How Psychiatrists Approach Treatment for Insomnia

Does your day begin only after a long, sleepless night? You might lie in bed for hours, your mind racing, or you might wake up repeatedly and struggle to fall back asleep. The next day, you feel exhausted, irritable, and unable to focus. This struggle with sleep, known as insomnia, is one of the most common and distressing problems in mental health.

At Televero Health, we understand that insomnia is not just a minor inconvenience; it’s a serious condition that can have a profound impact on your mood, your health, and your quality of life. It is both a common symptom of many psychiatric conditions and a condition that can exist on its own. A psychiatrist’s approach to treating insomnia is careful and comprehensive, aimed at restoring your body’s natural ability to rest.

Insomnia’s Connection to Mental Health

Insomnia and psychiatric conditions have a very strong, two-way relationship. It’s often hard to tell which came first.

• Insomnia as a Symptom: Difficulty sleeping is a core diagnostic criterion for many conditions. The racing thoughts of anxiety, the hopelessness of depression, or the hyperarousal of PTSD can all make it nearly impossible to get a good night’s sleep.
• Insomnia as a Cause: A lack of sleep can also trigger or worsen a mental health condition. As we’ve discussed, sleep is essential for emotional regulation and brain health. Chronic sleep deprivation can make you more vulnerable to developing depression or anxiety.

Because of this tight link, treating the underlying psychiatric condition is often the most important step in treating the insomnia. As your depression or anxiety improves with medication and therapy, your sleep will often improve as well.

The First Line of Treatment: Behavioral Changes

Before jumping to medication, the gold-standard, first-line treatment for chronic insomnia is a specific type of therapy called Cognitive Behavioral Therapy for Insomnia, or CBT-I. This is a structured program that helps you to identify and change the thoughts and behaviors that are interfering with your sleep. It is highly effective and provides a long-term solution without the risks of medication.

CBT-I involves several key components:

• Sleep Hygiene Education: This involves learning and implementing healthy sleep habits, such as keeping a consistent sleep schedule, creating a relaxing bedtime routine, and optimizing your bedroom environment to be dark, quiet, and cool.
• Stimulus Control: This technique works to re-associate your bed with sleep. It means you only use your bed for sleep and intimacy. If you can’t fall asleep after about 20 minutes, you get out of bed, do something quiet and relaxing in another room, and only return to bed when you feel sleepy.
• Sleep Restriction: This may sound counterintuitive, but it involves temporarily limiting the amount of time you spend in bed. This can help to consolidate your sleep, making it deeper and more efficient. The time in bed is then gradually increased as your sleep improves.
• Cognitive Restructuring: This helps you to challenge the anxious and negative thoughts you may have about sleep, such as “I’ll never fall asleep,” or “If I don’t sleep tonight, I won’t be able to function tomorrow.”

The Role of Medication

While behavioral therapy is the preferred starting point, medication can also play a role in treating insomnia, especially in the short term. A psychiatrist may consider medication in a few situations:

• To break a cycle of acute insomnia: If you are in a period of intense stress and haven’t slept for days, a short course of a sleep medication can help to reset your sleep cycle and provide immediate relief.
• To manage insomnia caused by another medication: Some antidepressants can be activating and interfere with sleep. A doctor might prescribe a sedating medication to take alongside it to counteract this effect.

There are many different types of sleep medications, from traditional “sleeping pills” (like zolpidem) to certain antidepressants that have sedating properties (like trazodone) to other medications that work on different brain systems. Your psychiatrist will be very cautious when prescribing these medications. Many can be habit-forming and are best used only for short periods. The goal is always to use the lowest effective dose for the shortest possible time, while you work on the behavioral strategies that will provide a lasting solution.

A good night’s sleep is not a luxury; it is a biological necessity. By taking a comprehensive approach that addresses both your behaviors and, when necessary, your brain chemistry, you can find your way back to restorative rest.

Key Takeaways

• Insomnia is both a common symptom of many psychiatric conditions and a condition that can worsen them, creating a vicious cycle.
• The first-line, most effective treatment for chronic insomnia is a type of therapy called CBT-I, which focuses on changing the thoughts and behaviors that interfere with sleep.
• Medication can play a role in treating insomnia, but it is typically used for short-term relief and with caution due to potential side effects and dependence.
• A comprehensive approach that combines behavioral strategies with judicious use of medication is the best way to achieve lasting improvement in your sleep.

Ready to take the first step? We can help. Get started with Televero Health today.