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CBT-I: The First Line Treatment for Chronic Insomn ...
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This presentation explains Cognitive Behavioral Therapy for Insomnia (CBT-I) as the first-line, evidence-based treatment for chronic insomnia. It emphasizes that insomnia is common, costly, and often worsened by stress, anxiety, substance use, and maladaptive sleep behaviors. CBT-I is effective, durable, and comparable to sleeping medications without the same risks or side effects. The core CBT-I components include: - <strong>Cognitive restructuring</strong>: challenging negative thoughts about sleep, such as catastrophizing poor sleep or believing 8 hours is required to function. - <strong>Sleep scheduling</strong>: limiting time in bed to better match actual sleep time, increasing sleep pressure, and setting a consistent wake time. - <strong>Stimulus control</strong>: strengthening the bed as a cue for sleep by using it only for sleep and sex, going to bed only when sleepy, and following the 30-minute/30-minute rule. - <strong>Relaxation techniques</strong>: reducing physiological arousal with methods like breathing exercises, progressive muscle relaxation, body scans, and guided imagery. - <strong>Sleep hygiene</strong>: supportive habits such as avoiding caffeine late in the day, limiting alcohol and nicotine, reducing screen use in bed, exercising earlier, and maintaining a cool, dark, quiet sleep environment. The talk also reviews sleep physiology, common causes and maintenance factors of insomnia, and the importance of assessment through sleep history and sleep logs. It notes that sleep medications may help short-term but do not address the thoughts and behaviors that perpetuate insomnia and can have important drawbacks. A special focus is given to adapting CBT-I for patients with substance use disorders (SUD). These patients frequently have insomnia, may use substances as sleep aids, and face increased relapse risk when sleep remains untreated. CBT-I can improve sleep and may also improve distress tolerance and reduce reliance on substances, though expectations should remain realistic regarding substance use outcomes.
Keywords
Cognitive Behavioral Therapy for Insomnia
CBT-I
chronic insomnia
sleep scheduling
stimulus control
cognitive restructuring
relaxation techniques
sleep hygiene
sleep logs
substance use disorders
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