CBT-I Sleep Restriction & Stimulus Control Therapy 3

Question 1

How do sleep restriction therapy and stimulus control therapy complement each other within a comprehensive CBT-I program?

Accepted Answer

Sleep restriction builds homeostatic sleep drive while stimulus control reconditions the bed as a cue for sleepiness

Answer

Sleep restriction addresses cognitive arousal while stimulus control addresses physiological hyperarousal

Answer

Sleep restriction is always applied first and stimulus control is reserved for treatment-resistant cases

Answer

They target the same mechanism and are used interchangeably depending on patient preference

Question 2

For which patient population should sleep restriction therapy be used with the greatest caution or significant modification?

Accepted Answer

Patients with a history of bipolar disorder due to the risk of precipitating a manic episode

Answer

Patients with mild generalized anxiety who experience occasional sleep disruption

Answer

Elderly patients over age 65 who need only minor scheduling adjustments

Answer

Patients with treated obstructive sleep apnea who use CPAP nightly

Question 3

What is 'conditioned arousal' in the context of chronic insomnia, and which CBT-I technique most directly targets it?

Accepted Answer

An alerting response triggered by sleep-related cues such as the bed and bedtime, targeted by stimulus control therapy

Answer

Physiological hyperarousal driven by the HPA axis, targeted by relaxation training

Answer

Cognitive rumination at bedtime about sleep loss, targeted by sleep restriction to reduce available worry time

Answer

Autonomic dysregulation from chronic stress, targeted by biofeedback and mindfulness techniques

Question 4

A patient on sleep restriction has maintained a TIB of 6 hours and reports a sleep efficiency of 91% over the past week. What is the most appropriate next step?

Accepted Answer

Increase TIB by 15 to 30 minutes and reassess sleep efficiency the following week

Answer

Maintain the current 6-hour TIB for another two weeks to fully consolidate the improvement

Answer

Reduce TIB by 15 minutes to continue building sleep pressure and further improve efficiency

Answer

Discontinue sleep restriction entirely and transition to sleep hygiene education alone

Question 5

What is the rationale for discouraging clock-watching during the night within both sleep restriction and stimulus control frameworks?

Accepted Answer

Clock-watching is a hypervigilance safety behavior that reinforces anxiety about sleep and activates arousal

Answer

Clock-watching increases sleep pressure by reminding the patient how much remaining sleep time they have

Answer

Looking at a lit clock display suppresses melatonin secretion and delays sleep onset

Answer

Tracking nighttime awakenings by clock triggers REM sleep interruption and fragmentation

Question 6

Which outcome measure derived from the sleep diary most directly guides TIB titration decisions throughout a sleep restriction protocol?

Accepted Answer

Sleep efficiency (SE) calculated as TST divided by TIB, averaged weekly

Answer

Sleep onset latency (SOL) averaged across the preceding seven nights

Answer

Wake after sleep onset (WASO) totaled across the preceding seven nights

Answer

Number of nighttime awakenings recorded by actigraphy over the preceding seven nights

Question 7

A CBT-I therapist is explaining to a patient why temporary daytime sleepiness is expected and even desirable at the start of sleep restriction therapy. What is the most clinically accurate explanation?

Accepted Answer

Restricted TIB temporarily reduces total sleep time, building homeostatic sleep pressure that will subsequently consolidate and deepen nighttime sleep

Answer

The body is redistributing sleep architecture to increase slow-wave sleep at the expense of lighter stages

Answer

Stimulus control instructions that prohibit napping eliminate the daytime rest that was compensating for night waking

Answer

Cognitive restructuring exercises temporarily deplete cognitive resources, creating a fatigue effect