Insomnia

Bad news: it really sucks
Good news: it can be treated!

Insomnia can be caused by many factors. Initially it’s often a normal response to a stressor. If the stressor is quickly resolved, so normally is the insomnia. However, when it continues, people start to develop counterproductive thoughts and behaviors which perpetuate insomnia. Now, even if the original stressor is resolved, insomnia has acquired a life of its own; it has become chronic. Factors that can further complicate insomnia are unresolved underlying issues, of which people may not be aware, habituation to or paradoxical effects of medications, and comorbid sleep disorders.

Treatment wise, I use Cognitive Behavioral Therapy for Insomnia, which is the evidence based treatment for chronic insomnia, read more. Depending on the presence of the other complicating factors, treatment may also include:

• psychotherapy to resolve underlying stressors
• techniques to address psychophysiological arousal, including customized yoga instruction
• referral to pulmonology for assessment and treatment of any intrinsic sleep disorders

I will provide you with an initial evaluation for differential diagnosis (i.e. is this insomnia or something else) and to determine whether CBT-I can help you (there are conditions, such as seizure disorder that are a contraindication). I will explain what treatment entails and you will make a decision as to whether this is a good time for you to proceed. Treatment will likely require coordination of care with one or more of your physicians.

PERIODIC LIMB MOVEMENT DISORDER AND RESTLESS LEG SYNDROME

These are neurological conditions which are treated with medications by your physician. However, at times, medication may not be sufficient. CBT-I can be an adjunct treatment. As such, it does not eliminate the motor activity, but it depresses the arousal (i.e. despite the movement happening, you wake up less times or don’t wake up) resulting in better sleep quality.

NIGHTMARES

Nightmares are normal, we all have them. However, the frequency and intensity of nightmares can escalate to the point that it is really affecting your life. In these cases they can become a focus of treatment. Nightmares can be the result of another condition such as trauma, and can coexist with another disorder such as insomnia. Often, treating the comorbid disorders will positively impact nightmares. They can also be the only presenting problem. There are different approaches to treating nightmares, and we will chose the most appropriate to your presentation.