The treatment is different from the start. It begins with a comprehensive assessment of factors affecting your sleep; so that any subsequent recommendations are specifically targeted to your difficulty. By the time insomnia is “chronic” or by the time patients are taking sleep medications nightly, sleep hygiene recommendations alone are not found to be effective. Instead, the assessment looks at how you behave, think and feel about your sleep difficulty. In addition to any sleep education you may receive, treatment recommendations are tailored to your specific behaviors and your ability to implement changes. In addition, CBT-I incorporates aspects of treatment which focus on cognitions and how you feel. These interventions importantly also address sleep specific anxiety – common among individuals who have had sleep difficulties for an extended period of time, or sudden onset of sleep difficulties. Finally, the behavioral specialist will likely also recommend modifications to your sleep schedule; this is highly tailored to each individual and a very effective addition to treatment.
Many patients come to us on medications; in fact, the majority of patients we see are either on one or more sleep medications, psychiatric medications used for sleep, using over the counter sleep aids or dietary supplements for sleep. We integrate a physician approved tapering plan with our cognitive behavioral treatment as part of the comprehensive treatment plan. If you are on medications and these are not effective, or only partially so (e.g. help with sleep onset but not sleep maintenance), then we can easily incorporate cognitive behavioral treatment to improve sleep while you remain on the medications; subsequently tapering if desired. If your sleep issues are adequately addressed while you are on sleep medications; we can also discuss ways in which to begin reduction with minimal withdrawal or anxiety about doing so.

Treatment is flexible and dependent on your individual needs. On average, we treat patients within 4 sessions with good outcome. However, each patient is different and treatment is less about length than whether we are seeing the improvements you expect.

The initial session is an evaluation which will be about an hour. During this time we will comprehensively assess your sleep difficulty and factors that may affect it. We will then recommend interventions and encourage you to implement them and follow up with us, usually within 1-2 weeks, but flexibly dependent on your schedule and any individual needs. Medication tapering may extend treatment length, but with follow up visits spaced further apart, depending on need and agreed upon treatment plan.

A wealth of research across populations suggests that in general, 70 – 80% of patients demonstrate a significant improvement in their sleep. With behavioral treatments, implementation is ultimately up to the patient. Adherence with treatment recommendations and consistency in implementation also play a significant role in treatment outcome. We work with patient’s to tailor interventions such that adherence is optimized.
Behavioral Sleep Medicine services are usually covered under most insurance plans. Each insurance plan is different. If you need certainty regarding coverage, we encourage you to speak with our billing staff prior to your appointment. Ultimately, you are responsible for any services received in line with our practice policy.
Research studies suggest that even when there are significant co-occurring conditions which are likely to complicate sleep in other obvious ways; patients are still able to benefit from CBT-I. Disturbed sleep is often in a “negative feedback loop” with other health processes (e.g. metabolism, mood and pain systems). For example, the worse we sleep the more sensitive we become to pain; the more sensitive to pain, the worse we sleep. Similar processes have been documented for mood and stress. Improving sleep and disrupting this negative feedback loop is very helpful. In addition to improved sleep, several studies also demonstrated patients report improvement in co-occurring conditions – reporting improved pain, mood, etc. Although hormones play a significant role in our sleep; even hormonal fluctuations are likely to yield adaptations that are likely to perpetuate the insomnia behaviorally or due to anxiety. How we respond to sleep difficulties can make all the difference, and this is usually affected by interaction between physiological and behavioral/cognitive factors. We encourage patients to engage the behavioral sleep medicine specialist in a discussion about these concerns.
You can use our behavioral sleep medicine services without having a sleep study. If as part of our comprehensive assessment we feel one is necessary, we will discuss this with you. You may or may not wish to incorporate a sleep study as part of treatment. It is usually not necessary in most cases seen by the behavioral sleep medicine specialists.
Yes. While it was long thought that CPAP treatment for OSA would resolve insomnia complaints, current research suggests otherwise. Insomnia occurs distinctly from sleep apnea and can effectively be treated – sometime remarkably improving sleep even among OSA patients who haven’t started CPAP use. Researchers are currently investigating which treatment sequence for OSA with co-occurring insomnia works best; but we know that many individuals seeking treatment for OSA benefit from the addition of a behavioral sleep medicine evaluation – sometimes before engaging CPAP, some during, and others after initiating CPAP use. If you are having difficulty with use of the CPAP; research has already demonstrated that the addition of CBT-I can improve your ability to effectively use CPAP. If you are anxious about using CPAP and having difficulty sleeping, behavioral sleep medicine treatment can improve sleep, reduce anxiety and facilitate CPAP initiation.
All of our services are focused on the sleep related symptoms you may be experiencing. Even in situations where patients are already in some form of counseling or psychotherapy, it is rare that the counselor or therapist has experience with sleep medicine and behavioral sleep medicine beyond “sleep hygiene” recommendations. It is helpful to understand what issues may be a focus in your treatment, but otherwise, our recommendations are likely to be uniquely different.

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