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

Outline

Assessment Assessment

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

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

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

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

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

Counterarousal Strategies: Counterarousal Strategies: Five MustKnow Strategies to Quiet an Active MindFive MustKnow Strategies to Quiet an Active Mind

• Establish a buffer zoneEstablish a buffer zone
• Scheduled thinking timeScheduled thinking time
• Combat excessive ruminationCombat excessive rumination
• Mindfulness strategiesMindfulness strategies
• Relaxation therapiesRelaxation therapies

Cognitive Therapy: Cognitive Therapy: Identify and Change Distorted Thoughts about Sleep Identify and Change Distorted Thoughts about Sleep

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

Modify Insomnia Treatment for Clients with Comorbid DisordersModify Insomnia Treatment for Clients with Comorbid Disorders

PTSDPTSD

• Fear of silenceFear of silence
• Fear of loss of vigilanceFear of loss of vigilance
• Delayed bedtimeDelayed bedtime
• Sleep avoidanceSleep avoidance
• Prolonged nightmare awakeningsProlonged nightmare awakenings
• Is hypnotic discontinuation necessary?Is hypnotic discontinuation necessary?

Anxiety Anxiety

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

Depression Depression

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

Chronic Pain Chronic Pain

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