Cognitive Behavioral Therapy for Insomnia (CBT-I) is now recommended as the first line treatment for chronic insomnia. This recommendation was, interestingly enough, made by the second largest medical organization in the United States (The ACP) and was published in the Annals of Internal Medicine (2016;165(2):125-133).
The recommendation is, in part, based on the following findings.
- CBT-I is as efficacious and effective as pharmacotherapy in the short run, and is more durable in the long run
- CBT-I has a more benign side effect profile than pharmacotherapy
- CBT-I yields substantial improvement in sleep continuity, and does so largely irrespective of medical or psychiatric comorbidity.
- CBT-I directly targets the factors that are thought to perpetuate insomnia (i.e., the mismatch between sleep opportunity and sleep ability).
- CBT-I has been shown to work well even with patients with a long history of using hypnotics
- Articulate the basics of sleep nomenclature including sleep period, phase, continuity, and architecture.
- Discriminate acute insomnia from Insomnia Disorder and articulate the importance of treating the chronic form as a specifically targeted co-morbidity.
- Assess for the most common intrinsic sleep disorders such as OSA, RLS, PLMS, circadian rhythm disorders, and narcolepsy.
- Evaluate the common medications used in the treatment of insomnia and understand their relative strengths and weaknesses.
- Communicate the relative efficacy of pharmacotherapy and cognitive behavioral therapies for insomnia.
- Communicate the evidence for the efficacy of CBT-I for both primary and co-morbid insomnia disorder.
- Apply the principles of the Spielman model of insomnia and employ it in the delivery of CBT-I.
- Apply the principles of Borbely’s two-process model of sleep regulation and demonstrate how to utilize this concept in the deployment of CBT-I.
- Score and analyze patient sleep diary data, and create a treatment plan based upon the data in the course of CBT-I treatment.
- Apply the techniques of Sleep Restriction therapy to the treatment of chronic Insomnia.
- Apply the techniques of Stimulus Control to the treatment of chronic Insomnia
- Educate patients in sleep hygiene principles and tailor to individual needs.
- Apply the techniques of cognitive therapeutic strategies to the treatment of chronic insomnia.
- Calculate sleep efficiency and titrate patient sleep windows
- Anticipate, identify and problem solve common resistances in CBT-I.
- Implement an action plan to prevent patient relapse.
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- Welcome announcements and orientation
- Basics of sleep and behavioral model of insomnia
- Pharmacological and behavioral treatment options for insomnia
- Assessment of insomnia Part I-Definition, differential diagnosis, indications for treatment.
- Session 1– Assessment Part 2-CBT-I forms, devices, setting up sleep diaries
- Session 2- Treatment planning, setting up sleep restriction and stimulus control
- Session 3– Adherence issues, problem solving and sleep hygiene.
- Session 4- Cognitive Therapy- General and targeted therapies
- Session 5, 6, & 7– Titration of sleep window, treatment delivery, therapist factors, and charting.
- Session 8– Relapse prevention
- Concluding Remarks