Donn Posner – Treating Insomnia: Transdiagnostic Clinical Strategies to Optimize Sleep & Improve Outcomes in Clients with PTSD, Anxiety, Depression & Chronic Pain

Outline

Sleep Regulation Problems: How Insomnia Develops

• Factors that weaken the sleep drive
• Factors that weaken the signal of the circadian clock
• How the circadian clock & sleep drive work together to regulate sleep
• How the arousal system interferes with sleep regulation
• Cognitions & behaviors that create cognitive arousal & interfere with sleep
• Identify conditioned insomnia

Assessment & Treatment Planning

• Treat insomnia to improve outcomes of PTSD, chronic pain, depression & anxiety
• Why treating a primary mental health disorder won’t cure insomnia
• Insomnia-informed considerations for the clinical interview
• Who is a good candidate for CBT-I
• Hypnotic medications & sleep
• Drugs that can cause sleep disturbance
• Take-home assessment resources
• Sleep diary
• Limitations of research & potential risks

Assessment Factors

• Assess for comorbid sleep disorders
• Evaluate sleep continuity
• Identify daytime symptoms of insomnia
• Discern bad sleep habits
• Other assessment considerations
• When to refer to a sleep specialist

Sleep Hygiene: Decrease Clients’ Vulnerability to Insomnia

• Clock watching & implications for sleep diary
• Environmental concerns
• How eating affects sleep
• When to exercise
• Address caffeine, alcohol & nicotine use

Sleep Restriction Therapy (SRT): Strengthen the Sleep Drive and Signals From the Circadian Clock

• Goals of sleep restriction
• Sleep restriction rationale
• SRT: Step-by-step
• Considerations for setting the sleep window
• How & when to extend time-in-bed
• Rules for before-bed activities
• Address clients’ fears about SRT
• Combat difficulty with waking on time
• Troubleshooting insufficient progress

Stimulus Control (SC): Address Conditioned Arousal

• Goals of stimulus control
• Rational for stimulus control
• Stimulus control: Step-by-step
• Counter arousal strategies
• Activities for nighttime wakefulness
• Address clients’ practical concerns
• Overcome obstacles to stimulus control

Cognitive Therapy: Help Clients Change Thoughts & Beliefs that Interfere with Sleep

• Reduce arousal: The buffer zone & worry time
• Educate your client to become an expert on their own sleep disorder
• Tools to identify cognitions & belief that interfere with sleep
• Combat intrusive thoughts during sleep time
• Activities to help clients with arousal
• Reduce sleep effort & worry about lack of sleep
• Correct clients’ unrealistic expectations
• Strategies to restructure thoughts
• Behavioral experiments