We’ll introduce a respected conceptual model of chronic insomnia and highlight basic sleep physiology, including both biological rhythms and homeostatic forces regulating sleep. We'll also briefly describe symptoms indicative of disordered REM vs. NREM sleep, setting the stage for understanding and detecting several common parasomnias.
We’ll explore diagnosis and treatment of two common sleep disorders often masquerading as insomnia and thus risk poor clinical outcomes as well as potential liability for the unaware clinician. Where relevant, discussion of available pharmacotherapies will be included.
Cognitive-Behavioral Therapy for Insomnia (CBT-I) is deemed first line therapy over chronic medication by two large professional medical societies. An introduction to the basics of CBT-I will occupy the afternoon, including the clinical use of patient-generated sleep logs, with illustrative examples. Procedures for six different CBT-I techniques will be outlined, with guidance on selecting those most appropriate and likely to succeed in the context of different patient types.
A case of chronic, medicated insomnia will be presented over the course of the program along with a method for gradual, successful elimination of long-standing, habituated use of a prescription hypnotic.
Learning Objectives
Participants will be able to:
1. define chronic insomnia and common factors contributing to its development and persistence
2. recognize the separate roles of the circadian rhythm for sleep and the homeostatic forces regulating sleep in the development and maintenance of chronic insomnia and utilize this information in the selection of appropriate therapeutic regimens on a case-by-case basis
3. appreciate the effects of aging, alcohol abuse, and total sleep duration vs. time in bed on the quality and restorative value of sleep
4. readily diagnose and understand the treatment of at least two other disorders of sleep that may present primarily or solely with complaints of insufficient or poor quality sleep
5. instruct patients on the use of sleep logs and interpret the resulting data, facilitating selection of optimal treatment recommendations
6. understand the pros and cons of each of six different components of Cognitive-Behavioral Therapy for Insomnia (CBT-I) and select the most likely combination of these for success in individual cases