2017 Principles and Practice of CBT-I-Cognitive Behavioral Therapy for Insomnia – Donn Posner , Michael Perlis and Jason Ellis

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Cognitive Behavioral Therapy for Insomnia (CBT-I) is now recommended as the first line treatment for chronic insomnia. This recommendation was, interestingly enough, made by the second largest medical organization in the United States (The ACP) and was published in the Annals of Internal Medicine (2016;165(2):125-133).

The recommendation is, in part, based on the following findings.


  1. Articulate the basics of sleep nomenclature including sleep period, phase, continuity, and architecture.
  2. Discriminate acute insomnia from Insomnia Disorder and articulate the importance of treating the chronic form as a specifically targeted co-morbidity.
  3. Assess for the most common intrinsic sleep disorders such as OSA, RLS, PLMS, circadian rhythm disorders, and narcolepsy.
  4. Evaluate the common medications used in the treatment of insomnia and understand their relative strengths and weaknesses.
  5. Communicate the relative efficacy of pharmacotherapy and cognitive behavioral therapies for insomnia.
  6. Communicate the evidence for the efficacy of CBT-I for both primary and co-morbid insomnia disorder.
  7. Apply the principles of the Spielman model of insomnia and employ it in the delivery of CBT-I.
  8. Apply the principles of Borbely’s two-process model of sleep regulation and demonstrate how to utilize this concept in the deployment of CBT-I.
  9. Score and analyze patient sleep diary data, and create a treatment plan based upon the data in the course of CBT-I treatment.
  10. Apply the techniques of Sleep Restriction therapy to the treatment of chronic Insomnia.
  11. Apply the techniques of Stimulus Control to the treatment of chronic Insomnia
  12. Educate patients in sleep hygiene principles and tailor to individual needs.
  13. Apply the techniques of cognitive therapeutic strategies to the treatment of chronic insomnia.
  14. Calculate sleep efficiency and titrate patient sleep windows
  15. Anticipate, identify and problem solve common resistances in CBT-I.
  16. Implement an action plan to prevent patient relapse.

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