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Most people know what it feels like to have a bad night’s sleep
Few know that an entire clinical specialty exists to treat chronic insomnia. Many are also unaware that there are too few specialists nationwide to meet the demand
When poor sleep becomes a chronic problem, many people do not know where to turn. Many patients struggle for months or years before being referred to a behavioral sleep medicine specialist. By then, they may have tried over-the-counter remedies, sleep hygiene tips, prescribed medications, online advice, or changes to their bedtime routine without lasting relief
That matters in Rochester because behavioral sleep medicine is available here, but many patients do not know it exists until they have already spent months or years struggling with sleep
Behavioral sleep medicine is a clinical specialty that uses evidence-based, non-pharmacological approaches to treat insomnia and other sleep disorders. Patients may be referred for chronic insomnia, nightmares, narcolepsy-related concerns, restless legs syndrome, difficulty adjusting to CPAP therapy, or circadian rhythm problems (when the body’s natural sleep-wake rhythm is out of sync with the demands of daily life). Of these conditions, chronic insomnia is one of the most common reasons for referral to behavioral sleep medicine.
For chronic insomnia, the recommended first-line treatment is cognitive behavioral therapy for insomnia, or CBT-I. CBT-I is much more than sleep hygiene. It is a structured treatment that helps patients address the thoughts, behaviors, and patterns that can keep insomnia going. For many patients, fear of not sleeping becomes part of the problem itself. Sleep has a paradoxical quality. The harder many people try to force themselves to sleep, the more awake and anxious they become.
Even patients with medical training are often surprised by what CBT-I actually involves. One physician who recently completed treatment told me he had long been familiar with sleep hygiene and CBT-I in theory, but only after experiencing the structured therapy did he feel “a weight lifted off” and gain confidence that he could sleep without relying so heavily on medication
That does not mean insomnia is “in your head” or simply a matter of attitude. Chronic insomnia is a medical and mental health condition that can affect nearly every aspect of a person’s life. It is associated with depression, chronic pain, reduced quality of life, and other health challenges. According to the American Academy of Sleep Medicine, approximately 12 percentof Americans live with chronic insomnia.
Effective treatment exists. Access to it is another matter
Nationally, fewer than 300 providers are board certified in behavioral sleep medicine. That number does not capture every clinician who may provide aspects of behavioral sleep care, but board certification signals a specific level of expertise in this field. Behavioral Sleep Medicine is also interdisciplinary. Psychologists, physicians, nurse practitioners, social workers, physical therapists, and other health care professionals can develop expertise in this area.
Here in Rochester, the need is visible in the wait for care. Patients seeking behavioral sleep medicine services at the University of Rochester Medicine Comprehensive Sleep Disorders Center may wait months for an appointment. That demand reflects both the prevalence of sleep disorders and the limited number of specialists trained to provide this care
But barriers to access begin even earlier than the wait list. Many people never seek behavioral sleep medicine because they do not know the specialty exists. Instead, they may assume their only options are medication, medical devices, or general sleep advice
Even when patients do find behavioral sleep medicine, they often have misconceptions about what it involves. One of the most common is the belief that behavioral treatment means stopping sleep medication. In reality, behavioral treatment does not necessarily mean stopping medication on day one. Many medications are intended for short-term use, and some patients may eventually reduce or stop them with medical guidance. The goal is not to take tools away from patients. The goal is to give them more effective tools for understanding and improving sleep.
As more patients learn about behavioral sleep medicine, ensuring they can access that care becomes equally important. To help meet that need, the UR Medicine Comprehensive Sleep Disorders Center is expanding access to behavioral sleep medicine. Daniel B. Kay, Ph.D., DBSM, a board-certified clinical sleep psychologist, will join the program this month. His arrival will expand access to evidence-based behavioral treatment for insomnia as well as other sleep disorders commonly treated within behavioral sleep medicine.
Expanding local access is an important step, but it also reflects a broader challenge. One new clinician will not solve a national workforce shortage, but it will improve access for patients in our region who have spent months, and sometimes years, searching for effective treatment. Meeting the growing need for behavioral sleep medicine will require both expanding clinical services and training the next generation of providers.
Sleep is one of the most fundamental human needs, and many sleep disorders, including chronic insomnia, have effective behavioral treatments supported by decades of research. The challenge is ensuring that patients know these treatments exist and that enough trained specialists are available to provide them
Leisha Cuddihy, Ph.D., DBSM, is director of Behavioral Sleep Medicine and an assistant professor of psychiatry and neurology at the University of Rochester Medical Center
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