Why Insomnia Is a Symptom, Not a Diagnosis

Welcome back to the Hidden Sleep Disorders Show! In this episode, we're taking a deep dive into the real causes behind insomnia, a condition that affects countless people and frustrates both patients and doctors alike. Too often, insomnia is treated as the primary problem, but as Dr. Vishal Sani explains, sleeplessness is frequently a symptom of hidden issues like sleep apnea, restless leg syndrome, anxiety, or even long-standing habits and genetics. We'll break down why popular sleep hacks and over-the-counter remedies fail so many, when to suspect an underlying disorder, and how proper evaluation can change the story for chronic insomniacs. Whether you've tried every trick in the book, or you're just beginning your journey toward better sleep, this episode will help you understand why getting to the root of insomnia is the key to finally getting the rest you deserve.

Timestamps:

00:00 Understanding insomnia and its causes

06:26 Addressing the root cause of insomnia

08:48 Understanding and Treating Sleep Apnea

10:50 Understanding Restless Leg Syndrome

17:07 Challenges with over-the-counter sleep aids

18:37 Misuse and overuse of melatonin

23:21 Understanding causes of insomnia

26:56 Identifying causes of insomnia

28:58 Challenges with CBT-I availability

33:13 Discussing insomnia with your doctor

35:53 Encouraging listeners to subscribe

Dr. Vishal Saini - https://www.mwcsd.com/dr-vishal-saini/

Show Website - https://the-hidden-sleep-disorders-sho.beam.ly/

Podcast Producer - https://tophealth.care/

“Disclaimer: Informational only. Not medical advice. Consult your doctor for guidance.”

Transcript

SPEAKER_00 0:00

The challenge with insomnia is sometimes it's super tricky to pinpoint did my problem start before insomnia or is insomnia causing some of these symptoms? Sleep hygiene influencers are everywhere. Any TikTok I watch these days or anything on social media, everyone's trying to play psychologist who could fix the insomnia just by doing one thing. Unfortunately, life doesn't work that way. Let's say I have a sleep apnea patient who cannot stay asleep, they're waking up multiple times to go to the bathroom. If I don't really treat that underlying problem, then no matter how strong of a sleeping pill I take, no matter how many sleep hygiene tricks I try, those are not gonna be very effective. Just because I'm dealing with more underlying problems, I think that's where a lot of these strategies fail because they don't really try to understand what is actually driving the insomnia for each individual.

SPEAKER_01 1:32

So many people are handed a diagnosis of insomnia and told to try better habits, a new medication, or more discipline around bedtime, but yet nothing changes. So today we're gonna take a look at why insomnia is often a symptom rather than a true diagnosis and what is actually happening underneath sleepless nights that really never seem to resolve. So, Dr. Snani, let's get into it. It's good to see you as always.

SPEAKER_00 1:54

I'm doing awesome, Layla. Thank you for having me. Usually we dedicate these to, you know, different groups of people that inspire us. I think I'm gonna dedicate this to all the soccer lovers and soccer fans around the world. You know, USA is already out, so we're kind of bummed about that. But you know, hopefully not too much insomnia going on because of watching too much soccer. Right.

SPEAKER_01 2:21

Lots of lots of sleep loss, I'm sure, keeping up with the World Cup. It's been a good fun summer to be into sports. I don't follow uh soccer as much, but I was really big into the Knicks and five.

SPEAKER_00 2:34

Especially in New York, you know, there's all kinds of sporting activities happening. So absolutely, yeah.

SPEAKER_01 2:40

It's an exciting summer for that. And then speaking about loss of sleep and insomnia, let's hop into this episode because I think similar to kind of like what we talked about in previous episodes with narcolepsy, people have a perception of what it is, and it's not always accurate to what it truly is. I think insomnia is one of those things as well. So I think many people come in thinking they may have insomnia, and insomnia is their diagnosis, but it may only be a symptom. So, what do you mean when you say insomnia is often a symptom rather than an underlying problem?

