Sleep Disorders Are More Than Sleep Apnea and “Just Insomnia” - The Role of the Psychiatric Sleep Medicine Specialist™️

When most people think of sleep medicine, they think of one thing: Sleep apnea. And when they think of non-apnea sleep problems, they think: Insomnia. But sleep disorders are more complex than that.

There are structural sleep disorders. There are behavioral sleep disorders. And then there are psychiatric sleep disorders — conditions rooted in stress physiology, trauma, mood instability, circadian disruption, and medication effects.

That’s where Psychiatric Sleep Medicine comes in.

The Three Lenses of Sleep Medicine

Sleep problems generally fall into three broad categories. Understanding the difference matters — because treatment must match the mechanism.

Structural Sleep Disorders

These are conditions caused by anatomical or mechanical issues in the body.

Examples include:

• Obstructive Sleep Apnea (OSA)

• Upper airway resistance

• TMJ-related sleep disruption

• Nasal or sinus obstruction

• ENT-related structural issues

These conditions often require:

• CPAP or oral appliance therapy

• Surgery

• Dental intervention

• ENT evaluation

Psychiatric Sleep Medicine Specialists do not treat structural airway disorders. These types of conditions are managed by pulmonary/critical care/sleep medicine providers or specialized dentists.

Classic Behavioral Sleep Medicine (BSM / CBT-I)

Behavioral Sleep Medicine is incredibly valuable. CBT-I is considered the gold standard for primary insomnia.

It focuses on:

• Sleep restriction

• Stimulus control

• Cognitive restructuring

• Sleep efficiency training

• Behavioral conditioning

For many patients with straightforward insomnia, CBT-I works beautifully.

But here’s where the gap appears:

Not all sleep disorders are conditioned insomnia.

Not all awakenings are behavioral.

Not all sleep disturbance responds to sleep restriction.

Psychiatric Sleep Medicine (PSM) and the Psychiatric Sleep Medicine Specialist™️

Psychiatric Sleep Medicine addresses sleep disorders rooted in:

• Chronic stress physiology

• Hyperarousal

• Trauma-related night disturbances

• Panic awakenings

• Narcolepsy and hypersomnia

• Circadian rhythm disruption

• Medication-related instability

• Mood disorder–related sleep changes

• Perimenopausal sleep shifts

• Complex polypharmacy

These conditions are not structural. But they are also not “simple insomnia.”

They often involve:

• Cortisol dysregulation

• Autonomic nervous system overactivation

• REM instability

• Neurochemical imbalance

• Trauma memory activation

• Medication timing or interaction effects

These patients often say:

“I’ve already tried CBT-I.”

“My sleep study was normal.”

“I wake up at 3AM every night.”

“I wake in a panic.”

“I’ve tried everything.”

That’s the population Psychiatric Sleep Medicine is designed for.

A Simple Comparison

Here’s how the three areas differ:

Structural Sleep Disorders	Classic BSM / CBT-I	Psychiatric Sleep Medicine (PSM)
Airway obstruction	Conditioned insomnia	Stress-driven awakenings
Anatomical or mechanical	Behavioral conditioning	Nervous system dysregulation
Treated with devices/surgery	Treated with sleep restriction & behavioral change	Treated with targeted behavioral + psychiatric + physiologic strategies
OSA, TMJ, ENT disorders	Primary insomnia	Narcolepsy, trauma nightmares, panic awakenings, circadian disorders, medication-related sleep instability
Managed by pulmonology, ENT, dental sleep	Managed by behavioral sleep specialists	Managed by psychiatric-sleep specialists

None of these categories are “better” than the others.

They are simply different mechanisms.

And mechanism determines treatment.

Why This Matters

If someone wakes at 3AM every night due to stress hormone surges, sleep restriction will not fix that.

If someone wakes in panic due to trauma activation, stimulus control alone will not resolve that.

If someone has narcolepsy, sleep hygiene will not regulate REM intrusion.

If medication timing is destabilizing sleep architecture, no amount of cognitive restructuring will fix it.

When the mechanism is psychiatric or neurobiological, the treatment must reflect that.

What Psychiatric Sleep Medicine Specialists ™️Do Differently

Psychiatric Sleep Medicine integrates:

• Behavioral sleep science

• Trauma-informed interventions (including nightmare-specific therapies)

• Circadian regulation strategies

• Thoughtful medication management when appropriate

• Nervous system recalibration

• Mood stabilization as it relates to sleep

• Reduction of sleep performance anxiety

• Root-cause evaluation of repeated night awakenings

It is not anti-CBT-I.

It is not anti-medical.

It is simply focused on a different mechanism.

Sleep Disorders Are Not One-Size-Fits-All

If you:

• Wake at 3AM every night

• Wake in a panic

• Live with nightmares

• Struggle with narcolepsy

• Feel like your nervous system never “turns off”

• Have tried standard insomnia treatment without success

Your sleep problem may not be structural.

And it may not be simple insomnia.

It may be a psychiatric sleep disorder — and that requires a different lens.

Intelligent Nervous System Recalibration

At its core, Psychiatric Sleep Medicine is about:

Lowering threat.

Stabilizing rhythms.

Rebalancing neurochemistry.

Reducing hyperarousal.

Treating the root driver of the sleep disturbance.

Because sleep improves when the nervous system no longer feels under threat.