Colleen E. Carney – Insomnia Treatment: Evidence-Based Strategies to Enrich Sleep & Boost Clinical Outcomes in Clients with PTSD, Anxiety, Chronic Pain & Depression

Outline

Assessment

• Sleep regulation
• The elements of insomnia
• Goals of assessment
• Diagnostic criteria
• Comorbid conditions
• Other sleep disorders
• When to make a referral to a sleep clinic
• Take-home assessment tools
• Limitations of the research & potential risks
• Case Study: Sleep phase delay vs. insomnia

Stimulus Control (SC): Address Conditioned Arousal to Reduce Wakefulness

• Psychoeducation for your client
• Rules for reassociating the bed with sleep
• Fatigue management strategies to eliminate napping
• Ideas for late-night activities
• Case Study: Is the client a candidate for stimulus control?

Sleep Restriction Therapy (SRT): Restore the Sleep Drive to Improve Sleep Quality

• How to present rationale to your client
• Calculate time-in-bed prescription
• Placing the time-in-bed window
• Identify & overcome obstacles to adherence
• Sleep extension
• How to combine SC & SRT effectively
• Sleep hygiene
• Case Study: Would you increase time in bed?

Counterarousal Strategies: Five MustKnow Strategies to Quiet an Active Mind

• Establish a buffer zone
• Scheduled thinking time
• Combat excessive rumination
• Mindfulness strategies
• Relaxation therapies

Cognitive Therapy: Identify and Change Distorted Thoughts about Sleep

• Thought records
• Behavioral experiments
• Socratic questioning
• Case Study: Interpreting thought records

Modify Insomnia Treatment for Clients with Comorbid Disorders

PTSD

• Fear of silence
• Fear of loss of vigilance
• Delayed bedtime
• Sleep avoidance
• Prolonged nightmare awakenings
• Is hypnotic discontinuation necessary?

Anxiety

• When stimulus control rules can’t be tolerated
• Combat hastiness to get out of bed
• Sleep compression: An alternative to SRT
• Identify sleep anxiety vs. high arousal in bed
• Considerations for panic disorder

Depression

• Sleep’s impact on mood
• Distorted time-in-bed to time sleeping ratio
• Use of coping cards
• Troubleshoot adherence problems
• Worsening moods
• Case Study: Struggling to get out of bed

Chronic Pain

• Pain meds & sleep
• Considerations for use of stimulus control
• Break the association of bed & pain
• When it’s physically difficult to get out of bed