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, 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.

Actiwatch 2 Child.png — We utilize **actigraphy** to assess sleep and wake patterns over multiple weeks objectively.

We can complement your self-reported sleep duration and other parameters from a sleep diary to the actigraphic 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.

Insomnia originates from a state of hyperarousal. We may recommend sensitive **home sleep testing** with peripheral arterial tonometry to quantify your sleep patterns and evaluate sleep-disordered breathing and sympathetic arousal frequency.

Nox A1 Child.jpg — **Laboratory sleep testing**, performed in your home, may be necessary to evaluate additional sleep disorders contributing to sleep fragmentation.

We offer sophisticated testing to elucidate areas of brain imbalance. A **brain map** can pinpoint which brain areas are hyperactive and hypoactive and assess which networks between brain areas are improperly functioning. Together, the data allows us to determine if the brain imbalances support a diagnosis of anxiety, depression, or another disorder associated with insomnia.

Our scientifically-based **cognitive-behavioral therapy for insomnia** therapy is a rigorous, 4-week program designed to treat insomnia.

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. Scientifically vetted questionnaires before and after the CBT-I program document and provide feedback on your progress.

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.