Sleep disturbance

There are three versions of this and people usually describe one of them.

The first is the night that will not start. Lights off at eleven, and then a mind that picks this exact moment to open every file it has — a conversation from Tuesday, a payment due, a sentence said eight years ago. People describe watching the clock do the arithmetic against them: four hours left, three, two.

The second is the night that breaks. Sleep comes easily enough, and then at half past three the eyes open for no reason anybody can name, and the hours between that and Fajr are the longest of the day.

The third is the one people almost never mention, because it does not sound like a problem. They sleep. Seven hours, eight, sometimes more — and they wake up as tired as they lay down, and stay tired until evening.

Around all three, people describe the same second thing: bedtime starts to feel like something to dread, and the bed becomes a place where you fail at resting. Then come the workarounds — the late tea, the phone, the nap at five that costs that night's sleep, the weekend that never quite catches up.

Recognising yourself in a paragraph on a website is not the same as knowing what is going on. This page describes; it does not assess you, and there is nothing here for you to score yourself against.

A bad week of sleep after a hard week of life is ordinary, and it usually settles on its own.

What a clinician pays attention to is duration and cost. Difficulty most nights for several weeks or longer rather than a run of bad nights that has now passed. Days visibly shaped by it — work that takes twice as long, a temper that goes faster than it used to, driving you would rather not be doing.

One thing worth saying plainly: sleep has medical causes as well as psychological ones. Breathing that stops and starts at night, thyroid difficulty, pain and some medicines all affect sleep, and a doctor ruling those out is a sensible step rather than a wasted one. It is also common for sleep difficulty to arrive attached to something else — low mood, worry, grief, a new baby, a job — which is one of the things an assessment is for.

Only a qualified clinician can tell you what is going on — a website cannot. What a page like this can tell you is that the question is a reasonable one to bring.

PHC is an assessment-first practice. Before therapy begins there is an initial session, and its job is to work out what is actually happening rather than to start treating it.

1. An initial sessionWe ask what has been going on, for how long, and what it is costing you. We will ask whether a doctor has looked at the physical side, and if not we may suggest that first. Nothing is administered before this conversation.
2. Emotional assessment and symptom screeningA structured screening of emotional functioning and what you are presenting with, using internationally validated instruments. Its purpose is to decide which further tests, if any, are clinically warranted — you will not be given tests you do not need. It is also what separates a sleep difficulty in its own right from one sitting on top of something else.
3. A psychologist matched to what the assessment foundPsychologists at PHC are not assigned on availability. Assignment is based on speciality, your presenting needs and clinical fit.
4. Therapy, reviewed as it goesFor sleep difficulty the modality most often indicated is Cognitive Behavioural Therapy (CBT), which PHC uses for anxiety, depression and negative thought patterns. Some people also use the Hypno-yoga at PHC DHA alongside their sessions, in a group, four days a week. Sessions are 50 minutes, in clinic at our PECHS clinic or in DHA, or online.

• Anxiety
• Depression
• Work-related stress
• Emotional assessment
• CBT at PHC