Treating Insomnia: Evidence-Based Strategies to Help Your Clients Sleep – Meg Danforth

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One of the biggest mistakes you as a clinician can make is NOT asking about the client’s sleeping habits. We all know the necessity of sleep – especially for those who are depressed, anxious, obsessively worried, or in chronic pain – yet often we overlook this. And worse, we think there’s nothing we can do to help them.

Join me, Meg Danforth, and I’ll show you successful, proven techniques I’ve developed over the last decade on how to optimize your clients sleep – without medication!

Discover evidence-based strategies to help your clients increase energy during the day, sleep more deeply, and re-initiate sleep after hot flashes, panic attacks or nightmares. The strategies I will show you can be easily integrated into existing treatment for depression, chronic pain, trauma and anxiety.

Take the next step and join me today, I will help you learn new assessment tools, step-by-step CBT, and counter-arousal strategies that your client can immediately use. My engaging workshop will include discussion of case vignettes, experiential exercises, examples of sleep logs and other tools to use in your clinical practice.

1. Select assessment tools that screen for other sleep disorders and identify insomnia treatment targets as it relates to case conceptualization.
2. Teach clients about the science of sleep, causes of chronic insomnia and the impact on overall mental health.
3. Explore three models of CBT-I delivery and implementation issues for different practice settings.
4. Specify why CBT-I is effective for clients with co-occurring issues such as pain, depression, anxiety or trauma.
5. Set-up treatment strategies that clients can easily implement to manage fatigue.
6. Collaboratively design a sleep schedule with clients using a sleep diary to improve client’s sleep efficiency and daytime functioning.

Sleep Regulation

• Sleep homeostasis
• Behaviors that interfere with the build-up of sleep-drive
• The circadian system
• Behaviors that interfere with optimal timing of sleep
• Arousal system: behaviors that cause conditioned arousal and cognitive emotional hyperarousal

Assessment

• How to get useful information from sleep diaries
• The difference between sleepiness and fatigue
• When to make a referral to a sleep clinic
• Other assessment issues

Sleep Medications

• Why some medications do not work
• CBT-I as the most effective and longer lasting treatment

Cognitive Behavior Therapy for Insomnia (CBT-I)

• Sleep Restriction Therapy (SRT): Restore the Sleep Drive
  • Calculate optimal time-in-bed prescription
  • Collaborate on the best “sleep window”
  • Special cases: when to use sleep compression instead
• Stimulus Control (SC): Addressing Conditioned Arousal
  • Select an optimal standard rise time
  • Fatigue management strategies to eliminate napping
  • Special cases: when to use counter control instead
  • Combining SC and SRT in one-session CBT-I

Counter-Arousal Strategies

• Identify and change negative thoughts that keep people awake
• Behavioral experiments
• Thought records
• The buffer zone
• Socratic questioning
• Structured, scheduled problem-solving
• Mindfulness
• Troubleshooting difficulties with adherence
• High sleep anxiety vs. high arousal
• Awakenings from pain, hot flashes, panic or nightmares
• Using light and activation in those with depression

Modifications to CBT for Insomnia in Complex Cases & Comorbidity

• Major Depressive Disorder
• Chronic pain
• Anxiety disorders
• Post-Traumatic Stress Disorder

Implementation Issues

• Relapse prevention
• Delivery issues