Insomnia & sleep

Few things predict the course of a mood disorder as reliably as sleep. Insomnia often arrives before a depressive episode and lingers after it; a run of short nights can precede a manic one. In this practice sleep is evaluated and treated directly, not left to resolve on its own.

Who this is for

• Chronic insomnia — difficulty falling or staying asleep most nights for months or longer.
• Sleep problems that accompany depression, bipolar disorder or anxiety, or that persist after those conditions have improved.
• Disrupted sleep rhythms — a body clock that runs late, shift work, or a schedule that has drifted.
• Long-term reliance on sleeping medication, and a wish to reduce it safely.
• Sleep disturbance that may be a side effect of psychiatric or other medication.

How we evaluate

The evaluation takes a detailed sleep history — timing, duration, quality and daytime consequences — often with a sleep diary, and places it alongside the course of your mood and anxiety. It looks for the contributions of caffeine, alcohol, medications and timing, and screens for conditions such as sleep apnea and restless legs that need a sleep-medicine referral rather than a psychiatric treatment.

Treatment

• Cognitive-behavioral therapy for insomnia (CBT-I). The first-line treatment for chronic insomnia, with effects that outlast those of medication. [State whether CBT-I is delivered in the practice or by referral]
• Regular rhythms. Stabilizing sleep and wake times is itself a treatment — particularly in bipolar disorder, where it protects against relapse.
• Medication, used carefully. Chosen with an eye to long-term safety and tolerability, and with a plan for how and when it will be reviewed or tapered.
• Coordination. With sleep-medicine specialists when a sleep study or other treatment is needed.