SPEAKER_00 3:11

So, what I really mean by that is you have to rule out a lot of underlying causes that drive insomnia. The challenge with insomnia is sometimes it's super tricky to pinpoint did my problem start before insomnia or is insomnia causing some of these symptoms? A good example is especially if I'm dealing with a lot of mood symptoms, if I have a lot of anxiety or if I have depression, sometimes we blame those as the big driver for insomnia, which they are, but a lot of times it's actually the other way around where insomnia could be driving some of these conditions too. For example, I could have long-standing insomnia, which is impacting my mood and leading to a lot of anxiety. And the other way is extremely valid as well. For example, I have sleep apnea, I cannot stay asleep, or I'm tired, or I'm taking naps throughout the day, which is feeding insomnia at nighttime. So all these different disorders are sort of interconnected, and sometimes it takes an astute clinician to figure this out and confirm that hey, that maybe your insomnia is being fed or being driven by an underlying cause and not just purely insomnia. By the way, there are people who have pure insomnia too, but you cannot really say that unless you rule out the underlying conditions.

SPEAKER_01 4:47

Absolutely. And then patients often describe trying every sleep hygiene tip they can find, and a lot of the time there's really no improvement. So why do you think that insomnia treated as a standalone problem often fails to really help long term?

SPEAKER_00 5:02

So you're absolutely right. You know, sleep hygiene influencers are everywhere, right? Any TikTok I watch these days or anything on social media, there's everyone's trying to play a psychologist who could fix the insomnia just by doing one thing, you know, and and unfortunately life doesn't work that way. So, yes, there's all kinds of advice out there, which I think is sort of doing disservice to all the people who are actually struggling with that, because then you know you try it and one thing doesn't work, and then you try another thing, that doesn't work, and then you you're tired of trying all that, which honestly kind of makes my job a little bit harder too, because then you know when I'm trying to present some of these ideas is like, oh yeah, I've done all this. So then it's it's hard for sometimes patients to commit to what it really takes to improve their insomnia just because they've been burned out from trying all these random advices from other avenues. So let's go back to that question. The the main reason is that anything you would do, and here's a classic example. Let's say I have a sleep apnea patient who cannot stay asleep, they're waking up multiple times to go to the bathroom, or their snoring is so loud, or their bed partner's very restless and and waking them up, whatever that reason might be, if I don't really treat that underlying problem, then no matter how strong of a sleeping pill I take, no matter how many sleep hygiene tricks I try, those are not gonna be very effective. Just because I'm dealing with a more underlying problem, that's the big driver. So as long as my airway is shutting down, my oxygen is dropping, my brain is waking up to react to that to help me stay alive, basically, there's no way those sleeping aids or sleeping pills or over-the-counter sleep medications are gonna be very helpful for you. So I think that's where a lot of these strategies fail because they don't really try to understand what is actually driving the insomnia for each individual. So I think that's very important to not just put yourself in the bucket of insomnia because it's a variable condition for each individual.

SPEAKER_01 7:36

Absolutely. And then speaking about that, and we we've talked about sleep apnea in other episodes and how a lot of time there's so many symptoms that overlap and hide as sleep disorders and things like that. I think sleep apnea is a huge, a huge one of those. So I know that sleep apnea is usually associated with snoring and also with daytime fatigue. Not really something that people talk about when it comes to laying awake at night. So, how can undiagnosed sleep apnea actually present as insomnia?

SPEAKER_00 8:04

That's right. And in fact, we find it so common, Leila, that we had to come up with its own term. We now call it COMISA. And now COMISA, you're like, okay, what is that? So COMISA is is an acronym, C-O-M-I-S-A, COMISA, meaning comorbid insomnia with sleep apnea. So this is a a very tough cohort to deal with because everyone is either focused on sleep apnea treatment and missing the insomnia piece, and then these patients are coming back and say, hey, I've been using CPEB religiously 100% of the time, how come I'm not sleeping better still? And guess what? They have underlying insomnia. So this group is pretty tough to figure out and treat, but once you're aware of it and then you can start focusing and on fixing how, but if you don't even understand or don't even know about it, then it's super easy to miss because then you know something else is gonna end up getting the blame, which may not be true. So there are you know all these little caveats where these underlying problems, for example, once I fix my patient's sleep apnea, their oxygen fluctuations drop, their brain does not have to respond or react to these oxygen drops throughout the night. So it stays in those sleep stages in a much better, much healthier way instead of transitioning in and out of those deep sleep stages and make them feel more rested and more refreshed. So that's how it tends to improve. So you can't really ignore if I have sleep apnea and you go to your sleep doc and say, just put me to sleep. I don't want to deal with CPAP or I don't want to treat my sleep apnea. Guess what? You're only going to get very limited results from that. That's not gonna treat your sleep or fix your sleep in a holistic manner.

