CBT-I: The First-Line Treatment for Chronic Insomnia with Dr. Donn Posner (Part 1 of 2)

Dr. Donn Posner is one of the most active educators in CBT-I. He's founder and president of Sleepwell Consultants, adjunct clinical associate professor in Psychiatry and Behavioral Sciences at Stanford, and spent twenty-five years before that as director of behavioral sleep medicine at the Sleep Disorders Center of Lifespan Hospitals.

In this first of two episodes, Dr. Posner argues that chronic insomnia is a disorder in its own right — not just a symptom of something else — driven by perpetuating factors that become the targets of treatment. He covers:

How insomnia disorder is defined, and what a proper CBT-I assessment looks like
The sleep diary as the clinician's version of an X-ray
The two core behavioral components — sleep restriction (more accurately, time-in-bed restriction) and stimulus control — and the mechanisms each one targets: homeostatic sleep drive and conditioned arousal
Why sleep can't be willed — it's never under a patient's voluntary control
How far the protocol can flex for individual patients
The evidence base showing CBT-I works even alongside depression, anxiety, PTSD, or chronic pain — and that those conditions don't need to be treated first

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