CBT-I CBT-I Special Populations & Comorbidities 2 — Questions and Answers
Question 1: When treating insomnia in cancer patients, which unique factor must be incorporated into the CBT-I case conceptualization?
- Lack of circadian variation
- Treatment-related symptoms such as pain, nausea, and hot flashes that disrupt sleep (Correct answer)
- Absence of conditioned arousal
- Normal homeostatic sleep pressure
Correct answer: Treatment-related symptoms such as pain, nausea, and hot flashes that disrupt sleep
Cancer treatment side effects like pain, hot flashes, and nausea interact with insomnia and must be incorporated into the CBT-I case conceptualization.
Question 2: CBT-I adaptations for individuals with bipolar disorder most importantly include:
- Eliminating sleep restriction due to risk of triggering mania (Correct answer)
- Extending sleep windows indefinitely
- Avoiding all cognitive components
- Using aggressive sleep restriction to stabilize mood
Correct answer: Eliminating sleep restriction due to risk of triggering mania
Sleep restriction is generally avoided in bipolar disorder because sleep deprivation can trigger manic episodes.
Question 3: For patients with generalized anxiety disorder and insomnia, treatment should:
- Address only the insomnia, as it will resolve the anxiety
- Target both conditions, as they share maintaining mechanisms (Correct answer)
- Delay CBT-I until GAD is fully resolved
- Avoid any relaxation techniques
Correct answer: Target both conditions, as they share maintaining mechanisms
GAD and insomnia share hyperarousal and worry as maintaining factors, and integrated treatment targeting both produces better outcomes.
Question 4: Which sleep-related comorbidity must be identified and treated before CBT-I can be fully effective?
- Restless legs syndrome
- Obstructive sleep apnea (OSA) (Correct answer)
- Hypersomnia
- Narcolepsy
Correct answer: Obstructive sleep apnea (OSA)
Untreated OSA fragments sleep mechanically, which can undermine CBT-I outcomes; OSA should be identified and treated alongside or before CBT-I.
Question 5: In treating insomnia in adolescents with CBT-I, what key biological factor must be considered?
- Increased slow-wave sleep compared to adults
- Delayed circadian phase that conflicts with early school schedules (Correct answer)
- Absence of conditioned arousal in teens
- Shorter REM cycles than adults
Correct answer: Delayed circadian phase that conflicts with early school schedules
Adolescents have a biologically delayed circadian phase, meaning school start times often conflict with their natural sleep timing.
Question 6: Insomnia co-occurring with shift work differs from typical insomnia because it involves:
- No conditioned arousal component
- Circadian misalignment as a key etiological factor alongside conditioned arousal (Correct answer)
- Sleep restriction being contraindicated
- Stimulus control as the only effective component
Correct answer: Circadian misalignment as a key etiological factor alongside conditioned arousal
Shift work insomnia requires addressing both the behavioral and circadian components, sometimes including light therapy and strategic napping.
CBT-I CBT-I Special Populations & Comorbidities 2
When treating insomnia in cancer patients, which unique factor must be incorporated into the CBT-I case conceptualization?