SPEAKER_01 10:04

Right. And then so this is something I don't know much about at all, and I want I'm not sure if our listeners do, but restless leg syndrome. So that's something that can be subtle and easy to dismiss as simple rest something along those lines. But in what ways does restless leg syndrome masquerade as ordinary, difficult falling asleep patterns?

SPEAKER_00 10:24

Yes, uh oh my gosh, restless legs is gonna be several different episodes, Leila, which we'll cover. But the the bottom line is one of the things that restless legs does, in fact, clinically, that's what we're assessing, is how hard is it making that that weird sensation in my legs where I gotta move them, otherwise they just feels weird. And some people can describe it like pain or pinprick sensation, but most often it's an extremely weird feeling that all you can tell me is that yeah, I've got some weird sensation in my legs where I gotta move my legs, otherwise I don't I don't feel good. And that delays my sleep onset and makes it harder for me to fall asleep. But not just that, sometimes, you know, we just get hung up on the sleep onset at the start of the bedtime. A lot of these folks have worsening of their restless leg symptoms early in the morning, early hours, and that's when it's waking them up too, where their legs are bothering them, and so you have to treat that underlying restless leg syndrome, but unless you fix that RLS or restless leg syndrome by treating it, and there are several good treatments out there these days that you're gonna get very mixed results or mixed outcomes for whatever else you're doing to manage your insomnia.

SPEAKER_01 11:52

So is that kind of like what people refer to as like pins and needles? Is that kind of that sensation, like that tingling sensation?

SPEAKER_00 12:01

Yes, that's right. So some people describe pins or bricks, achy sensation, or like ants crawling in my my legs, and sometimes they call it just dull achy pain. Some people even report it feel almost feels like my legs are cramping. And then there are times where it's just very hard to describe what that feeling is, but it it could go from just pins and needles to actual pain in my legs. So it's very variable in terms of what different descriptors that our patients use.

SPEAKER_01 12:34

That's so interesting because when I read Restless Legs, I kind of just naturally assumed that I was totally off, I guess. It's kind of like when you just like shake your leg a little to fall asleep, but not particularly because of a feeling. Some I think that's something that is often associated or thought of with like anxiety, kind of just like, or like nighttime stress, anxiety, kind of just like bouncing your legs.

SPEAKER_00 12:53

That's right. That's right. And some people may have that too, where I'm just habitually shaking my legs. You know, we've all been next to a person who's really, you know, bouncing their legs and makes it really hard to focus for everyone else, but they may be in their zone and they may not even be aware that they're actually doing it. You know, so but that they're doing that mostly when they're wide awake. Restless legs is generally has a little bit of a circadian pattern, meaning it especially works in the evening hours. And some people only notice it when they actually go lay down in the bed. They don't notice it the rest of the day because they're active, they're busy, so it doesn't really bother them. But as soon as they hit the bed and they're like, oh my gosh, I'm bad tired, but guess what? My legs are bothering me now, and and that's causing me insomnia. So then, you know, and the funny thing is a lot of the things that we use for insomnia, for example, over-the-counter stuff, you know, antihistamines like Benadryl and whatnot, that actually make restless legs worse, you know. So, so you know, you you you would think that, okay, I'm gonna manage my insomnia by taking these over-the-counter sleep aids, and you end up making it worse.

