When I see patients in my office I would say that 75% have as a major complaint of insomnia or having difficulty going to sleep and/or staying asleep. Many times the problem has been going on for years.
But who should you see for persistent sleep issues? Your general practitioner? A sleep ppecialist? Your mental health specialist?
I like to start with a few questions to narrow it down:
1. How long have you had this problem?
If it’s only been a few days or weeks then I would say it would be ok to see your general practitioner or mental health practitioner. Both have the knowledge to help you get to sleep.
If you've had trouble with sleeping all your life--especially after a large weight gain--then you're best off seeing a sleep specialist. Sometimes sleep issues can come from having sleep apnea, where you stop breathing during sleep, sometimes thousands of times a night!
How do you know if it's sleep apnea? One clue is loud and persistent snoring that's interrupted. (Usually your sleep partner is the one who observes this first-hand!) People with sleep apnea usually have extreme fatigue during the day because their sleep is constantly interrupted.
2. Do you exhibit some symptoms for mental health issues in addition to interrupted or restless sleep? This can be persistent stress, feelings of hopelessness, anxiety, an inability to "turn off your brain," even throwing yourself into late-night projects and running on a high burn until you crash.
These are just a few indicators that may mean you have a mental health condition that interferes with your sleep, such as Major Depression, General Anxiety Disorder, PTSD and Bipolar Disorder. All these conditions can interfere with your sleep, and are treated in different ways.
In my practice I teach my patients “Sleep Hygiene.” This is a program to help the body cue itself that it is time for sleep. We often lose that cue with bad habits and lack of routine over time.
If needs be, I recommend medications that can help with insomnia, always starting with the mildest remedies that are not addictive.
I usually start with melatonin and antihistamines. If those don't work, I prescribe medications in the antidepressant class such as Trazadone. It is very effective. Next would be other antidepressants and mood stabilizers according to what are the diagnoses.
(Note: I totally avoid the Benzodiazepine class because they're only meant to treat the occasional sleep problem in the short term. Benzos can be highly addictive and actually cause depression in the long-term. If you have issues with addictions or have family members with addiction, I would recommend avoiding Benzos altogether. They're not worth the risk.)
If you're having persistent sleep issues related to your mental health, come talk to me. Let me see how I can help you get better sleep.