281 Index Acceptance and Commitment Therapy (ACT), 204–206, 208, 223, 373 ACT. See Acceptance and Commitment Therapy Adenosine, 17–18, 24, 61, 211 Adherence in the case of Sam, 201–204, 209–213, 218–219, 221 in the case of Sophie, 171–172, 176, 180–183, 185–186, 192 in treatment planning, 140, 145–158, 225–226, 229–233 with CPAP, 39–40, 42, 70 with sleep diary, 75–76 with sleep restriction therapy, 97, 98–106, 130–132 with stimulus control, 90–92, 130–132 with behavioral experiments, 124 Advance sleep phase syndrome (ASPS), 36–37 Advanced sleep phase type. See Circadian rhythm sleep–wake disorders AHI. 38, 197–198 Alcohol, 7, 61–62, 112, 157, 227 dependence, 144 in sleep hygiene, 116 in the case of Sam, 196, 222 in the case of Sophie, 163, 171 American Academy of Sleep Medicine, 3 Anhedonia, 40, 45, 73, 86, 92, 132, 149 Apnea–hypopnea index (AHI), 38, 197–198 Arousal down-regulation, 25 Arousal threshold, 50, 134 Atonia, 14, 48, 50 Aversion to silence, 150 B Bariatric surgery, 32 Behavioral activation, 86, 132, 149–151, 229 Behavioral experiment(s), 30, 53, 137–138, 107, 116 in case conceptualization and treatment planning, 148, 149, 153, 157 in the case of Sam, 203, 218, 223 in the case of Sophie, 192 to address sleep-related worries and beliefs, 118, 121, 124 to promote adherence, 91, 128, 130 Behavioral jet lag, 91 Beliefs and attitudes about sleep, 28, 148. See also DBAS-16 Bipolar disorder, 43–44, 47, 52, 102, 154 assessing sleep in, 71 sleep restriction in, 98, 143, 149 Bootzin, Richard, 31 British Association of Psychopharmacology, 5 Buffer zone, 87, 108, 116, 148 in the case of Sophie, 170, 173–174, 179, 185–186 C Caffeine and adenosine, 24, 61 and masked sleepiness, 85 and sleep drive, 17–18, 24, 112 as model for insomnia, 26 assessment of use, 61, 79 half-life, 61 in case conceptualization and treatment planning, 145–146
282 Index Caffeine (cont.) in sleep hygiene, 112, 116 in the case of Sam, 196, 201, 203, 211–213, 218, 222 Care-taking duties at night, 61, 145–146 Carryover sedation, 51, 62 Chinese finger cuff/trap, 27, 125, 138 Chronic pain, 4, 10, 49, 51–52, 202 assessment of insomnia in, 73–74 in case conceptualization and treatment planning, 150 in the case of Sam, 10–11, 72, 194–203, 209–210, 215, 221–223 medications for, 51 sleep restriction therapy in, 102 sleep hygiene in, 114 stimulus control in, 86, 89–90 Chronotype, 19, 21, 23. See also Circadian clock, and morningness–eveningness assessment of, 63–65 eveningness, 21, 24, 115–116, 132 assessment of, 66–67 night-to-night variability in sleep times in, 77 in circadian rhythm sleep–wake disorders, 36 in sleep restriction therapy, 95–97, 99–100, 102, 105 in case conceptualization and treatment planning, 141, 145, 147–148, 156 in the case of Sam, 201 in the case of Sophie, 176 morningness, 21, 24, 116 assessment of, 58, 67–68 Circadian clock, 18–23, 25, 27. See also Process C; Circadian rhythm sleep–wake disorders and alerting signals, 36–43, 46, 151, 185, 216, 278, 294 amplitude, 37, 42 and morningness–eveningness, 21, 65, 66, 91–92 and eating, 51, 62 and fixing wake time, 82, 91, 106 and light exposure, 113–116 assessment of, 63 behavior affecting, 19, 20, 45, 152 definition of, 18 in case conceptualization and treatment planning, 145, 148 misalignment, 19 scientific fact about, 20 Circadian rhythm