SPEAKER_01 14:09

And then another thing I think that is really common, even I don't know if it's more common than restless leg syndrome. My assumption would be that it is, you know, you lay down, you go to sleep, erasing mind is happens at bedtime, and it's usually blames on either stress or anxiety or or something else, but it can actually be very much tied to this. So, how can you tell the difference between anxiety-driven sleeplessness and, like you mentioned, a circadian rhythm disorder that really kind of looks like anxiety?

SPEAKER_00 14:38

So, yeah, and that is a tough one. And sometimes you can't, you can't tell them apart. What I will say though, is now there's plenty of research data out there that shows that in a person who has both anxiety and insomnia, if you get your insomnia under control, your anxiety levels are going to drop. So, and yes, you're right, daily stress, you know, whatever else is going on in the world can mess up and cause those symptoms and anxiety. And a lot of times the focus just stays on the anxiety itself and thinking that, okay, I'm gonna go see this psych doctor or that psych doctor, or I'll go to therapy for anxiety, and then the focus is only on the anxiety symptoms during the daytime, but more often than not, when we focus on the nighttime sleep and get their insomnia under control, their anxiety levels drop down, their mood symptoms get better, their depression gets better as well.

SPEAKER_01 15:41

And another thing you mentioned prior to that was over-the-counter medication and medicine and things like that. So I know some patients have probably taken medication for years without ever really even being evaluated for what is actually the root cause of keeping them awake. So, are there risks? And if so, what are the risks of treating insomnia with medication alone without actually really identifying that root cause?

SPEAKER_00 16:04

So, yes, the risks vary depending on which product you're using. But you're absolutely right. There is a reason every big box store you'll see aisles and aisles filled with over-the-counter sleep aids, right? Because millions of people deal with insomnia and they self-treat with these medications, whether it's melatonin, whether it's a combination product, you know, that's sold under the guise of natural GABA or thionine or you name it, there are like gazillions out there. And uh, in fact now there's a whole bunch of gummies. And I recently wrote an article on, you know, uh CBDs, you know, and THC and all this stuff that's out there and what's the evidence as well. So in fact, I think we should talk about that in more detail in in one of these next episodes. So, but what I'm I was trying to say is that yes, and some people might find them helpful initially, and a lot of the times where you know, from my point of view, by the time patient comes and sees me, they've already failed all this. And obviously that's why they end up in my office, right? If those things were helping them, generally they don't need to then schedule a follow-up or an appointment or a consultation with their sleep doctor. So the patients that we end up seeing in clinic obviously haven't responded to multiple medications, and they all have you know untoward side effects. So I would make sure that if I am going to use a certain product, that one I get it from a reputed brand and make sure that it's somehow it's tested, especially over-the-counter stuff, that it's tested to show that it actually contains the amount that it the label says. Because that's a big problem with over-the-counter products, is that the label may say something, but the actual content may not match what the label is saying. So the reputation of the manufacturer and from where you're buying is of utmost importance because these things are not really monitored or checked by FDA. So there's all kinds of you know quality issues there.

SPEAKER_01 18:23

That's interesting too, because even as a a consumer or a patient, you buy those things, but you don't even really know what those numbers really equate to. Like what does that really mean? I feel like the average person doesn't even really have a I actually I would go even farther.

SPEAKER_00 18:39

Even even very people in medicine, like if if even a lot of sleep clinicians won't really have much uh clue as to okay which product is gonna contain what, because it's just that there's not a whole lot of testing being done on these products. So uh really it's not just the consumer, even the clinicians can be left in the dark. So sometimes you you have to, you know, do your due diligence and check the source of these products and make sure you're getting what the label actually says. And now having said that, I've seen patients who've escalated the doses of these medications, and that's one of the long-term consequences that we see is that hey, I I one milligram of melatonin used to work just fine for me, but now I'm taking three, four, five, ten. I've had patients who've taken up to thirty, forty milligrams of melatonin, hoping that it'll do something, and they're still it's not still helpful. And that's just because you you know, you're using the product for something that it's not really intended to do. It's just being heavily marketed that way. But that doesn't mean it's gonna it's gonna solve that problem, you know. But marketing is very tricky. So that's really one of the big challenges when it comes down to some of these over-the-counter sleep aids. And sometimes we build tolerance, even for sleeping medications that I use as a prescriber, you know, there's I have to monitor my patients carefully and make sure they're not developing any kind of tolerance, meaning that they're needing higher and higher doses to get the same effect. So that's tolerance. And then there is something called as dependence, meaning they feel dependent on the drug or on the product, meaning if they don't take that medication, then they cannot sleep, or the insomnia comes back with vengeance. So then they have to keep taking the medication in order to get some sleep, and it may not still be fixing all of their sleep issues. So tolerance and dependence is a is a big uh risk and and big factor in deciding and choosing what sort of sleep medications and sleep drugs are gonna ultimately be prescribed or used on long-term basis.

