Psychiatrist and sleep medicine physician Nishi Bhopal, MD explains why chronic insomnia can persist despite sleep hygiene, medications, supplements, melatonin, and even CBT-I, outlining three commonly missed issues in clinical practice: misunderstanding insomnia-related hyperarousal and the patient’s learned relationship with wakefulness at night, the counterproductive effect of trying to force sedation, and targeting the wrong perpetuating factors. Using the 3P model and a case of a 34-year-old tech worker with worsening insomnia, she emphasizes focusing on what perpetuates insomnia rather than what triggered it, introduces the CSH framework (circadian patterns, sleep drive, hyperarousal) to guide targeted, simplified interventions, and highlights how clinician communication and expectations can reduce anxiety and rebuild patient confidence.
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.
