CBT-I CBT-I Special Populations & Comorbidities 1 — Questions and Answers
Question 1: When applying CBT-I to older adults, which modification is most commonly needed?
- Eliminating stimulus control entirely
- Using a less aggressive sleep restriction with a floor of at least 6 hours (Correct answer)
- Avoiding all relaxation techniques
- Extending the titration period to 6 months
Correct answer: Using a less aggressive sleep restriction with a floor of at least 6 hours
Older adults may be more sensitive to sleep deprivation, so the minimum sleep window is typically kept at 6 hours rather than 5.
Question 2: CBT-I is considered first-line treatment for insomnia comorbid with which conditions?
- Obstructive sleep apnea only
- Depression, anxiety, and chronic pain conditions (Correct answer)
- Narcolepsy
- Restless legs syndrome only
Correct answer: Depression, anxiety, and chronic pain conditions
Evidence supports CBT-I as first-line across a wide range of comorbidities, including mood disorders and chronic pain.
Question 3: In patients with PTSD and insomnia, which CBT-I component requires special consideration?
- Sleep hygiene education
- Stimulus control — specifically the instruction to get out of bed (Correct answer)
- Sleep diary completion
- Relaxation timing
Correct answer: Stimulus control — specifically the instruction to get out of bed
For PTSD patients, the out-of-bed instruction may be contraindicated if it exposes them to unsafe environments or triggers trauma-related responses.
Question 4: Which aspect of CBT-I typically needs modification for patients with chronic pain?
- Sleep diary format
- Sleep restriction, since pain may make extended wakefulness more distressing (Correct answer)
- The use of cognitive restructuring
- Bright light therapy timing
Correct answer: Sleep restriction, since pain may make extended wakefulness more distressing
Sleep restriction may exacerbate pain sensitivity, so the protocol is often delivered more slowly with less aggressive restriction.
Question 5: CBT-I for patients with major depressive disorder should be:
- Withheld until depression remits
- Delivered concurrently with depression treatment as it improves both outcomes (Correct answer)
- Limited to sleep hygiene only
- Replaced entirely with pharmacotherapy
Correct answer: Delivered concurrently with depression treatment as it improves both outcomes
Research shows that treating insomnia with CBT-I concurrently with depression treatment improves both sleep and mood outcomes.
Question 6: For pregnant women with insomnia, CBT-I is preferred over sleep medications primarily because:
- Medications are more effective in pregnancy
- Most sleep medications carry risks to fetal development (Correct answer)
- Pregnant women do not experience hyperarousal
- CBT-I works faster during pregnancy
Correct answer: Most sleep medications carry risks to fetal development
Most sleep medications are contraindicated or carry teratogenic risks during pregnancy, making CBT-I the safest first-line option.
CBT-I CBT-I Special Populations & Comorbidities 1
When applying CBT-I to older adults, which modification is most commonly needed?