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 increases homeostatic sleep pressure (Process S) while stimulus control dismantles conditioned arousal, together addressing the two major perpetuating mechanisms of chronic insomnia.

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

Sleep deprivation resulting from sleep restriction can trigger manic or hypomanic episodes in patients with bipolar disorder, making this a critical contraindication or modification point.

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

Conditioned arousal is the learned alerting response that occurs when sleep-related stimuli (bed, bedroom, bedtime routine) become associated with wakefulness; stimulus control systematically extinguishes this association.

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

SE ≥85% is the standard threshold for TIB expansion; with SE at 91%, the protocol calls for increasing TIB by 15-30 minutes while continuing to monitor SE the following week.

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 is a safety behavior that fuels hypervigilance and anxiety about sleep loss, reinforcing the arousal cycle that perpetuates insomnia and directly counteracting both stimulus control and cognitive goals of CBT-I.

(CBT-I) CBT Insomnia Certification Practice Test

(CBT-I) CBT Insomnia Certification Practice Test

CBT-I Sleep Restriction & Stimulus Control Therapy 3