Therapists can refer clients to psychiatry on UpLift. Psychiatric providers are available to answer questions about medication, changing treatment plans, side effects, and more.
Through a collaborative approach, harm reduction works within the realities of our world and addresses those truths, rather than deny them.
Through a collaborative approach, harm reduction works within the realities of our world and addresses those truths, rather than deny them.
Through a collaborative approach, harm reduction works within the realities of our world and addresses those truths, rather than deny them.
Through a collaborative approach, harm reduction works within the realities of our world and addresses those truths, rather than deny them.
How can psychiatry help with sleep?
Sleep disorders or insomnia deeply impacts both physical and mental health—and can come in different forms that benefit from tailored treatment.
6
min read
In the realm of mental health, the gravity of a good night's sleep cannot be overstated. Sleep is a fundamental pillar of well-being, and disruptions in sleep patterns can have profound effects on both mental and physical health. Understanding how psychiatrists approach the diagnosis and treatment of sleep disorders can shed light on a crucial aspect of overall mental wellness.
What factors can affect sleep?
A comprehensive approach is important to evaluate and diagnose sleep disorders. It requires recognizing comorbid conditions that can affect sleep, and looking broadly at the many medical, psychiatric, and lifestyle factors that can contribute to or intensify insomnia.
Psychiatric conditions
- Depression
- Anxiety
- Substance use disorders
- Posttraumatic stress disorder
- Bipolar disorder
- Psychotic disorders
- Eating disorders
Medications and substances
- Central nervous system stimulants
- Central nervous system depressants
- Bronchodilators
- Antidepressants
- Beta antagonists
- Diuretics
- Glucocorticoids
- Caffeine
- Alcohol
Medical Conditions
- Diabetes
- Cancer
- Pregnancy
- Menopause
- Lyme disease
- Human immunodeficiency virus (HIV) infection
- Myalgic encephalomyelitis/chronic fatigue syndrome
- Dermatologic conditions, such as pruritus
Pulmonary
- Chronic obstructive pulmonary disease
- Asthma
Musculoskeletal
- Arthritis
- Fibromyalgia
- Chronic pain
Cardiovascular
- Heart failure
- Ischemic heart disease
- Nocturnal angina
- Hypertension
Endocrinologic
- Hyperthyroidism
Urinary
- Nocturia
Gastrointestinal
- Gastroesophageal reflux
Neurological conditions
- Neurodegenerative diseases, such as Alzheimer’s, dementia, and Parkinson’s disease
- Neuromuscular disorders, including painful peripheral neuropathies
- Cerebral hemispheric and brainstem strokes
- Brain tumors
- Traumatic brain injury
- Headache syndromes, including migraines, cluster headaches, hypnic headaches, and exploding head syndromes
- Fatal familial insomnia
Diagnosing insomnia
The reasons for why someone experiences insomnia and how long it lasts are part of how we diagnose insomnia.
When the sleep disorder is a result of one of these conditions, medication, or substance use, then it’s usually classified as secondary insomnia—which means it’s due to another cause.
If the sleep disorder isn’t caused by another condition or substance, it can be classified as primary insomnia. The distinction between primary and secondary insomnia guides treatment strategies.
Pretreatment screenings and assessments help clarify the diagnosis and severity of insomnia, which then helps dictate the treatment approach.
We can clarify a diagnosis of primary insomnia by defining its subtype, based on duration of time—or how long the patient has experienced insomnia.
Short-term insomnia
Insomnia that lasts a short while could be classified as transient or acute insomnia. Transient insomnia lasts a few days, and acute insomnia may last for a few weeks. These can be addressed through lifestyle changes and short-term interventions by focusing on stressors and precipitating factors. Usually, these resolve within 12 weeks.
There are cases where acute insomnia, though, is more severe or is associated with significant distress. In these cases, we often recommend therapy. We may also sometimes offer short-term use of sleep aids to reduce disruption to daytime functioning, anxiety about being sleepless, or maladaptive behavioral patterns that can lead to chronic insomnia.
Long-term insomnia
For chronic insomnia, a comprehensive approach involving cognitive-behavioral therapy (CBT) as a first-line treatment is recommended. Chronic insomnia has similar diagnostic features of acute insomnia, but lasts longer than 12 weeks. CBT is often accompanied by pharmacotherapy for most effective outcomes in treating chronic insomnia.
