CBT-I Cognitive Behavioral Techniques & Sleep Interventions 3 — Questions and Answers
Question 1: A patient with insomnia has a sleep efficiency of 62% over the past two weeks, sleeping an average of 5.5 hours in a 9-hour time in bed window. What initial sleep window should the therapist prescribe using sleep restriction?
- 5.5 hours, but no less than 5 hours (Correct answer)
- 6.5 hours to allow buffer time
- 9 hours to match current time in bed
- 8 hours based on normative recommendations
Correct answer: 5.5 hours, but no less than 5 hours
Sleep restriction prescribes a sleep window equal to average total sleep time (5.5 hrs), with a floor of 5 hours to prevent dangerous sleep deprivation.
Question 2: In CBT-I, the term 'sleep hygiene' refers specifically to:
- Lifestyle and environmental practices that promote sleep (Correct answer)
- The cleanliness and organization of the sleep environment
- A comprehensive standalone treatment for chronic insomnia
- Rules for maintaining the sleep diary accurately
Correct answer: Lifestyle and environmental practices that promote sleep
Sleep hygiene encompasses behavioral and environmental factors (caffeine, light, noise, exercise timing) that influence sleep quality, but is insufficient as a standalone insomnia treatment.
Question 3: Cognitive restructuring in CBT-I typically uses which therapeutic technique to help patients evaluate their sleep-related beliefs?
- Socratic questioning to examine evidence for and against the belief (Correct answer)
- Systematic desensitization through imaginal exposure
- Behavioral experiments using extended time in bed
- Journaling about childhood sleep experiences
Correct answer: Socratic questioning to examine evidence for and against the belief
Socratic dialogue guides patients to examine the evidence supporting catastrophic sleep beliefs and generate more balanced, realistic alternatives.
Question 4: Which component of CBT-I directly targets hyperarousal by teaching patients to observe thoughts without judgment?
- Mindfulness-based techniques (Correct answer)
- Stimulus control
- Sleep restriction
- Sleep hygiene education
Correct answer: Mindfulness-based techniques
Mindfulness practices reduce the cognitive and somatic arousal that perpetuates insomnia by fostering nonjudgmental awareness of mental activity.
Question 5: A patient reports lying awake worrying about work and family issues every night. Which CBT-I technique is MOST specifically designed for this?
- Scheduled worry time earlier in the evening (Correct answer)
- Deep breathing exercises at bedtime
- Extending the sleep window by 30 minutes
- Avoiding naps during the day
Correct answer: Scheduled worry time earlier in the evening
Scheduled worry time (constructive worry) externalizes rumination to a fixed, pre-bedtime period, reducing intrusive cognitive activity at night.
Question 6: Which of the following is a contraindication or reason for caution when implementing sleep restriction therapy?
- History of bipolar disorder or seizure disorder (Correct answer)
- Mild sleep apnea with CPAP compliance
- Anxiety disorder currently in remission
- Prior unsuccessful use of sleep medications
Correct answer: History of bipolar disorder or seizure disorder
Sleep restriction-induced sleep deprivation can trigger manic episodes in bipolar disorder and lower seizure threshold, requiring clinical caution or modification.
Question 7: After two weeks of sleep restriction, a patient achieves 88% sleep efficiency. What should the CBT-I therapist do next?
- Increase the sleep window by 15–20 minutes (Correct answer)
- Keep the sleep window unchanged for another week
- Reduce the sleep window by 15 minutes to consolidate gains
- Transition immediately to a normal 8-hour window
Correct answer: Increase the sleep window by 15–20 minutes
When sleep efficiency reaches 85–90%, the protocol calls for gradually expanding the sleep window (typically 15–20 min) to allow more total sleep time while maintaining consolidation.
CBT-I Cognitive Behavioral Techniques & Sleep Interventions 3
A patient with insomnia has a sleep efficiency of 62% over the past two weeks, sleeping an average of 5.5 hours in a 9-hour time in bed window.
What initial sleep window should the therapist prescribe using sleep restriction?