sleep–wake disorders, 37, 115 advanced sleep phase type, 65, 67, 111, 115, 263, 310. See also Advanced sleep phase syndrome delayed sleep phase type, 65, 66, 67, 111, 115, 263, 309. See also Delayed sleep phase syndrome irregular sleep–wake type, 65, 67 non–24 hour sleep–wake type, 65, 68 Circadian tendency, 65, 80, 95, 173. See also Chronotype, eveningness; Chronotype, morningness Claustrophobia, 39 Clock checking (watching or monitoring), 9, 30, 111, 137, 148, and sleep diary, 75, 154 and stimulus control, 87, 115 Cognitive arousal, 28, 63, 87, 145, 153, 171–173 Conditioned arousal, 31–33, 106 and stimulus control, 81–83, 86–87, 91, 93 behaviors contributing to, 61, 62 in case conceptualization and treatment planning, 145–146, 148, 150 in chronic pain, 49, 150 in depression, 45 in etiological model of insomnia, 33 in nightmare disorder, 41 in the case of Sam, 200, 201, 203, 212, 213 in the case of Sophie, 170, 171, 173, 192 Confusional arousal, 50 Constructive worry, 108–109, 149, 173, 181–182 Continuous positive airway pressure (CPAP), 39–40, 42 adherence with, 42, 70, 197–198, 211 adjustment to, 141, 145, 213 in case conceptualization and treatment planning, 141, 145, 197, 226–227 in the case of Sam, 97, 193, 197–198, 200–204, 211–222, 226 Contraindication for CBT-I, 1, 11, 140, 142, 226 for components of CBT-I, 42, 226 for group CBT-I, 230 in case conceptualization and treatment planning, 152, 154, 157 Core body temperature, 18, 20–21, 26, 114–115 Cortical activation, 26 Cost–benefit analysis, 118, 127–128, 131, 134, 137–138 in case conceptualization and treatment planning, 148–149, 153 Counterarousal, 104, 116, 148, 183, 231 Countercontrol, 90, 93–94, 143 CPAP. See Continuous positive airway pressure D Daytime impairment, 2, 4–5, 16, 141, 166 DBAS-16, 63–65, 159, 170–171. See also Beliefs and attitudes about sleep Deep sleep, 14–15, 17, 209, 211
Index 283 Delayed sleep phase syndrome (DSPS), 36 Delayed sleep phase type. See Circadian rhythm sleep–wake disorders, delayed sleep phase type Delta sleep, 3. See also Slow-wave brain activity; Slow-wave sleep Dental appliances, 39 Depression, 3, 6, 52, 72–73 assessment of insomnia in, 58, 67, 72–73 factors to consider in the treatment of, 44–46 impact of CBT-I on, 149, 232 implementation of stimulus control in, 86, 92 in case conceptualization and treatment planning, 52, 86, 146, 149, 229, 232 insomnia as a risk for, 5, 43 residual insomnia in, 44 sleep deprivation in, 47 sleep in, 44–46 waking up early, 37, 67, 73 Desensitization, 39 Diagnostic and Statistical Manual for Psychiatric Disorders (DSM), 2–3, 35, 46, 51, 71, 115 Diaphragmatic breathing, 110 Didgeridoo, 39 Downward arrow technique, 118, 121, 183 Dream enactment, 48, 50 Delayed sleep phase syndrome (DSPS) 36, 115. See also Circadian rhythm sleep–wake disorders, delayed sleep phase type Dysfunctional beliefs and attitudes about sleep (DBAS-16) 63, 65 E EEG, 26 Emotional reasoning, 128, 130 Environmental temperature, 114 Environmental light exposure, 114 Eszopiclone, 9, 60, 162 Eveningness, 21, 23, 36. See also Chronotype, eveningness assessment of, 65–67 difficulty waking up, 58, 92 in sleep restriction therapy, 96, 102 in stimulus control, 91–92 light exposure in, 107, 115–116, 132 Excessive daytime sleepiness, 69, 98, 144, 166 F Fear of loss of vigilance, 48, 50, 