All specialisms

Health and pain

Insomnia

Persistent sleeplessness, and the anxiety about sleep itself that keeps the cycle going.

How I see this presentation

Insomnia is a specialist area in my practice. Most people arriving have already tried sleep hygiene, apps, and short courses elsewhere, and the difficulty has shifted from trouble sleeping into a bigger pattern: anxiety about sleep itself, daytime functioning under pressure, and a relationship to the bed that has become loaded. Lying awake and watching the clock is often the least of it.

How I tend to work with it

The lead approach is Cognitive Behavioural Therapy for insomnia (CBT-i), the NICE-recommended treatment. The components, sleep restriction, stimulus control, cognitive restructuring around sleep beliefs, and where appropriate work on the underlying arousal, are introduced collaboratively and paced carefully. CBT-i is unusual among insomnia interventions in that the evidence base is strong and the gains tend to hold once the work is finished.

What a course might look like

Sessions are 50 minutes, online, typically weekly. CBT-i work is often shorter than other clinical presentations. A defined course typically runs six to eight sessions, though this is not a fixed rule.

Next step

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