Insomnia

Insomnia is difficulty with sleep initiation, maintenance, or quality. Daytime impairment, a necessary component of insomnia, can manifest in different ways: fatigue, malaise, memory, concentration difficulties, mood disturbances, irritability, and behavioral problems such as hyperactivity and aggression. The severe and multi-factorial nature of insomnia is matched by the severe and multi-factorial impairment it causes. Unfortunately, many people suffering from insomnia have tried and failed various remedies over the years and have lost direction and hope.

What we offer at Sleep and Brain

At Sleep and Brain, we conduct a detailed clinical history and specialized physical examination to delineate your insomnia duration and type:

• Duration

  • Chronic insomnia lasting more than three months

  • Acute insomnia lasting less than three months

• Type

  • Initial insomnia or difficulty falling asleep

  • Middle insomnia or difficulty staying asleep

  • Late insomnia or difficulty with early morning awakenings

We prudently assess for sleep disorders, as exampled below, that may underlie your insomnia problem:

• Sleep-disordered breathing

  • Intermittent breathing cessations are associated with cortical arousals that lead to awakenings

• Restless Legs Syndrome

  • Growing pains or other uncomfortable sensations in the legs with the urge to move them can make falling asleep difficult.

• Periodic Limb Movement Disorder

  • Similar to sleep-disordered breathing, intermittent leg jerks at night can cause cortical arousals that lead to awakenings

• Circadian Dysrhythmias

  • A misaligned circadian rhythm can lead to insomnia.

In addition to assessing sleep disorders, we evaluate environmental, physiological, and psychological factors contributing to your insomnia, such as the following:

• Drugs and alcohol

  • Alcohol, nicotine, and caffeine; cold remedies and other over-the-counter medications; and acclimation to and withdrawal from prescription medications can hinder sleep.

• Medical conditions

  • Chronic pain, heart and lung problems, nocturnal hypoglycemia, and an enlarged prostate that necessitates frequent trips to the bathroom can cause insomnia.

• Psychological conditions

  • Anxiety, depression, mania, and psychosis can substantially impair sleep.

We also attend to babies with sleep difficulties. Not all babies can put themselves to sleep or return to sleep if they awaken in the night. We help parents recognize the signs of sleep readiness - rubbing eyes, yawning, fussing - and create bedtime rituals to foster sleep. We also help parents make their baby feel secure and handle separations, returning to sleep independently if awakening at night. Examples of ways we help you help your baby sleep are listed below:

• Allow naps as needed for your baby's age.

• Cuddle and comfort your baby, particularly when they are frightened

• Schedule stimulation and activity

• Establish a bedtime routine using a bath, reading, music, and rocking.

We also review the American Academy of Pediatrics recommendations to reduce the risk of Sudden Infant Death Syndrome from birth to age one. In this regard, we will discuss the sleeping position, sleeping surface, breastfeeding, bed sharing, room sharing, skin-to-skin care, clothing, bedding, toys, pacifiers, tobacco smoke, alcohol, and drugs. 

We can complement your self-reported sleep duration and other parameters from a sleep diary to the Sleeptracker-AI data. The information helps us rule out sleep disorders such as circadian dysrhythmias and sleep-state misperception, a condition manifest by a disconnect between perceived and actual sleep.

Sleeptracker-AI is used in conjunction with our Insomnia Cognitive Behavioral Therapy program. Besides sleep education, we apply stimulus control techniques to retrain the brain that nighttime and your bedroom are for sleep. Our personalized sleep hygeine assessment focuses on your bedroom environment, habits, rituals and optimizes your diet. We reorient negative thinking that inevitably develops from insomnia. We implement sleep restriction to ensure comfort, compliance, and success. We also utilize relaxation techniques such as guided imagery, deep breathing, and mindfulness meditation to put your mind at ease and improve sleep.

Several medication classes treat insomnia, including anti-anxiety drugs, antidepressants, orexin antagonists, and non-benzodiazepines. However, these medications mitigate symptoms rather than cure the underlying cause. We judiciously use medications, if necessary, until we identify and treat an underlying reason for insomnia.

Behavioral hypocapnia occurs when you overbreathe, often due to stress, anxiety, or poor breathing habits. This leads to lower-than-normal carbon dioxide levels in the blood. Since carbon dioxide is critical in maintaining the body's pH balance and oxygen delivery, hypocapnia impairs sleep and brain function.

You will also be sent home with a portable capnometer to assist with your breathing retraining plan. Depending on the severity of the hypocapnia, the Breathing Recovery Plan will begin with weekly online sessions with our breathing behavior specialist.