134, 149 Feeding and eating disorders, 51, 71 Fibromyalgia, 49, 51, 61, 72 assessment in, 90 in the case of Sam, 10, 46, 49, 61, 72, 195–221 medication for, 51 sleep restriction therapy in, 102–103 treatment of, 46, 51, 221 G Gabapentin, 10, 51, 197, 202 Generalized Anxiety Disorder (GAD), 48, 108, 149 H Half-life, 59–61, 146, 147, 227 Haynes, Patricia, 27 Help-seeking, 5 HIV, 144 Homeostatic sleep process, 16. See also Process S; Sleep drive Hyperarousal, 25, 27, 80 –81, 85, 107, 116, 140 cognitive, 31, 45, 164, 197 conditioned. See Conditioned arousal in case conceptualization and treatment planning, 145, 146, 150, 170–171, 173, 201 in PTSD, 50 physiological, 25–26 Hypervigilance, 32, 85, 93, 107, 110, 111 in PTSD, 50, 94, 104, 115, 134 in case conceptualization and treatment planning, 145, 173 Hypnotic dependent insomnia, 7, 223, 225 Hypnotic medication, 5–7, 11, 59, 140, 227, 228 Hypoxemia, 37–38 I ICSD-2. See International Classification of Sleep Disorders Imagery rehearsal, 41 International Classification of Sleep Disorders (ICSD-2), 3, 7, 35, 51, 223 Ironic processes, 125 K Kabat-Zinn, Jon, 125 L Light exposure therapy, 45, 92, 113, 132, 140, 148 in circadian rhythm sleep–wake disorders, 107, 115–116 in sleep restriction therapy, 156 Lingering, 77–78
284 Index M Major depressive disorder (MDD), 43–44, 52, 102, 197. See also Depression Mania, 47, 98 Manic episode, 47, 73, 143, 149 Masking sleepiness, 85, 108, 113 Mattress, 114, 150 MDD. See Major depressive disorder Medication taper, 6, 227–228 Meditation, 110–111, 116, 148 Melatonin, 20 Metabolic rate, 26 Metacognitive processes, 30–31, 33 Mindfulness meditation, 125, 138 Morin, Charles, 28, 228 Morningness, 20–21, 102. See also Chronotype, morningness assessment of, 58, 63–65, 67–68 in sleep restriction therapy, 96, 99 light exposure in, 107, 115–116 Morningness–eveningness, 20, 63–64, 102 Motivational enhancement, 94, 131–132, 138–139, 148, 229 MSLT. See Multiple sleep latency test Multiple sleep latency test (MSLT), 26, 60 N N1. See Stages of sleep, N1 N2. See Stages of sleep, N2 N3. See Stages of sleep, N3 Nicotine, 61–62, 111–113, 162 Night eating syndrome, 51 Night terrors, 98, 143 Night-to-night variability in sleep times, 55, 75, 77, 155 Night-to-night variability in sleep symptoms, 55, 75, 77, 155, 225 Nightmare disorder, 41–42, 50, 71, 134, 142, 166 Nocturnal hot flashes, 147 Nocturnal panic, 46–48, 74, 150 Nocturnal Sleep-Related Eating Disorder, 51 Non-rapid eye movement (NREM), 13–14, 16, 143 Non-refreshing sleep, 144 NREM. See Non-rapid eye movement O Obesity, 38–39 Obsessive–compulsive disorder (OCD), 43, 46, 49, 71, 74 Obstructive sleep apnea hypopnea (OSAH), 37–42, 69 and alcohol, 62, 112 assessment of, 69–70 in case conceptualization and treatment planning, 141–144, 150, 226–227 in depression, 46 in PTSD, 50 in stimulus control, 93 in sleep restriction therapy, 97 in the case of SAM, 44, 103, 136, 197–199, 202, 211, 221 OCD. See Obsessive–compulsive disorder Older adults, 7, 15, 102, 104, 122, 124 OSAH. See Obstructive sleep apnea hypopnea P Pain. See Chronic pain Panic, 9, 32 in the case of Sophie, 162, 164, 171–173, 176 nocturnal, 74, 150 Panic disorder (PD), 46–48, 98, 143 Paradoxical insomnia, 3 Parasomnia, 51, 143, 150 Periodic limb movement disorder (PLMD), 41, 70, 142–144 Perpetuating factors (mechanisms), 32–34 PD. See Panic disorder PLM index, 41 PLMD. See Periodic limb movement disorder Polysomnography (PSG), 3, 12–13, 26, 39, 42, 48, 70, 144 PSG. See Polysomnography Posttraumatic Stress Disorder (PTSD), 6, 42–43, 48–52, 142 addressing cognitions in, 134–135, 138 and prolonged exposure therapy, 144 and sleep avoidance, 138 assessment of insomnia in, 73, 85 aversion to silence in, 114–115 in case conceptualization and treatment planning, 144–146, 149, 172 relaxation in, 110 sleep-avoidance behaviors in, 138 sleep related cognitions in, 134 sleep restriction therapy in, 104 stimulus control in, 94 Prazosin, 41 Pre sleep writing task, 110 Precipitating events (factors), 32–34, 146, 145–146 in the case of Sam, 195 in the case of Sophie, 162, 171 Predisposing factors, 32–34, 36, 145–146 in the case of Sophie, 171 Pressure to sleep, 16. See also Sleep drive
Index 285 Process C, 16, 18–20, 22–23, 25, 33, 140, 146. See also Circadian clock Process S, 16–17, 19–20, 22–25, 33, 140, 146. See also Sleep drive Prolonged exposure therapy (PE), 144 Psychological dependence on sleep medications, 6–7, 227–228 assessment of, 59 in case conceptualization and treatment planning, 140, 145–146, 172 in the case of Sam, 201–202, 219 PTSD. See Posttraumatic stress disorder R Rapid eye movement sleep, 13. See also REM Readiness to change, 147 Recalibrating TIB, 101–102 Regulation of sleep, 8, 12, 16, 25–26, 63, 90, 93 in case conceptualization and treatment planning, 146, 152–153, 158 in cognitive therapy, 118, 135 in the case of Sam, 202 in the case of Sophie, 160, 172, 176 Relapse prevention, 153, 156–158, 231 in the case of Sam, 221 in the case of Sophie, 189–190 Relaxation, 57, 85, 107, 110–112, 116 in case conceptualization and treatment planning, 148, 150, 153, 155, 158 in the case of Sophie, 173, 181, 183 Relaxation-induced anxiety, 110, 150 REM, 13–15, 49, 134 and alcohol, 62, 112 and nightmares, 41 and sleep avoidance, 134 effects of antidepressants on, 46 in PTSD, 48–50 pressure, 14 suppression, 46, 62, 112 REM behavior disorder, 50 Restless leg syndrome (RLS), 40–42, 144, 226 assessment of, 42, 70 in case conceptualization and treatment planning, 142, 144 in the case of Sophie, 166 RLS. See Restless leg syndrome S Safety behavior, 27, 30, 34, 63–64, 114 addressing, 127–128, 132, 138–139 in case conceptualization and treatment planning, 145–146, 149, 232 in the case of Sam, 194, 201, 203 in the case of Sophie, 170–171, 173, 192 Scheduled hypnotic use, 228–229 Scheduled worry, 108–109, 148–149, 156 SE. See Sleep efficiency Seizure disorder, 102, 143, 198 Self-efficacy, 8, 29, 132–133, 138, 155, 220, 227–228 Shift work, 22, 35, 37, 141 Sleep apnea. See Obstructive sleep apnea hypopnea Sleep architecture, 12, 124 Sleep avoidance, 50, 73–74, 134–135, 138 Sleep cycle, 14–15 Sleep debt, 16–17 Sleep deprivation, 14, 16–17, 26, 85, 121–122, 143 and pain, 49 and panic, 143, 147, 150 in bipolar disorder, 73, 98, 143, 149 in depression, 47 in sleep restriction therapy, 96 in PTSD, 134 Sleep drive, 16–23, 25, 60–61, 80, 106, 134. See also Pressure to sleep; Process S and sleep restriction therapy, 95–99 and sleepiness, 84, 85 and stimulus control, 84, 88, 93 in case conceptualization and treatment planning, 145–148, 152 in chronic pain, 49, 150 in depression, 45 in PTSD, 50 in the