SPEAKER_01 20:56

Absolutely. And I think that even talking about medications and things like that, you think about going to let's say your primary care doctor and maybe expressing some of this, but with primary care visits, you know, they're short. And insomnia is also like we talked about, one of the things that can be really complicated to unpack in such a short period of time with a primary physician. So what questions should a patient expect or even ask for when insomnia is being properly evaluated?

SPEAKER_00 21:22

That's a valid, valid point. Primary care, they're probably the biggest prescriber of insomnia medications, okay? So a lot of my primary care physicians' peers are excellent in dealing with insomnia and they do a good job. In fact, without their help, my office would be flooded with insomnia and I would have no time to take care of any of them. So they are our first line defense, and a lot of them have gotten really good at managing short term insomnia, straightforward insomnias, and then when things get more complicated or they're not seeing initial. Results, then they generally typically refer these patients out to the sleep clinics for more advanced care, more further care, which I think that's a pretty good protocol or workflow. But the challenge is when you don't have access to sleep specialists, where you don't have access to testing for insomnia, and all you can do is here's a good example. You know, currently there is so much push on home sleep testing, and there are all these gazillions of companies that are offering home sleep testing. But home sleep test doesn't even really look at your brainwaves. It's only basically just sort of trying to tell you, hey, is sleep apnea there or not there? So then I don't really get a good picture or good sense of what sort of brain waves or what sort of sleep stages my brain is going through through the night. So if I don't have that understanding, then it's harder to manage or do anything about it. So that's really one of the things that we do when we're assessing for insomnia is we go back and ask the patient, and and it can be a long conversation because generally chronic insomnia, people have been dealing with it for you know, if not most of their lives, then at least you know, five, ten, fifteen years. That's not uncommon for these patients to be dealing with insomnia by the time they come and see us. So then you have to sort of unpack that whole story. So along with you know, trying to figure out, okay, was there any precipitating cause? You know, did you have a big stressor or big trauma that started your insomnia? So generally how I think of insomnia is I like to break it down into three sort of big major factors. The first factor being, hey, did something precipitate your insomnia? Was there some life event that happened to you that caused you to start having insomnia? Or have you always been, were you born with poor sleep? You know, did you have insomnia the day you were born? Or did it start somewhere down the road? So so then sometimes I am. For example, a lot of our PTSD patients can relate to a big trauma in their life, and they can say, oh yeah, after I got uh recruited or if after I went to uh Afghanistan or Iraq or, you know, I I then I uh and I've had insomnia ever since, or I had this accident or that accident, you know. So there sometimes there is a good precipitating cause that patients will remember, but majority of the times it it's super sneaky and it just kind of shows up out of the blue and starts to get worse. So then in those cases we don't really get to see any any cause. So then let's say we determine that okay, this event or this episode triggered your insomnia, then why is it still there five years, ten years down the road? So what is perpetuating it? Meaning what is it making it so that it's ongoing still? How come it hasn't resolved itself, right? For example, let's say I have I'm in a tough job, but I'm no longer in a tough job. Now I have a cushy job, but my insomnia that started after my new job is still ongoing. So then obviously there is something or some some things that I'm doing that are leading or causing this insomnia to perpetuate or to keep going. So those are you know put under perpetuating factors. For example, oh yeah, since I retired, now I'm in the habit of watching TV in my bed, and I just end up getting hooked to a show or you know, and then I've slowly reduced my bedtime more like a watching TV time, you know. So then that particular habit is a big factor that's driving your insomnia to persist. So those are perpetuating factors, right? And then of course there are genetic factors like, hey, do you have family history of insomnia where hey, my sister has insomnia, my mom has insomnia, her mom had insomnia, and there are multiple generations of insomnia. So there's some genetic predisposition as well that that could drive insomnia as well. So all this you have to sort of unpack from all the history, all the questions that we ask from our patients.

