Sleep Disorder FAQs

  1. How do I know if I have a sleep problem?
  2. What is psychophysiological insomnia?
  3. What if I have anxiety or depression that caused the insomnia?
  4. What are the treatment options for insomnia?
  5. What is Cognitive-Behavioral Treatment of Insomnia?
  6. How do I know that Cognitive-Behavioral Treatment of Insomnia will work for me?
  7. Will getting a new mattress/pillow/air filter/sleep partner help me sleep?
  8. How much does insomnia treatment cost?
  9. Do you treat other psychological problems?
  10. What about other health-related problems?

How do I know if I have a sleep problem?

There is a wide range of what can be considered “normal” behavior when it comes to sleep.  You may have a sleep problem if you do any of the following:

  • Take more than 30 minutes to fall asleep or wake up during the night for a total of more than 30 minutes.
  • Wake earlier than you want and can’t get back to sleep.
  • Snore so loudly that your bed partner complains.
  • Stop breathing or wake gasping for air during sleep.
  • Wake feeling like you’ve hardly slept at all.
  • Feel really tired or sleepy during the day in spite of having slept for at least seven hours.
  • Find yourself falling asleep when you don’t mean to during the day.
  • Do any other odd behaviors during sleep like walk around, yell, kick, or have frequent bad dreams.
  • Hallucinate or start dreaming before falling asleep or upon waking up.
  • Feel like you can’t move for a few seconds when you wake up, no matter how badly you want to.

What is psychophysiological insomnia?

Psychophysiological insomnia occurs when the associations between bed and sleep are broken, resulting in:

  • Negative emotions such as anxiety and frustration when it’s time to go to bed or when thinking about going to bed.
    Example:  “I get so upset about not sleeping that I can’t sleep!”
  • Physical tension in association with the bed or bedroom.
    Example:  “I’m falling asleep on the couch, but when I get in bed, I’m wide awake!”
  • Daytime fatigue, tiredness, irritability, and perceived decrease in the ability to function.
    Example:  “My sleep problem is so bad that I don’t make plans for the mornings because I don’t know how I’ll feel!”

What if I have anxiety or depression that caused the insomnia?

Insomnia can be a symptom of anxiety and depression. It can also contribute to symptoms that linger and increase risk for relapse after treatment. Cognitive-Behavioral techniques (see below) are effective in treating a wide range of problems and were actually developed first for anxiety and depression.

What are the treatment options for insomnia?

There are currently two treatment options for insomnia.  One is medication (e.g., Ambien, Lunesta, Sonata just to name a few).  These medications work well for some people, but they should not be taken for more than two or three nights per week and never on consecutive nights because of the risk of physical and/or psychological dependence.  Also, they address the symptoms, but not the underlying problem.  When medication is used too regularly, the difficulty sleeping likely will return as soon as the medication is discontinued, sometimes worse than it was before.

The second treatment option, which has been shown to be just as effective as medication in the short-term and more effective long-term, is called Cognitive Behavioral Treatment of Insomnia, or CBT-I.  CBT-I can be used to help people get off sleeping medications.

What is Cognitive-Behavioral Treatment of Insomnia?

CBT-I is a multicomponent treatment, which means that it has several different parts, and not every patient will require every part.  CBT-I will teach you how to sleep again in your desired sleeping environment, and the skills you will learn will help you in the future if your insomnia symptoms come back.

There are two main parts to CBT-I, behavioral strategies and cognitive restructuring.  Behavioral strategies are something that can be started right away and will help you to re-associate bed and sleep.  You may have tried “sleep hygiene” techniques.  It is important to remember that CBT-I goes beyond sleep hygiene and is an individually tailored approach.

During the cognitive component of treatment, we will look at the different thoughts you may have about sleep that are making it more difficult as well as common “sleep myths.”  For example, many people think that they need eight hours of sleep, and the pressure that they put on themselves to achieve that increase anxiety around bed and sleep to the point that they make it impossible to get that amount.  The fact is that there is wide variability with how much sleep people need, even from night to night.

How do I know that Cognitive-Behavioral Treatment of Insomnia will work for me?

CBT-I is empirically supported, which means that several studies have shown it to be effective for both primary insomnia as well as insomnia secondary to several different psychiatric and medical disorders including:

  • Depression
  • Anxiety
  • Posttraumatic Stress Disorder
  • Alcoholism
  • Breast cancer
  • Pain disorders
  • Mixed medical disorders and mixed psychiatric disorders (more than one present in the same patient)

Will getting a new mattress/pillow/air filter/sleep partner help me sleep?

By the time patients come to a sleep disorders center or behavioral sleep medicine specialist, they have often tried several different strategies.  My patients and clients have tried sleeping in a room apart from their spouse or partner, spending thousands of dollars on a brand-name mattress, listening to books on tape or music, and many others.  Sometimes they work for a while, but if the underlying psychophysiological insomnia is not treated, the problem just comes back.

How much does insomnia treatment cost?

Because of managed care contracts, there is a range of fees and copays.  I am in-network for several major insurance carriers including Aetna, Blue Cross,  Humana, Medicare, and Tricare.  I also see patients who are experiencing financial troubles on a sliding scale with no-interest payment plans.  We can discuss your particular situation at your first visit.  Please consider how lack of sleep may be impacting your health and productivity.  This may be the most important investment you ever make.

Do you treat other psychological problems?

I am a licensed clinical psychologist and am qualified to treat a range of psychological issues.  In addition to behavioral sleep medicine and health psychology, I am interested and have helped many patients with anxiety, depression, and personality disorders.

What about other health-related problems?

Quitting smoking and losing weight are two of the most difficult tasks a person can undertake.  You and I will break the problem down to basic behaviors, beliefs, and desires that have kept your efforts from succeeding to this point.  Then I will help you to develop and practice new skills that will continue to be effective long after we finish treatment.  We can also address any underlying anxiety, depression, or other psychological issues that may have sabotaged your motivation in the past.