case of Sam, 201–223 in the case of Sophie, 170–191 Sleep efficiency (SE), 3, 12, 156, 160, 200, 215 computation of, 77, 78, 99 in sleep restriction therapy, 99–103 Sleep efficiency training, 96. See also Sleep restriction therapy Sleep effort, 27–28, 31, 51, 63, 106, 110– 111 addressing with cognitive therapy, 117, 124–126, 138 and sedating medications, 51 assessment of, 63–64, 73, 80 in case conceptualization and treatment planning, 145–146, 148–149, 170 in depression, 45, 73 in stimulus control, 86, 90, 91 Sleep-interfering thoughts/beliefs, 28, 30, 31, 33, 63, 64, 110, 137 Sleep restriction therapy, 94–106, 225–226, 231 cautions and contraindications, 142, 143 in treatment planning, 147–156 in the case of Sophie, 170, 174, 177–181
286 Index in the case of Sam, 200, 203, 204, 208–209, 213– 214, 217, 221 in PTSD, 104 in group CBT-I, 230–231 Sleep environment, 32, 55, 61, 64, 80–81, 113, 127 in case conceptualization and treatment planning, 145–146, 148, 155, 160 in the case of Sam, 196 Sleep hygiene, 7, 107, 111, 116, 148, 227, 229–230 Sleep interfering thoughts, 28, 30–31, 34, 63–64, 108, 110, 137 Sleep interpreting thoughts, 28, 30–31, 33–34, 64 Sleep need, 15–16, 20, 96, 100, 103, 124, 156, 159 Sleep onset latency (SOL), 2, 12, 27, 77, 78–79, 161, 213 Sleep paralysis, 50 Sleep quality, 77–78, 113, 120–121 in the case of Sam, 215 in the case of Sophie, 170 in sleep restriction therapy, 94–96, 99, 100, 102 Sleep regulation. See Regulation of sleep Sleep walking, 98, 143 Sleep-related threat cues, 29–31 Sleep-state misperception, 3, 13 Slow-wave brain activity, 16–18. See also Delta sleep Slow-wave sleep, 13–14, 48, 143. See also Delta sleep Snoring, 39, 61, 69, 145, 196, 197, 214–216 Socratic questioning, 118, 121, 127, 130, 135, 139, 153 example of, 124, 183 SOL. See Sleep onset latency Spectral power, 26 Spielman, Arthur, 32–34, 94, 102, 153 Stages of sleep, 12–15, 48, 97, 124, 208 N1, 13–15, 48, 124 N2, 13, 15 N3, 13–16, 61, 124, 143 Stanford University, 54 Stimulus control, 81–94, 108, 109, 114, 117, 125 cautions and contraindications for, 143 cognitive therapy in, 130–134 combining with sleep restriction therapy, 104–106 in group CBT-I, 230–231 in PTSD, 94, 115 in the case of Sam, 185–186, 203–204, 211–213, 221 in the case of Sophie, 170–180 in case conceptualization and treatment planning, 148–150, 153–156, 225 Suicidal ideation, 143, 151, 232 T Temazepam, 5, 60 Thought records, 135, 139, 186–187 Thought suppression, 30, 108–109 TIB, 77–79, 94–106 Time in bed (TIB), 77–79, 155, 94–106 Time-in-bed (TIB) window, 95–98, 102, 145, 156 in the case of Sam, 201, 209, 217, 219 in the case of Sophie, 171, 173, 177, 181, 190 Time awake after sleep onset, 2, 75, 163, 196. See also WASO and wakefulness after sleep onset Tolerance, to a medication, 6–7, 145, 219 Total sleep time (TST), 12–13, 77–79, 155 in sleep restriction therapy, 95–104, 143, 230 in the case of Sam, 200, 202, 206, 208, 213 in the case of Sophie, 160–161, 168, 173, 180, 186 TST. See Total sleep time Total wake time (TWT), 77–78 Two-process model, 12, 16, 25, 146 V Vocalizations during sleep, 48 W Wakefulness after sleep onset (WASO), 12, 78–79, 161, 200. See also Time awake after sleep onset WASO. See Wakefulness after sleep onset Wegner, Daniel, 30, 125 White noise, 90, 113–114, 150 Z Zolpidem, 5 Zopiclone, 5