SPEAKER_01 26:34

And so what I'm gathering too is that insomnia just it looks so different in everyone. So I'm assuming that it's pretty hard to like we talked about, it's hard to diagnose, but I think also not every case of insomnia requires an overnight sleep study. So how do you decide when insomnia needs a closer diagnostic workup rather than a behavioral treatment at first?

SPEAKER_00 26:56

So one of the clinical definition for insomnia is that my symptoms have to be at least ongoing for three months or longer. So generally, if it's been sticking around for more than three months, then obviously I gotta get some more answers here, do some more testing. Now, when you look at a person and they have other risk factors, if they have history of snoring, or if they have restless legs, or if they their spouse is saying, Hey, I notice you quit breathing in your sleep, or if they have daytime sleepiness, or if they have multiple other medical conditions, or they have multiple other medications. So that whole clinical picture is going to determine that are we dealing with just some kind of condition that's causing insomnia versus insomnia as being the primary problem. So that's really what will determine whether I do end up getting tested or not. But if it's a short-term insomnia, we might just do sleep logs or sleep diaries, or some places we can do activity where we're monitoring your activity levels throughout the night and predict what times you might be sleeping. And that's the same thing what our Apple Watch does, or you know, some of these other trackers do, is basically they monitor our our activity levels through the night, and based off of that, it does a prediction that okay, you must be sleeping from these times to these times. And a lot of times, especially now with most people having some sort of tracker on their wrist or or temple or or wherever, then I'm easily able to get some of that data, which wasn't so common, you know, five, ten years ago.

SPEAKER_01 28:42

Right. And then with cognitive behavioral therapy, so with that for insomnia, it's considered the gold standard or the gold standard treatment, right? But when does it work well and when is it the wrong first step because it could actually be something else that's driving the sleeplessness?

SPEAKER_00 28:58

That's right. I think CBTI, yes, it is the gold standard, but there are several caveats. One is a big issue around the availability of people who actually know how to do CBTI well. There are all kinds of people who claim that they can do therapy for insomnia, or there are a lot of therapists that I have seen are really good at therapy for anxiety or depression, but they haven't had any formal training on insomnia therapy, but they just still kind of take it on. And a lot of their CBTI advice is just basically sleep hygiene advice. So one big myth that I want to sort of bust here is that sleep hygiene advice is not equal to CBTI. Yes, CBTI can encompass sleep hygiene, but sleep hygiene is is like a tiny sliver of nail in the all the different pillars that CBTI works with. So CBTI is way more holistic, way more broader than just sleep hygiene advice that you would get from a TikTok influencer. So that's really what people should be aware of that don't assume that sleep hygiene is equal to CBTI. CBTI includes sleep restriction, it includes stimulus control, it includes changing your cognition about sleep, changing your thinking as to how you think about sleep. So it's much more effective therapy, but not everyone has access to it, because there are not very many good providers that that could take everybody on. So what that means is there are millions of people who don't have access to this, so then what are they gonna do? If we said, okay, yes, CBTI is the answer, then where are all the providers that who could do CBTI well? There are some digital CBTI products, in fact, on the market to help reduce that, you know, because of this challenge that there aren't i enough providers, but even then the access is a big concern. So if you don't have access, then it doesn't matter how well the CBTI works or doesn't work. If I can't even have access to that therapist, then it's pointless. Okay? And the other challenge is that I get low quality CBTI from a therapist who's not well trained. Because if that's what's happening, then I'm not gonna get good results anyways, you know. So CBTI works only well depending on how well trained my therapist is. So that's another big limitation of CBTI. And then third, it needs a lot of work on for a patient to take on, and a lot of patients may not have that level of energy left or motivation left to actually pull through, even though it's a short-term therapy, it's only five, six, seven sessions generally, but still it asks a lot of commitment from the actual person who is doing it. So and a lot of times patients may not even be ready to take that on. So that's another big challenge. And I, you know, if I can't commit to making all those changes or I find it extremely hard to make those changes, then it's gonna be extremely tough to to go through it. So then it sort of becomes pointless as to why am I doing it. And it's not so much I don't think I I blame my patients that, oh, they're not committed or they don't want to get better. No, that's not the case. It's just the nature of the problem that I'm so drained, I'm so tired, I'm so fatigued. There is just n no fuel left in my tank to commit to something that that is asking for more commitment. Okay. So those are I think the the big limitations as far as CBTI is concerned.

