Task 2 Flashcards

1
Q

Sleep restriction theory

-maurer

A

-improve consolidation of sleep
-therapist prescribed TIB equals average TST
-Sleep efficiency criterion changes to TIB
-SOL reliably decreased reflecting increased sleep pressure
-3P model (diathesis-stress model) basis for application SRT
predisposing=increase vunerability to insomnia
precipitating=trigger the onset of insomnia
perpetuating=maintain symptoms
-SRT addresses to perpetuating factors that maintain symptoms

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2
Q

The triple-R model of SRT

-maurer

A
  • psychological processes dysregulate sleep
  • modification to sleep can feed-back psychological processes
  • this interaction maintains insomnia
  • Restricting time in bed awake, Regularising time of sleep and wake, Re-conditioning the association between bedroom factors and sleep
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3
Q

The role of personality traits in insomnia

  • 3 factor model
  • van de laar
A
  • 3 factor model describes predispositions, precipitants and perpetuating factors interact to induce and maintain insomnia
  • predisposing=biological traits, personality traits, social factors
  • precipitating=medical illness, psychiatric illness, stressful life events
  • perpetuating=excessive TIB, napping, conditioning, worrying, perception
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4
Q

Role personality traits in insomnia

  • worrying
  • primary, psychophysiological and paradoxical insomnia
  • van de laar
A
  • tendency to be overconcerned (lacking self-confidence and doubts about actions)
  • associated with perfectionism and self-imposed strain
  • primary insomnia high neuroticism, internalization, high concern over bodily functioning, social introversion
  • psychophysiological insomnia normal but also more pessimistic, fearful, shy and more easiliy fatigued
  • paradoxical insomnia (i.e. sleep state misperception) more focus on somatic complaints and also higher neuroticism, extraversion and hysteria scores
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5
Q

Personality and treatment responses

-van de laar

A
  • association between baseline personality characteristics and treatment results
  • scores on different personality scales reflect the severity of the subjective insomnia complaints
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6
Q

The internalizing hypothesis

-van de laar

A
  • high neuroticism, perfectionism traits and anxiety related to different areas
  • introverted and express negative feelings less easily
  • hypothesis describes how an internalizing process could account for a state of constant emotional arousal
  • not expressing feelings –> emotional arousal –> initiating or maintaining sleep
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7
Q

CBT of insomnia

-dolan

A
  • positive changes noted in all sleep diary
  • CBTi resulted in remission of insomnia
  • majority of improvements in sleep diary within first 2 sessions of treatment
  • sleep efficiency increased with CBTi
  • sleep medication declined
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8
Q

Insomnia disorder

  • definition
  • manber
A

-charachterized by persistent difficulty initiating or maintaining sleep, accompanied by distress and perceived negative daytime consequences

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9
Q

Insomnia disorder

  • treatment
  • manber
A
  • CBTi aims to strengthen the sleep drive and improve placement of the sleep opportunity window and reduce physiological and cognitive arousal
  • stimulus control aim to strengthen the bed as a cue for sleep, only in bed in a state of mind conducive for sleep
  • SRT reduced time in bed then gradually increasing time in bed as sleep is consolidated and sleep quality improves
  • Relaxation practice
  • psycho-education and sleep hygiene
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10
Q

Diagnosis and treatment of insomnia

  • definition and diagnosis
  • Riemann
A
  • non-organic insomnia is subjective experience
  • A disturbance of nocturnal sleep (difficulty initiating/maintaining sleep, early waking up, difficulty sleeping without parent, resistant going to bed early)
  • B related daytime impairment (fatigue, concentration impairment, impaired social performance, irritability, daytime sleepiness, behavioral problems, reduced energy, proneness accidents, concerns about sleep)
  • C cannot explained by inadequate opportunity or inadequate circumstances
  • D at least 3 nights a week for period of 3 months
  • E not explained by another sleep disorder
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11
Q

Diagnosis and treatment of insomnia

  • Diagnostic procedure
  • Riemann
A
  • medical and psychological anamnesis is mandatory
  • often suffer from a co-morbid mental disorder or neurodegenerative disorder
  • sleep history assessment
  • pseudo-insomnia/sleep state misperception/paradoxical insomnia because TST reduced with 25 minutes but subjective TST reduces by 2 hours
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12
Q

Diagnosis and treatment of insomnia

  • health risks of insomnia
  • Riemann
A
  • risk factor for cardiovascular diseases and type 2 diabetes
  • short sleep duration risk factor for obesity, type 2 diabetes, hypertension and cardiovascular disease
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13
Q

Diagnosis and treatment of insomnia

  • treatment of insomnia
  • Riemann
A
  • CBTi is psychoeducation, sleep hygiene rules, relaxation training, stimulus control therapy, SRT and cognitive therapy
  • Relaxation therapy aimed at reducing somatic tension or intrusive thoughts at bedtime
  • SRT curtail the time in bed to the actual amount of sleep being achieved
  • Stimulus control therapy are behavioral instructions designed to re-associate the bed with sleep and to re-establish a consistent sleep-wake schedule
  • Cognitive therapy are methods to identify, challange and change misconceptions about sleep (mindfullness and hypnotherapy)
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14
Q

Diagnosis and treatment of insomnia

  • Pharmacotherapy
  • Riemann
A
  • BZs (benzodiazepines) and BZRAs (benzodiazepine receptor agonists) used for short term
  • Antidepressants used for short term
  • antihistamines, antipsychotics, melatonin and phytotherapy not recommended
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15
Q

Diagnosis and treatment of insomnia

  • light therapy and exercise
  • Riemann
A
  • light therapy used for seasonal affective disorder and circadian rhythm disorder
  • exercise has positive effects on physiological and physical healt
  • both recommended by insomnia
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16
Q

Diagnosis and treatment of insomnia

  • algorithm for diagnostic and therapeutic process
  • Riemann
A

Patient with sleep onset and/or sleep maintenance disturbance/early morning awakening and daytime impairment
–> clinically significant impairment?
no–> psychoeducation/prevention
yes–>sleep pattern in sychrony with circadian rhythm?
no–>psychoeducation/prevention
yes–>intake of substances effect sleep?
yes–>change of medication
no–>comorbid somatic or mental disorder?
no–>treatment insomnia with CBTi as first line, BZ,BZRA or sedating antidepressants short term
yes–>treatment of comorbid and insomnia