Understanding insomnia
Insomnia is more than just difficulty sleeping — it includes trouble falling asleep, frequent awakenings during the night, waking too early and being unable to return to sleep, or non-restorative sleep despite adequate time in bed. Chronic insomnia (lasting 3+ months, occurring 3+ nights per week) significantly impacts daytime functioning, mood, concentration, and physical health.
Insomnia often co-occurs with depression, anxiety, PTSD, and stress. Sometimes insomnia is the primary problem; other times it is a symptom of an underlying mental health condition. Dr. Shrestha evaluates the full picture — sleep patterns, mental health, medical factors, and medication use — to determine the most appropriate treatment approach.
- Difficulty falling asleep, staying asleep, or waking too early
- Non-restorative sleep despite adequate time in bed
- Chronic: 3+ nights per week for 3+ months
- Impacts mood, concentration, physical health, and quality of life
- Often co-occurs with depression, anxiety, PTSD, and stress
Related: Psychiatry → · Dr. Jitendra Knowledge Hub → · ICHD-3 Topic →
CBT for insomnia (CBT-I)
CBT for insomnia (CBT-I) is the first-line treatment for chronic insomnia, recommended over sleep medication by major medical guidelines. CBT-I addresses the thoughts and behaviours that maintain insomnia through techniques including sleep restriction (consolidating sleep by limiting time in bed), stimulus control (re-associating bed with sleep), cognitive restructuring (challenging unhelpful beliefs about sleep), and sleep hygiene education.
CBT-I is typically delivered over 6–8 sessions and produces lasting improvement. Unlike sleep medication, which works only while taking it, CBT-I teaches skills that continue to benefit sleep long after treatment ends. Dr. Shrestha delivers CBT-I and monitors progress using sleep diaries and validated sleep measures.
| Technique | How it helps | Duration |
|---|---|---|
| Sleep restriction | Consolidates sleep, builds sleep drive | Integrated into 6–8 sessions |
| Stimulus control | Re-associates bed with sleep | Applied nightly |
| Cognitive restructuring | Challenges catastrophic beliefs about sleep | Sessions 2–4 |
| Sleep hygiene | Environmental and behavioural optimisation | Ongoing |
Practical steps and what to bring
For your first appointment, it helps to keep a sleep diary for one week before the consultation: record bedtime, estimated time to fall asleep, number of awakenings, wake time, and how rested you feel. This information helps Dr. Shrestha understand your sleep pattern and tailor the treatment plan.
Also bring a list of current medications (some medications disrupt sleep), any previous sleep-related treatments, and information about caffeine, alcohol, and screen use in the evening. The evaluation typically takes 45–60 minutes and covers sleep history, mental health screening, and treatment planning.
- Keep a one-week sleep diary before your first appointment
- Record bedtime, awakenings, wake time, and restedness
- Bring medication list (some medications affect sleep)
- Note caffeine, alcohol, and evening screen habits
- Initial evaluation: 45–60 minutes