SPEAKER_01 32:51

You know, that that that makes a lot of sense. If you're already fatigued, you're tired, so really have to commit to that is commitment for lack of another better word.

SPEAKER_00 32:59

Exactly. Exactly.

SPEAKER_01 33:00

And I think that I'm sure a lot of listeners may recognize themselves in this conversation that we're having. So what is the one question that you wish every patient with chronic insomnia would ask their doctor?

SPEAKER_00 33:13

So what they should ask their doctor is, especially if it's been going on for l more than three months, then they can, you know, be very honest that, hey, I've tried over-the-counter stuff, I've weighed, I've done basic sleep hygiene stuff, then can we rule out other causes that may be driving my insomnia? And then generally will open up the conversation more. And that would be one important question that if you ask it right, I think there is no clinician who's not gonna sit down and listen. You know, challenge is, you know, when you sort of keep it towards the, you know, last thing that I'm gonna bring up, you know, instead of bringing it up at the end, I think our patients should bring it at the top of their appointment where, hey, I'm concerned about my insomnia, can we talk about that first? You know, before you start talking to me about did I get my flu shot or not this year?

SPEAKER_01 34:13

Absolutely. And it opens the conversation, I think, to also be able to kind of pinpoint other things and really make them come together throughout the appointment. And before we do wrap up another great episode, do you have anything else that you want to add or maybe something you didn't have the opportunity to touch on?

SPEAKER_00 34:28

So insomnia is a vast topic, Leila. I don't think one episode can do justice to it. But I think you asked very important questions as to what can a patient ask their clinician to drive the conversation in the right direction. One thing that we I or I didn't say is that, you know, in this day and age we all have some sort of tracker on our wrist. Just show that data to your clinician. Just show them the screenshot that, hey, this is what it looks like, and I'm really struggling. And don't hesitate, because you know, uh we're a data-driven society, and everyone loves data, especially if I'm a you know, speaking of sleep clinicians. I don't think anyone who doesn't love data would be in this field. So we love data, so please track your sleep, and if you do, make sure to present it to your sleep clinician so that they can take good care of your insomnia symptoms.

SPEAKER_01 35:27

Absolutely, that's such a good idea too. And I'm sure, like you said, you wouldn't be in this field if you didn't love data. So it's definitely something helpful to have some kind of concept like going into the appointments. And I think that today we really broke down why insomnia is so often a symptom rather than a full diagnosis, and why identifying what is really driving sleeplessness is one of the most critical steps in finding lasting relief. A diagnosis of insomnia is not the end of the story, and understanding that distinction could really change the path forward for a lot of people. And so, if anyone was listening and found this conversation helpful, make sure that you are following the show. Be sure to follow it so you don't miss another episode. Next episode, I think we should get into what we talked about today more. So the restless leg syndrome and also the medication. So we have a lot of good episodes coming up. And everyone listening, thanks for listening to the Hidden Sleep Disorder show. Make sure you're following, subscribe, share. It's a pleasure speaking with you as always. And I can't wait for the next episode and talk to you soon.

SPEAKER_00 36:24

Thank you, Layla. Thank you.