CBT-I Special Populations & Comorbidities Flashcards

When applying CBT-I to older adults, which modification is most commonly needed?

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.

CBT-I is considered first-line treatment for insomnia comorbid with which conditions?

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.

In patients with PTSD and insomnia, which CBT-I component requires special consideration?

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.

Which aspect of CBT-I typically needs modification for patients with chronic pain?

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.

CBT-I for patients with major depressive disorder should be:

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.

For pregnant women with insomnia, CBT-I is preferred over sleep medications primarily because:

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.