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 likeThe sleep diary as the clinician's version of an X-rayThe 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 arousalWhy sleep can't be willed — it's never under a patient's voluntary controlHow far the protocol can flex for individual patientsThe 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