CBT-I Patient Assessment & Treatment Planning 3

Question 1

A patient's two-week sleep diary shows a highly variable sleep schedule with bedtimes ranging from 10 PM to 2 AM. What does this pattern primarily suggest for treatment planning?

Accepted Answer

Irregular sleep-wake rhythm requiring circadian stabilization as part of CBT-I

Answer

Highly variable sleep timing indicates a disrupted circadian anchor, so consistent wake time is established first in CBT-I to stabilize the sleep-wake cycle.

Question 2

Which sleep diary variable is used as the primary metric when making week-to-week adjustments in sleep restriction therapy?

Accepted Answer

Sleep efficiency (SE) averaged over the preceding week

Answer

Weekly average SE guides TIB titration: SE ≥90% expands the window; SE <85% maintains or contracts it.

Question 3

A 72-year-old patient reports waking at 3 AM and being unable to return to sleep. Which assessment consideration is most age-specific for this presentation?

Accepted Answer

Advanced sleep phase, which is more common in older adults and alters target bedtime recommendations

Answer

Older adults commonly experience an advanced sleep phase with earlier natural sleep and wake times, which must be incorporated into sleep window scheduling.

Question 4

During the assessment phase, a patient scores 16 on the PHQ-9 alongside an ISI of 19. What is the recommended CBT-I planning approach?

Accepted Answer

Address both disorders concurrently using an integrated CBT protocol

Answer

Evidence supports treating comorbid insomnia and depression concurrently because improvement in sleep often amplifies antidepressant response.

Question 5

What information from a patient interview would most support a diagnosis of psychophysiological insomnia rather than another insomnia subtype?

Accepted Answer

Sleeping better away from home and heightened arousal at bedtime in the home environment

Answer

Psychophysiological insomnia is characterized by conditioned arousal; sleeping better in novel environments (e.g., hotels) is a hallmark diagnostic feature.

(CBT-I) CBT Insomnia Certification Practice Test

(CBT-I) CBT Insomnia Certification Practice Test

CBT-I Patient Assessment & Treatment Planning 3