When Sleep Becomes the Enemy

If you're reading this at 3 AM, exhausted but unable to sleep, or if you're dragging through days in a fog because sleep won't come—you already know that sleep problems affect everything. Your mood. Your focus. Your health. Your ability to function.

Sleep disorders are real medical conditions. You're not "bad at sleeping." And there are effective treatments that can help.

Table of Contents

• Types of Sleep Disorders We Treat
• How Sleep Disorders Affect Mental Health
• Medical Causes We Check First
• Our Approach to Sleep Treatment
• Medication Management
• Sleep Hygiene & Behavioral Strategies
• What Treatment Looks Like
• Ages We Serve
• Telehealth Throughout Colorado
• Insurance & Access
• Frequently Asked Questions

Types of Sleep Disorders We Treat

Insomnia

What It Looks Like:

• Difficulty falling asleep (sleep onset insomnia)
• Difficulty staying asleep (sleep maintenance insomnia)
• Waking too early and can't get back to sleep
• Non-restorative sleep (sleeping but not feeling rested)
• Daytime impairment (fatigue, mood problems, difficulty concentrating)

Types:

• Acute Insomnia: Short-term (days to weeks), usually related to stress or life events
• Chronic Insomnia: At least 3 nights per week for 3+ months
• Primary Insomnia: Not caused by other conditions
• Secondary Insomnia: Caused by or worsened by other conditions

Circadian Rhythm Disorders

Delayed Sleep Phase Disorder:

• Natural sleep time is much later than desired (e.g., can't fall asleep until 2-3 AM)
• Difficulty waking for morning obligations
• Common in teens and young adults
• Not just "being a night owl"—causes significant impairment

Advanced Sleep Phase Disorder:

• Early evening sleepiness, very early morning waking
• More common in older adults

Shift Work Sleep Disorder:

• Difficulty sleeping during the day when working night shifts
• Excessive sleepiness during work hours

Irregular Sleep-Wake Rhythm:

• No consistent sleep pattern
• Multiple sleep periods throughout 24 hours

Nightmares & Night Terrors

Nightmares:

• Disturbing dreams that wake you up
• Often related to anxiety, PTSD, or trauma
• Remember the dream content
• Can cause fear of sleeping

Night Terrors:

• Sudden arousal from sleep with intense fear
• Usually no memory of the event
• More common in children but can occur in adults
• Different from nightmares

REM Sleep Behavior Disorder:

• Acting out dreams (sometimes violently)
• Loss of normal muscle paralysis during REM sleep
• Can be dangerous

Restless Legs Syndrome (RLS)

• Uncomfortable sensations in legs (crawling, tingling, aching)
• Overwhelming urge to move legs
• Worse at rest, especially at night
• Movement temporarily relieves discomfort
• Significantly disrupts sleep

Hypersomnia

• Excessive daytime sleepiness despite adequate nighttime sleep
• Difficulty staying awake during the day
• Long nighttime sleep (10+ hours)
• Difficulty waking, grogginess upon waking

Important: If you have symptoms of sleep apnea (loud snoring, gasping during sleep, witnessed breathing pauses), we'll refer you for a sleep study. We can manage psychiatric aspects but sleep apnea requires specialized treatment (CPAP, etc.).

How Sleep Disorders Affect Mental Health

The Bidirectional Relationship:

• Mental health conditions cause sleep problems
• Sleep problems worsen mental health
• It becomes a vicious cycle

Sleep & Depression:

• 80-90% of people with depression have sleep problems
• Insomnia is a risk factor for developing depression
• Sleep deprivation can trigger depressive episodes

Sleep & Anxiety:

• Anxiety causes hyperarousal that prevents sleep
• Poor sleep increases anxiety
• Racing thoughts at bedtime

Sleep & Bipolar Disorder:

• Decreased need for sleep can signal manic episode
• Sleep disruption can trigger mood episodes
• Sleep regularity is crucial for mood stability

Sleep & ADHD:

• Most people with ADHD have sleep problems
• Sleep deprivation worsens ADHD symptoms
• Racing thoughts prevent sleep

Sleep & PTSD:

• Nightmares are core PTSD symptom
• Hypervigilance prevents sleep
• Fear of nightmares causes sleep avoidance

Sleep & Psychosis:

• Severe sleep deprivation can cause psychotic symptoms
• Sleep problems common in schizophrenia

Medical Causes We Check First

Before diagnosing a sleep disorder, we rule out medical conditions:

We Test For:

• Thyroid problems: Both hyper and hypothyroidism affect sleep
• Iron deficiency/Anemia: Can cause restless legs syndrome
• Vitamin D deficiency: Associated with sleep problems
• Sleep apnea screening: Questionnaires and referral for sleep study if indicated
• Hormonal imbalances: Menopause, testosterone, cortisol
• Chronic pain conditions: Pain disrupts sleep
• Medication side effects: Many medications affect sleep
• Substance use: Alcohol, caffeine, cannabis, stimulants

We Also Consider:

• Environmental factors (noise, light, temperature, bed partner)
• Shift work or irregular schedule
• Travel across time zones
• Caffeine and alcohol use patterns
• Screen use before bed
• Exercise timing
• Napping patterns

Our Approach to Sleep Treatment

Comprehensive Sleep Assessment: We need to understand:

• What exactly is happening with your sleep
• When did sleep problems start
• Pattern of sleep problems
• What makes it better or worse
• Daytime impairment
• Sleep environment
• Mental health conditions affecting sleep
• Medical conditions affecting sleep
• Medications and substances
• Previous sleep treatments

Multi-Modal Treatment: We use a combination of:

• Sleep hygiene education
• Behavioral strategies (CBT-I principles)
• Medication when appropriate
• Treating underlying mental health conditions
• Addressing medical factors

We Understand:

• You've probably already tried "good sleep hygiene"
• You can't just "relax and fall asleep"
• Sleep problems cause real distress and impairment
• Chronic insomnia requires more than just melatonin

Medication Management

Important Philosophy:

• Medication is one tool, not the whole solution
• Behavioral strategies are essential
• We use the lowest effective dose
• We have a plan for long-term management (not indefinite sedatives)
• We address underlying causes

For Insomnia:

Non-Benzodiazepine Sleep Medications ("Z-drugs"):

• Zolpidem (Ambien), eszopiclone (Lunesta), zaleplon (Sonata)
• Help with sleep onset
• Risk of dependence with long-term use
• Can cause complex sleep behaviors (sleep-walking, sleep-eating)
• We use these short-term or intermittently

Sedating Antidepressants:

Orexin Receptor Antagonists:

• Lemborexant (Dayvigo), suvorexant (Belsomra)
• Newer mechanism
• Help with sleep maintenance
• Less dependence risk than z-drugs
• Can be expensive

Melatonin Receptor Agonists:

• Ramelteon (Rozerem)
• Helps with circadian rhythm issues
• Not sedating per se
• No dependence risk

Benzodiazepines:

• Temazepam, triazolam, others
• Effective for sleep but significant downsides
• Risk of dependence and tolerance
• Cognitive impairment, falls (especially in elderly)
• We use these rarely and short-term only

Antihistamines:

• Hydroxyzine
• Over-the-counter: diphenhydramine, doxylamine
• Can help short-term
• Tolerance develops quickly
• Not for long-term use

For Depression/Anxiety Causing Insomnia:

• Treating underlying condition often improves sleep
• SSRIs, SNRIs (some are activating, some sedating)
• Choice depends on other symptoms

For Bipolar-Related Sleep Problems:

• Mood stabilizers
• Atypical antipsychotics (many are sedating)
• Sometimes sleep medications

For PTSD-Related Nightmares:

• Prazosin: Very effective for trauma nightmares
• Atypical antidepressants
• Atypical antipsychotics in low doses

For Restless Legs Syndrome:

• Iron supplementation if deficient
• Dopamine agonists (pramipexole, ropinirole)
• Gabapentin or pregabalin
• Sometimes opioids for severe cases

For Circadian Rhythm Disorders:

• Melatonin (timing is crucial)
• Light therapy
• Sometimes wake-promoting agents

Our Medication Approach:

• Start with non-habit-forming options when possible
• Use benzodiazepines and z-drugs sparingly
• Have a plan for tapering/discontinuation
• Address underlying causes
• Combine with behavioral strategies
• Regular reassessment of necessity

Sleep Hygiene & Behavioral Strategies

We know you've heard this before, but these really do matter:

Sleep Schedule:

• Consistent wake time (even weekends)
• Go to bed only when sleepy
• Get out of bed if not sleeping after 20 minutes

Sleep Environment:

• Cool, dark, quiet
• Comfortable mattress and pillows
• Reserve bed for sleep and sex only

Daytime Behaviors:

• Morning sunlight exposure
• Regular exercise (but not close to bedtime)
• Limit naps (or nap strategically)

Evening Routine:

• Wind-down routine before bed
• Limit screens 1-2 hours before bed (blue light)
• Avoid caffeine after noon
• Avoid alcohol (disrupts sleep architecture)
• Light snack if hungry, not heavy meal

Cognitive Strategies (CBT-I Principles):

• Sleep Restriction: Temporarily limiting time in bed to consolidate sleep
• Stimulus Control: Reconditioning bed as place for sleep
• Cognitive Restructuring: Addressing anxiety-provoking thoughts about sleep
• Relaxation Techniques: Progressive muscle relaxation, breathing exercises

For Trauma-Related Sleep Problems:

• Feeling safe in sleep environment
• Nighttime safety planning
• Imagery rehearsal therapy for nightmares
• Processing trauma with therapist

What Treatment Looks Like

Initial Evaluation (60-90 minutes): Detailed sleep history, mental health assessment, medical screening.

Sleep Diary: We may ask you to track sleep for 1-2 weeks to identify patterns.

Lab Work: Blood work to check for medical causes.

Treatment Planning: Collaborative plan including:

• Sleep hygiene education
• Behavioral strategies
• Medication if appropriate
• Referrals if needed (sleep study, CBT-I specialist)

Follow-Up: Regular check-ins to assess sleep improvement and adjust treatment.

Long-Term Management:

• For chronic insomnia, ongoing support
• Tapering or discontinuing medication when appropriate
• Addressing relapses
• Maintaining behavioral strategies

Ages We Serve

• Teens (12+): Often have delayed sleep phase; sleep crucial for development
• Young adults: Peak time for developing insomnia
• Adults: Chronic insomnia, stress-related sleep problems
• Older adults: Age-related sleep changes, medical conditions affecting sleep

Telehealth Throughout Colorado

All appointments are virtual:

• No need to lose sleep getting to appointments
• Available throughout Colorado
• Comfortable discussion from home

Insurance & Access

We accept most major insurance including:

• Aetna
• Cigna
• United Healthcare
• Oscar
• Optum
• Blue Cross Blue Shield
• Private pay options

Note: We do not accept Medicaid or Medicare at this time.

Sleep is Essential

Poor sleep affects every aspect of your life—your mood, your health, your relationships, your work. You deserve to sleep well.

Ready to Sleep Better?

If you're exhausted from not sleeping, if you've tried everything and nothing works, if you're ready for comprehensive sleep treatment—we're here.

Book an appointment online or call us at (719) 212-1951.

Same-week appointments available. Better sleep is possible.

Frequently Asked Questions

Forest Path Psychiatry & Healing is a nurse-led psychiatric practice serving all of Colorado via telehealth. Our board-certified PMHNPs provide comprehensive sleep disorder treatment with understanding of the mental health-sleep connection.