single session CBT-I
- CBT-I and hypnotic medication
- Practice guidelines: CBT-I as first line treatment for chronic insomnia
- Combining CBT-I with sleep medication
- Positive and negative effects of sleep medications
- Use of ineffective sleep medications
- Promote noncontingent use of sleep medication
- Strategies to support hypnotic discontinuation
Depression
- CBT-I and MDD
- Troubleshooting adherence in depressed patients
- Anhedonia
- Sleep or bed as avoidance
- Fatigue and fatigue management strategies
- Rumination in depression
- Case examples
- Sleep and antidepressants
- Troubleshooting adherence in depressed patients
- Sleep effort: Core target of CBT-I
- Covert manifestations of sleep effort
- Cognitive restructuring of sleep anxiety
- Paradoxical Intention
- Troubleshooting adherence with anxious clients
- When SRT/SC increase anxiety
- Counter control and sleep compression
- High sleep anxiety vs high arousal
- Panic Disorder and nocturnal panic
- OCD and CBT-I
- Sleep and PTSD
- CBT-I trials in PTSD
- Behavioral targets in clients with insomnia vs PTSD
- Common treatment challenges in clients with PTSD
- Nightmares and nightmare treatments
- Comorbid TBI
- Sleep and TBI
- Efficacy of CBT-I in mild TBI (mTBI)
- Modify insomnia treatment for mTBI
- Efficacy of CBT-I for those with chronic pain
- Chronic pain and stimulus control
- Common treatment challenges in clients with chronic pain
- Pain medications and other considerations
- Combined guided hypnotic taper approach
- Factors sustaining hypnotic dependence
- Unhelpful beliefs
- Learning
- Strategies to support client during hypnotic taper
- Psychoeducation about psychological dependence and rebound insomnia
- Cognitive therapy to target unhelpful beliefs
- Sample taper schedules
Co-Occurring Sleep Apnea
- Obstructive sleep apnea
- Morbidity and mortality of OSA
- Relationship of nocturia and OSA
- Sleep apnea treatments
- Obstacles to treatment adherence
- Physical comfort
- Mechanical problems
- Social and other factors
- Psychological factors
- Improve adherence
- Work with stages of change
- Respond to common concerns
- CPAP desensitization for claustrophobia
- Treating insomnia in patients with comorbid OSA
- Morbidity and mortality of OSA
- Using light to leverage circadian timekeeper
- ”Exogenous” circadian challenges
- Cope with shift work
- Adjust to jet lag
- ”Endogenous” circadian disorders: Advanced and delayed sleep phase
- Phototherapy for delayed sleep phase
- Nightmares and nightmare disorder
- Differential diagnosis
- Assessment
- Self-monitoring via nightmare log
- Combine nightmare log and sleep diary
- Imagery Rescripting and Rehearsal
- Psychoeducation and rationale
- Nightmares and trauma
- Shaping imagery skills
- IRT steps
- Prazosin for nightmares
- Case conceptualization: Asking the right questions
- Case Formulation Form
- Factors weakening sleep drive
- Factors weakening the clock
- Evidence of hyperarousal
- Unhelpful sleep behaviors
- Comorbidities
- Case Examples


