You might struggle to fall asleep, wake several times or wake too early and be unable to get back to sleep. Sometimes a night does not sound particularly difficult to someone else, yet tiredness, irritability and trouble concentrating affect the whole day. That deserves attention in the consultation.
People living with insomnia have often already tried many things. Understanding what helped, what made things harder and how the problem has changed is more useful than starting again with a list of rules.
Understanding what is happening
The assessment considers your schedule, the time you spend in bed, how you feel during the day and the treatments you have tried. Your health, medicines and other substances, work and current circumstances also matter. A sleep diary can help us notice patterns and follow changes.
Sleep difficulties do not all have the same explanation. Sometimes other sleep problems or health conditions need to be investigated. Making that distinction helps us choose an approach that fits your situation.
When bed becomes a place of worry
A stressful period may end while the difficulty sleeping continues. Trying to make up for poor nights, spending long periods awake in bed and worrying about the next day can help keep this cycle going. This is not a conscious choice or something that simply requires more effort.
Cognitive Behavioural Therapy for Insomnia, or CBT-I, addresses these mechanisms. It is a recommended treatment for chronic insomnia in adults and goes beyond sleep hygiene. It may involve reorganising schedules, adjusting time in bed and working on the relationship between sleep, behaviour and thoughts that arise at night.
In my medical practice, I use tools drawn from this approach, but I do not provide CBT-I as a structured course of therapy. When that intervention is needed, I can refer you to therapists who provide it and continue your care alongside them.
The tools we choose need to be adapted to your health and daily life. The aim is to understand the approach, observe your response and make adjustments with guidance and follow-up.
What about medication?
I also provide medication management for insomnia: assessing whether a medicine is appropriate, prescribing when indicated and monitoring its effects and any need for adjustments. What you currently take deserves the same attention as the rest of your history. Decisions take account of benefits, risks, duration of use and other treatment options.
When a reduction is appropriate, it needs to be agreed and monitored. Better sleep and better functioning during the day guide those decisions; stopping a medicine is not a condition for receiving care.
What about medical cannabis?
Medical cannabis can also be discussed during the consultation, including if you already use a product or have questions about it. Evidence for insomnia remains limited and does not support routine use. The assessment considers the product, possible adverse effects, interactions and other treatment options, without promising better sleep or replacement of other medicines.
Following changes in your everyday life
At subsequent appointments, we discuss your nights, your energy, worries about sleep and how practical the plan has been. Difficulties and adjustments belong in that conversation.
Sleep care also connects with mental health and daily routines and lifestyle. When another professional needs to be involved, care can be organised together.
Appointments can take place at the Jardim Botânico office or online, depending on the need for an in-person assessment.