Psychiatrist and sleep medicine physician Nishi Bhopal, MD shares a practical clinic workflow to make insomnia evaluations more straightforward, noting most clinicians receive little formal sleep medicine training. Using a case of a woman with refractory insomnia on zolpidem, he shows how missed factors—sleep environment (sleeping in an unventilated closet), undiagnosed obstructive sleep apnea, and behavioral drivers addressed with CBT-I principles like reducing time awake in bed—can lead to major improvement and medication tapering. He teaches a structured framework (FEEM: food, environment, emotional factors, medical conditions), highlights language clues patients use, and explains sleep drive with a hunger analogy. He recommends standardized tools (Epworth, ISI, GAD-7, PHQ-9, MDQ), AASM sleep history/diary, and the patient-centered FIFE interview (feelings, ideas, functioning, expectations) to uncover perpetuating beliefs and the patient’s relationship with sleep.
Have a patient who needs more than education? My clinical practice, Pacific Integrative Psychiatry, accepts referrals for insomnia and mental health care in California.
Referring a patient for the sleep programme? Effortless Sleep for clinicians has the referral details.
Not a clinician? The Effortless Sleep Program™ is the patient version of this work, available online, nationwide.
