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Evaluation ViewAttendees 6

Half Day Institute - Ticketed

Sleep / Wake Disorders

Institute 5 - Addressing Comorbid Insomnias: Moving Beyond Sleep Hygiene

Thursday, November 14, 2024
1:30 PM – 6:30 PM EST
Location: 414/415, Level 4, Downtown Marriott
Earn 5 Credit
Ticketed Session
Keywords: Sleep, Anxiety, Depression
Level of Familiarity: Basic to Moderate
Recommended Readings: Edinger, J. D., Arnedt, J. T., Bertisch, S. M., Carney, C. E., Harrington, J. J., Lichstein, K. L., ... & Martin, J. L. (2021). Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine, 17(2), 255-262.,   Edinger, J. D., Arnedt, J. T., Bertisch, S. M.,... & Martin, J. L. (2021). Behavioral and psychological treatments for chronic insomnia disorder in adults: An American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment. Journal of Clinical Sleep Medicine, 17(2), 263-298.,   Hertenstein, E., Trinca, E., Wunderlin, M.,... & Nissen, C. (2022). Cognitive behavioral therapy for insomnia in patients with mental disorders and comorbid insomnia: A systematic review and meta-analysis. Sleep Medicine Reviews, 101597.,   Granberg, R. E., Heyer, A., Gehrman, P. R., Gunter, P. W., Hoff, N. A., Guth, A., ... & Frasso, R. (2022). Patient and provider experiences with CBT-I administered in-person or via telemedicine: A randomized non-inferiority trial. Cogent Psychology, 9(1), 2038936.,   Selvanathan, J., Pham, C., Nagappa, M.,... & Chung, F. (2021). Cognitive behavioral therapy for insomnia in patients with chronic pain–a systematic review and meta-analysis of randomized controlled trials. Sleep medicine reviews, 60, 101460.
Sleep disruption is a shared challenge in anxiety, PTSD, chronic pain, and depression. Disregarding insomnia in these frequently comorbid conditions can result in unsatisfactory treatment outcomes and the recurrence of symptoms. Many providers mistakenly link Cognitive Behavioral Insomnia Therapy (CBT-I) with sleep hygiene, despite the ineffectiveness of sleep hygiene as a treatment. Moreover, therapists outside the sleep specialty often concentrate on the overlap between chronic insomnia and accompanying conditions, addressing issues like worry in anxiety cases rather than the factors perpetuating chronic insomnia. To promote sleep recovery in clients dealing with anxiety, PTSD, chronic pain, and depression, it is crucial to address insomnia-specific causal factors directly. Move beyond traditional sleep hygiene and invest half a day in learning effective strategies for treating comorbid insomnias. Emphasizing case formulation and treatment plans derived from client worksheets, questionnaires, and sleep diaries exercises, this training will enhance your understanding and equip you to provide relief from chronic insomnia using Cognitive Behavioral Therapy for Insomnia (CBT-I) – a concise, evidence-based gold-standard treatment.

Outline:
Assessment
Case Formulation and treatment approaches
a. What factors are affecting sleep drive, and what treatment approaches increase sleep drive?
b. What circadian are affecting the case, and what treatment approaches regulate the clock?
c. Is there evidence of conditioned arousal? Sleep effort? What treatment approaches effectively address arousal?
d. How do comorbid issues affect the case and the treatment plan?
e. How do substances/medications affect the case and the treatment plan?
f. Are there other factors (e.g., readiness for change, life event) to consider?
Treatment/Implementation Considerations
a. Session delivery outline: Group and Individual
b. Sequential vs concurrent decisions
c. Complementary strategies
Summary and Questions

Learning Objectives:

At the end of this session, the learner will be able to:
  1. Distinguish acute insomnia from chronic insomnia and identify treatment implications.
  2. Analyze data from sleep diaries to inform treatment decisions.
  3. Devise behavioral experiments that modify sleep thoughts that get in the way of sleep or engaging with the treatment.
  4. Identify cases in need of stimulus control and troubleshoot common barriers.
  5. Collaborate with clients on a manageable time-in-bed schedule that increases sleep drive.
  6. Long-term Goal: Distinguish acute insomnia from chronic insomnia in their practice.
  7. Long-term Goal: Use their client’s sleep diary data to inform treatment decisions.
  8. Long-term Goal: Devise behavioral experiments with clients to modify thoughts that get in the way of sleep or engaging with the treatment
  9. Long-term Goal: Implement stimulus control and troubleshoot barriers with their clients.
  10. Long-term Goal: Collaborate with clients on a manageable time-in-bed schedule to increase sleep drive.

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