Other options for diagnosing insomnia
Most clients with primary insomnia can be diagnosed clinically. Sometimes, a client may present with a case that is difficult to treat. Complex cases may require sleep studies that provide additional data for a more accurate diagnosis.
Types of sleep studies
- Actigraphy is a test to assess sleep/wake cycles over days to weeks. Patients wear small, non-invasive, wrist devices that measure movement.
- Polysomnography is commonly known as a “sleep study.” It is a diagnostic tool that assesses several parameters that can affect sleep, including brain waves, oxygen levels, heart and breathing rates, air flow, and more. This provides more data on the causes of a sleep disorder and can help rule out others, such as sleep apnea, periodic limb movement disorder, narcolepsy, and hypersomnia.
What are the treatment options for insomnia?
Understanding the various categories of medications for insomnia allows for tailored treatment plans. However, it's essential to consider the potential risks and benefits associated with each medication class, keeping in mind factors such as dependency, side effects, and suitability for long-term use.
Medications with regulatory approval for insomnia disorder can be characterized by four categories: benzodiazepines, non-benzodiazepine hypnotics, melatonin receptor agonists, and orexin receptor antagonists. Besides these, other types of medication can be used to treat insomnia, which we’ve included here.
Benzodiazepines
This class of medications acts on the central nervous system to promote relaxation and sleep by enhancing the effects of gamma-aminobutyric acid (GABA). These are neurotransmitters that block signals in the central nervous system and have a calming effect. Generally speaking, benzodiazepines—informally called “benzos”—are effective, yet pose a potential risk for dependency. This risk, along with its potential to cause grogginess or a “hangover” effect, makes it not ideal as a first line treatment for insomnia.
Some examples of benzodiazepines are temazepam, triazolam, and estazolam. Other benzodiazepines that have been FDA-approved for anxiety are sometimes prescribed for insomnia. This includes lorazepam, clonazepam, and alprazolam.
Non-benzodiazepine hypnotics (Z-Drugs)
These newer medications bind to the same GABA receptor complex as benzodiazepines. However, they are designed to bind more selectively to certain subunits and therefore are considered safer, with lower potential for dependence and side effects.
Sometimes called “z-drugs” because many of the medications begin with the letter “z,” these include zolpidem, eszopiclone, and zaleplon.
Melatonin receptor agonist
These mimic the action of the natural hormone melatonin, influencing the sleep/wake cycle. It is significantly more potent than over-the-counter melatonin.
An example of a melatonin receptor agonist is ramelteon.
Orexin Receptor Antagonist
These medications bind and inhibit the action of orexin—a neurotransmitter associated with wakefulness and arousal—to promote sleep.
An example of an orexin receptor antagonist is suvorexant.
Other commonly used sleep treatments
The aforementioned medications tend to target the chemicals and neurotransmitters responsible for sleep and relaxation more directly, but other types of medications may be used to treat insomnia as well.
Antidepressants
Some antidepressants, such as trazodone, mirtazapine, doxepin and amitriptyline, may be used off-label to treat insomnia.
Antidepressants may help initiate sleep and reduce arousal because many involve neurochemicals such as serotonin, norepinephrine, dopamine, and histamine receptor modulation among other neurochemicals.
Antihistamines
These medications inhibit histamine receptors, which play a role in regulating sleep and wakefulness. Examples include the prescription medication Hydroxyzine and for over-the-counter options, Diphenhydramine and doxylamine.
Anticonvulsant medications
Medications such as Gabapentin and Pregabalin may be used off-label for their calming and sedative effects on the central nervous system.
Collaborating with therapists and other providers
When navigating potential sleep disorders, collaboration across different kinds of providers is key. This includes mental health professionals, such as therapists and psychiatrists, but also means collaboration with primary care providers, sleep specialists, and when indicated, other medical specialists.
We know that mental health can significantly influence physical health, and sleep is no exception. By adopting a holistic and collaborative approach, clinicians can offer effective interventions that address the root causes of insomnia and other sleep disorders, ultimately contributing to improved mental wellness and overall quality of life for their patients.
Dr. Amar Mukhtar, DO is a psychiatrist on UpLift. He has experience working in integrated healthcare models and collaborating with therapists. He completed his psychiatry residency at Virginia Commonwealth University.
Eliana Reyes
Our fact checking standards
Every UpLift article is created by our team or other qualified contributors, and reviewed for accuracy by clinicians.
Jack Sykstus, LMFT
Interested in learning more about this provider’s practice or want to book a session?
view provider’s profile
