CBT-I CBT-I Sleep Hygiene & Lifestyle Factors 2 — Questions and Answers
Question 1: Regular aerobic exercise has been shown to improve insomnia by:
- Directly increasing adenosine levels during exercise
- Reducing anxiety, improving mood, and enhancing slow-wave sleep (Correct answer)
- Resetting the circadian clock to an earlier phase
- Eliminating the need for behavioral sleep interventions
Correct answer: Reducing anxiety, improving mood, and enhancing slow-wave sleep
Exercise reduces anxiety, improves mood, and increases slow-wave sleep, all of which benefit insomnia patients.
Question 2: What is the recommended timing of vigorous exercise relative to bedtime for patients with insomnia?
- Immediately before bed to induce tiredness
- At least 2-4 hours before bedtime (Correct answer)
- Only in the afternoon, never in the morning
- Timing has no effect on sleep quality
Correct answer: At least 2-4 hours before bedtime
Vigorous exercise raises core body temperature and arousal, which can interfere with sleep if done too close to bedtime; at least 2-4 hours of buffer is recommended.
Question 3: Napping guidelines in CBT-I generally recommend:
- Unlimited napping to compensate for nighttime sleep loss
- Avoiding naps during active treatment to preserve nighttime sleep drive (Correct answer)
- One 2-hour nap each afternoon
- Napping only on weekends
Correct answer: Avoiding naps during active treatment to preserve nighttime sleep drive
Daytime napping reduces homeostatic sleep pressure, undermining the sleep restriction component of CBT-I.
Question 4: Which dietary factor, besides caffeine and alcohol, is most associated with sleep disruption?
- Vitamin D deficiency
- Large or spicy meals close to bedtime (Correct answer)
- Insufficient protein intake
- Low carbohydrate diet
Correct answer: Large or spicy meals close to bedtime
Heavy, spicy, or large meals close to bedtime can cause discomfort, heartburn, and metabolic activation that disrupts sleep.
Question 5: Which statement about nicotine and sleep is correct?
- Nicotine has no effect on sleep quality
- Nicotine is a stimulant that can delay sleep onset and reduce sleep quality (Correct answer)
- Nicotine patches worn overnight improve slow-wave sleep
- Smoking cessation always immediately improves sleep
Correct answer: Nicotine is a stimulant that can delay sleep onset and reduce sleep quality
Nicotine stimulates the nervous system and has been linked to longer sleep onset latency, more nighttime awakenings, and reduced slow-wave sleep.
Question 6: Sleep hygiene education alone is most effective for:
- Severe chronic insomnia with conditioned arousal
- Mild or subclinical sleep disturbance or as prevention (Correct answer)
- Insomnia in patients with comorbid psychiatric disorders
- Insomnia that has persisted longer than 5 years
Correct answer: Mild or subclinical sleep disturbance or as prevention
Sleep hygiene has the most benefit for mild sleep disturbances or as a preventive measure; chronic insomnia requires the full CBT-I protocol.
CBT-I CBT-I Sleep Hygiene & Lifestyle Factors 2
Regular aerobic exercise has been shown to improve insomnia by: