Insomnia & Depression (Comorbid Insomnia-Depression)
Insomnia occurring alongside major depressive disorder, where depression worsens sleep and poor sleep worsens depression in a vicious cycle.
- Insomnia combined with depressive symptoms (low mood, anhedonia, guilt)
- Early morning awakening (terminal insomnia)
- Non-restorative sleep despite time in bed
- Daytime fatigue and reduced functioning
- Difficulty seeing improvement with antidepressants alone
- Sleep problems persisting or worsening with depression treatment
Depression and insomnia powerfully reinforce each other. Poor sleep worsens depressive symptoms, while depression perpetuates sleep problems. Standard CBT-I or depression treatment alone often produces incomplete results. Integrated treatment addressing both conditions simultaneously produces better outcomes than treating either condition in isolation.
Insomnia & Anxiety Disorders (GAD, Panic, Social Anxiety)
Chronic insomnia occurring alongside generalized anxiety disorder, panic disorder, social anxiety, or other anxiety conditions, where anxiety fuels sleep problems and sleep deprivation worsens anxiety.
- Racing thoughts and worry preventing sleep onset
- Nighttime panic attacks or fear of panic during sleep
- Hypervigilance and sleep-related safety concerns
- Sleep avoiding behaviors worsening insomnia
- Anticipatory anxiety about next night's sleep
- Daytime anxiety exacerbated by sleep deprivation
Anxiety disorders maintain insomnia through hyperarousal, racing thoughts, and sleep-related safety behaviors. Standard sleep treatment doesn't address underlying anxiety vulnerability. Integrated anxiety and sleep-specific CBT is necessary for effective treatment, combining cognitive restructuring for anxiety with sleep-specific behavioral interventions.
Sleep Problems & ADHD (Attention-Deficit/Hyperactivity Disorder)
Chronic sleep problems occurring in individuals with ADHD, where ADHD symptoms (hyperactivity, racing thoughts, difficulty focusing) disrupt sleep, and sleep deprivation worsens ADHD symptoms.
- Difficulty "turning off" mind at bedtime (racing thoughts, hyperfocus on worries)
- Restlessness and physical hyperactivity in bed
- Sleep onset insomnia or frequent awakenings
- ADHD symptoms significantly worse with poor sleep
- Impulsivity worsening sleep behaviors (irregular schedule, stimulating activities)
- Difficulty following sleep improvement strategies consistently
ADHD creates unique sleep challenges requiring adapted behavioral strategies that account for executive function difficulties, hyperfocus patterns, and stimulation needs. Standard CBT-I alone is often insufficient. Integrated treatment combining ADHD-aware behavioral strategies with sleep-specific interventions is essential for success.
Sleep Disruption & Chronic Pain (Fibromyalgia, Back Pain, etc.)
Severe sleep disruption caused by chronic pain conditions, where pain prevents sleep and sleep deprivation intensifies pain perception and suffering.
- Pain-related difficulty falling or staying asleep
- Frequent arousals from pain or discomfort
- Non-restorative sleep despite adequate sleep time
- Pain intensity significantly worse with poor sleep
- Daytime dysfunction from both pain and sleep deprivation
- Emotional distress exacerbated by chronic pain + poor sleep
Chronic pain and poor sleep create a self-perpetuating cycle: pain disrupts sleep, and poor sleep lowers pain threshold and increases pain perception. Integrated treatment must address both pain-focused strategies (acceptance, coping) and sleep-specific interventions to break this cycle and improve both sleep and pain management.
Sleep Problems with Medical Conditions (Diabetes, Hypertension, etc.)
Sleep disruption related to medical conditions (diabetes, thyroid disorders, cardiovascular disease, etc.) or their treatments, where medical factors and behavioral factors interact.
- Sleep disrupted by condition-related symptoms (nocturnal bathroom trips, breathing difficulty, etc.)
- Sleep medication side effects or ineffectiveness
- Medical condition symptoms worse with poor sleep
- Difficulty managing medical condition with inadequate sleep
- Behavioral factors (stress, poor sleep habits) worsening medical condition
- Complex medication interactions affecting sleep quality
Medical conditions often require coordinated treatment involving your primary care physician, specialists, and sleep-focused behavioral interventions. We work collaboratively with your healthcare providers to optimize sleep within the context of your medical care, providing behavioral strategies that complement medical treatment and improve both sleep and medical condition management.
Complex Comorbid Presentations (Multiple Concurrent Conditions)
Sleep disruption occurring with multiple concurrent mental health or medical conditions, requiring comprehensive, coordinated treatment addressing all interacting factors.
- Sleep disrupted by combinations of anxiety + depression + chronic pain, etc.
- Multiple contributing factors making treatment planning complex
- Prior treatment attempts addressing only one factor with limited results
- Significant functional impairment across multiple life domains
- Need for coordinated care with multiple healthcare providers
- High risk for treatment non-adherence due to complexity
Complex presentations require sophisticated, integrated assessment and treatment planning that addresses the interplay of multiple contributing factors. Standard single-focus treatment is inadequate. We provide comprehensive evaluation, integrated treatment planning, and coordination with other healthcare providers to create cohesive, effective care addressing the whole picture of your sleep, mental health, and medical situation.
