How is insomnia diagnosed?
Insomnia is diagnosed by history. In other words, a physician determines that a patient has insomnia by speaking to them. Sometimes sleep physicians may also ask a person to fill out “sleep diaries,” or “sleep logs,” in order to get a better idea about the person’s sleep schedule and habits.

Why should I meet with a sleep specialist to treat my insomnia?
You should involve your primary care physician in all aspects of your medical care. If you have a mental health professional, you should continue to see them. At The Center for Respiratory and Sleep Disorders we feel strongly that communication between health professionals enhances patient care. For this reason, we make efforts to communicate whenever possible with referring and other involved physicians.

However, many insomnia therapies should be prescribed and controlled by a sleep specialist. This is because:

1. Sleep may worsen before it gets better when these therapies are used. Patients who do not have the benefit of regular physician advice may become frustrated and give up before results are seen. We have seen this happen, and can provide guidance when it does.

2. Medical disorders may contribute to the cause and severity of insomnia. These should be addressed by a sleep specialist and primary care physician. These will be considered in your evaluation.

3. Medicines may be used in conjunction with non-drug therapies. These are usually prescribed by and controlled by a sleep specialist.

In some instances a sleep specialist may wish to try one therapy at a time, in order to truly evaluate its effectiveness. If more than one therapy starts at the same time, it may be difficult to figure out which one worked (or didn't work). On the other hand, we may perform several therapies simultaneously. These are best monitored by a specialist.How often must I follow up with a sleep specialist? Why so often?
Most patients see us for this because they are already frustrated. We want that frustration to end.

We want patients to be successfully treated, and feel that the best way to do this is with an intensive, closely monitored program. People with insomnia may be followed as often as every week until improvement occurs.

Will I need a sleep study to diagnose my insomnia?
Most patients with insomnia do not need a sleep study in order to diagnose it, unless there is concern that another sleep disorder is also present. A sleep expert is usually able to make a diagnosis of insomnia and treat it without ordering a sleep study.

Do I need to take medicines forever for my insomnia?
Most patients with insomnia which has been present for a long time (“chronic insomnia”) are more effectively treated with non-drug therapy. Drugs work very well in many patients. Sleep experts are often able to help patients sleep without them, by using other techniques.

What types of treatment do you offer?
At the Center for Respiratory and Sleep Disorders, we provide several therapies for insomnia. Whenever they are offered we attempt to collaborate closely with the patient’s primary care physician and mental health professional. These therapies include:

Drug Therapy
Sleep Restriction
Cognitive Behavioral Therapy and Stimulus Control Therapy
Light Therapy
Medicines – Drug Therapy

There are several medicines on the market which are very effective in causing sleepiness. They are effective in treating insomnia. Physicians prescribe these drugs often, and they work for many people. They are particularly helpful for insomnia which has not been present for a long time.

Sometimes treating other illnesses with medications is effective for insomnia, too. This is true especially for disorders such as depression and anxiety. Many persons who are effectively treated for these experience an improvement in sleep, as well. Some of the medicines which are used for these problems tend to cause sleepiness as a side effect. By using this side effect to our advantage we are able to effectively treat both problems.

Sleep Restriction
Sleep Restriction is a very effective non-drug therapy for chronic insomnia. Sleep restriction therapy involves the therapeutic use of sleep deprivation. By limiting the amount of sleep a person attains on a given day, the person becomes more sleepy the next day. This is continued for a few to several days. At that point, nightime sleepiness increases enough to allow the person to fall asleep. Sleep may be restricted to as few to 5 hours per night.

Sleep Restriction should only be prescribed by sleep physicians who have experience in its use.

This is one of the therapies which we prescribe at The Center for Respiratory and Sleep Disorders. When it is used, we follow the patient on a weekly basis.

Stimulus control therapy
Stimulus control therapy involves the development of an environment and atmosphere which promotes sleep. Many people who have chronic insomnia have developed habits which are not conducive to a restful night. Insomnia evaluation and treatment must address these issues to determine if a change in behavior is necessary.

Cognitive behavioral therapy (CBT)
Cognitive behavioral therapy for insomnia involves learning ways to cope with issues which inhibit sleep. It employs several components including changes in schedule, changes in behavior and sleep habits. CBT employs non-drug therapies to improve sleep. However, use of CBT does not mean that medicines are not helpful. In some patients both CBT and medicines are used. CBT therapies may be used alone, or may be used along with medicines to treat insomnia. Some CBT techniques include:

Strict Sleep Scheduling
Avoidance of Naps
Sleep Restriction
Stimulus Control Instructions
Sleep Hygiene Instruction (teaching good sleep habits)

Light therapy
Because our “body clocks” are “set” by light, we sometimes can use light to help us sleep. By using bright light given at the correct time of day, we are able to help initiate sleep at night. This therapy may also be effective in some cases of depression. At the Center for Respiratory and Sleep Disorders we assist patients in the use of this therapy.