Outline

There is sleep regulation.

• Sleep homeostasis
• Behaviors that interfere with the build-up of sleep-drive
• The circadian system
• Behaviors that interfere with optimal timing of sleep
• Arousal system: behaviors that cause conditioned arousal and cognitive emotional hyperarousal

Assessment

• How to get useful information from sleep diaries
• The difference between sleepiness and fatigue
• When to make a referral to a sleep clinic
• Other assessment issues

Sleep drugs.

• Why some medications do not work
• CBT-I as the most effective and longer lasting treatment

Insomnia can be treated with cognitive behavior therapy.

• Sleep Restriction Therapy (SRT): Restore the Sleep Drive
  • Calculate optimal time-in-bed prescription
  • Collaborate on the best “sleep window”
  • Special cases: when to use sleep compression instead
• Stimulus Control (SC): Addressing Conditioned Arousal
  • Select an optimal standard rise time
  • Fatigue management strategies to eliminate napping
  • Special cases: when to use counter control instead
  • Combining SC and SRT in one-session CBT-I

There are counter-arousal strategies.

• Identify and change negative thoughts that keep people awake
• Behavioral experiments
• Thought records
• The buffer zone
• Socratic questioning
• Structured, scheduled problem-solving
• Mindfulness
• Troubleshooting difficulties with adherence
• High sleep anxiety vs. high arousal
• Awakenings from pain, hot flashes, panic or nightmares
• Using light and activation in those with depression

Modifications to CBT for Insomnia in Complex Cases.

• Major Depressive Disorder
• Chronic pain
• Anxiety disorders
• Post-Traumatic Stress Disorder

Implementation issues are related.

• Relapse prevention
• Delivery issues