Can I use CBT-I if I suspect my patient has another sleep disorder, such as circadian rhythm disorder, shift work, restless leg syndrome, nightmares, or obstructive sleep apnea?Īnswer: This is a complicated question because patients suffering with other sleep disorders may have also developed bad habits that perpetuate insomnia.
Resources: VIDEO: CDP Presents: Chickens & Eggs - Treatment Order in Cases of Co-Morbid PTSD and Insomniaģ. In the absence of patient preference, consider which condition seems to be causing the patient the most distress currently (either symptomatically or functionally). Considering that patient buy-in is an important factor in the success of any treatment, patient preference may be sufficient when choosing treatment order. Often, a patient will express a preference for which condition they wish to address first or which type of treatment they are most willing to consider. Treatment order should instead be guided by the patient’s preference and your case conceptualization. There is no conclusive research evidence to suggest that one condition should be treated before another. Should I treat mental health co-morbidities such as depression, anxiety, or PTSD before providing CBT-I?Īnswer: Insomnia is often comorbid with other conditions. Unless your patient has an easily identifiable single source of sleep problems or sleep problems are acute, CBT-I is recommended.Ģ. That means it is unlikely that simply targeting sleep hygiene will be helpful, and indeed, research demonstrates that for patients who have Insomnia Disorder, even if they have poor sleep hygiene, sleep hygiene interventions alone are ineffective. However, patients with sleep problems generally have multiple contributing factors, particularly if the insomnia has become chronic. In these cases, targeting the problem directly can help.
What should I tell my patient to help him/her decide to pursue this treatment or try CBT-I?Īnswer: For some patients, difficulty sleeping can be attributed to a specific source, such as a noisy bed partner or uncomfortable mattress.
#Symptoms of insomnia visual aid manual#
Can we shift the sleep schedule to match that earlier time?ġ5. How do I adjust my patient’s sleep schedule after setting it for the first time?ġ6. My patient is midway through the CBT-I protocol, so why is sleep efficiency still low?ġ7. What should I do if I suspect my patient is getting more sleep or having less fragmentation than the sleep log shows?ġ8. If CBT-I has significantly improved a patient’s sleep before Session 8, is it alright to discontinue the protocol early?ġ9. Do you have a manual to provide group CBT-I?Ģ0. My recently referred patient is considering or has already started an intervention for sleep that I have never heard about (e.g., neurofeedback). How should I respond?ġ3. How do I respond when my patient has difficulty keeping the scheduled wake time consistently?ġ4. My patient regularly awakens before our scheduled wake time in the mornings. How do I tell the difference between Insomnia Disorder and insufficient sleep?ĥ. Are there any contraindications for CBT-I?Ħ. Should patients stop taking sleep medication before starting the CBT-I protocol?ħ. Do I include napping in sleep log scoring?Ĩ. Do I include time out of bed when engaging in stimulus control during middle-of-the-night awakenings as part of the scored ‘TIB’ from the sleep log?ĩ. How do I handle a patient who refuses to complete a sleep log, or insists on using a device like a fitness tracker instead of completing a log?ġ0. If a patient reports excessive caffeine, alcohol, or other substance use, should that be addressed before stimulus control and sleep restriction?ġ1. Can a patient get in bed before our scheduled bedtime if they are sleepy earlier?ġ2. My patient could only come up with stimulating activities to do when out of the bed awake. Would CBT-I be helpful for them?Ģ. Should I treat mental health co-morbidities such as depression, anxiety, or PTSD before providing CBT-I?ģ. Can I use CBT-I if I suspect my patient has another sleep disorder, such as circadian rhythm disorder, shift work, restless leg syndrome, nightmares, or obstructive sleep apnea?Ĥ. I was referred a patient who reports getting very little sleep, wakes up unrefreshed, and is tired during the day. My patient’s sleep problems seem to stem from poor sleep hygiene. įor those who have been trained in an EBP at any time by the Center for Deployment Psychology, a wealth of resources is available in our Provider Portal. For a schedule of upcoming training events, please click here. Please note that these responses do not take the place of becoming trained.
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