Sleep: A Clinical Guide

Specialist CBT therapy for anxiety, OCD, depression and more in West London

Sleep is shaped by interacting sleep pressure and circadian processes. Persistent sleeplessness can also be associated with stress, anxiety, low mood, routine, medication or physical health. This guide is educational and cannot determine the cause of an individual sleep difficulty. CBT I is a structured insomnia focused approach included in NICE guidance. Whether it is appropriate depends on an individual assessment, including medical context, sleep pattern and access to an appropriately trained provider. Some sleep conditions need medical assessment, particularly if there is loud snoring, witnessed pauses in breathing, gasping, severe daytime sleepiness or a safety concern. Understanding persistent sleep difficulty Occasional poor sleep is common and does not automatically mean insomnia. A more useful question is whether the difficulty is persisting, affecting daytime function or occurring despite adequate opportunity to sleep. Assessment can consider sleep timing, stress, changes in routine, pain, physical health, medication, caffeine, alcohol, mood and other factors. A guide cannot determine which of those is relevant for one person. It is important not to reduce every sleep problem to anxiety or poor habits. Loud snoring, witnessed breathing pauses, waking gasping, severe daytime sleepiness, sudden sleep attacks, unusual movements in sleep or new neurological symptoms may need medical assessment. Questions about prescribed or over the counter sleep medicines, including whether to start, change or stop them, belong with a prescriber or pharmacist. What therapy may explore Where anxiety, rumination, low mood or stress appears relevant, CBT based therapy may explore the cycle between worry, alertness, routines and day to day coping. This differs from providing CBT I. The Lyceum does not diagnose sleep disorders or deliver a formal CBT I programme. A clinician can discuss whether CBT based support, a GP review, a specialist sleep service or another route may be the relevant next step. General sleep information is not a treatment protocol. Strict sleep restriction, medication changes or rigid self directed rules can be unsuitable or unsafe for some people. Any structured intervention should be considered with an appropriately trained provider who can take account of medical history, risk, daytime safety and the practical demands of a person’s life. Safety and next steps If sleeplessness is accompanied by thoughts of self harm, inability to keep yourself safe, extreme agitation, confusion or a marked deterioration in mental state, seek urgent support. In immediate danger, call 999 or attend A&E. For related information, see https://lyceumclinic.co.uk/therapy/anxiety/, https://lyceumclinic.co.uk/therapy/depression/, https://lyceumclinic.co.uk/guides/anxiety physical symptoms/ and https://lyceumclinic.co.uk/guides/burnout measurement diagnosis/. Frequently asked questions Can therapy diagnose insomnia or sleep apnoea? No. Sleep disorders and possible breathing disorders require appropriate medical assessment. Does everyone with poor sleep need CBT I? No. Suitability depends on the sleep pattern, medical context, risk and access to an appropriately trained provider. At The Lyceum Clinic, Sanah Younis provides BABCP accredited CBT for anxiety, stress, low mood and rumination where clinically appropriate. The clinic does not diagnose sleep disorders or provide a CBT I programme. If sleep difficulties are affecting daily life, enquire about current availability or speak with an appropriate healthcare professional about the next relevant step.