Insomnia patients who struggle with their treatment usually can be defined by the categories below, although in my clinical experience, these scenarios often overlap for most insomnia patients, meaning that multiple problems are the norm not the exception.  These categories include:

• First and foremost, there has been a strong, unrelenting focus on gaining more hours of sleep, which almost never resolves insomnia issues, instead of focusing on sleep quality issues.

• Cognitive-behavioral therapy (CBT) has not produced the desired results because  the CBT was delivered by a therapist or doctor who could not effectively coach the patient to make the critical adjustments in his or her thinking or behavior that would have resulted in more improvement.

• CBT is not the best modality for the patient because the patient shows deficits in activating their natural capacity for human imagery, which must first be addressed before the CBT might prove effective.

• CBT is not the best modality for the patient because the patient shows deficits in emotional processing skills that must first be addressed before the CBT might prove effective.

• Sleep medications have been overemphasized for too long in the treatment plan: they may never have worked well from the outset; they no longer work well currently, or for other reasons the individual is struggling to get off these drugs.

• An undiagnosed physical sleep disorder is constantly thwarting attempts to treat the psychological components of insomnia.

• There is a recognition that a physical sleep disorder is a part of the equation, but the individual has been unsuccessful in treating this component, which then continues to thwart efforts to resolve the insomnia.

These 7 scenarios and the sequence with which they have been offered above mirror the 7 parts to my book Sound Sleep, Sound Mind.

What if you think your first sleep test was wrong...