INformation for Professionals & Parents

A psychologist who has training and experience in sleep psychology will treat insomnia with the recommended first-line treatment: Cognitive Behavioural Therapy for insomnia (CBT-Insomnia).

• • Other evidence-based treatments such as mindfulness, acceptance, bright light therapy, or guided sleep meditation may also be used.
  • To address other presentations of troubled sleep, sleep psychology can also treat circadian rhythm disorders, shift work related sleep problems, chronic nightmares, difficulty adjusting to CPAP, fatigue, stress, anxiety and depression.

A sleep physician, on the other hand, will treat most sleep disorders, most notably obstructive sleep apnea. They will commonly prescribe medication for sleep management, including for insomnia and circadian rhythm disorders.

An overnight sleep study (PSG) is not required or recommended for the assessment and diagnosis of insomnia. A clinical interview, validated questionnaires, and a sleep diary/log are used to diagnose and plan treatment for insomnia.

GPs, sleep physicians and psychologists often work together when patients require combined therapy. This may include medical, mechanical (ie CPAP), and psychological/behavioural interventions.

A clinical psychologist who specialises in behavioural sleep medicine has specialised training in sleep. This covers the behavioural, psychological and physiological factors that underlie normal and disordered sleep.

Clinical psychologists have undertaken highly specialised university training in the assessment, diagnosis, formulation, and psychological treatment of behavioural and emotional disorders. Additionally, the Sleep Matters team in Perth has had specific training for, and experience in sleep and its disorders.

These approaches are designed to treat the cause of the sleep disturbance, rather than provide temporary symptom management.

CBT-I usually will be the main treatment modality employed. This is recommended by peak professional bodies as the first-line treatment for Insomnia. Other evidence-based therapies such as mindfulness, motivational interviewing and bright light therapy may also be employed where necessary.

A sleep physician is a medical doctor with advanced training in the assessment, diagnosis, and treatment of sleep disorders. Sleep-related breathing disorders such as sleep apnea are one of their main specialities.

Often sleep physicians have specialty training in breathing disorders (and you will see respiratory and sleep physician in their title).

Additionally, a sleep physician will see patients with disorders such as narcolepsy, periodic limb movement disorder and restless legs. They also see patients with insomnia and circadian rhythm disorders, and may prescribe medication to manage these.

A sleep physician will not typically treat insomnia with CBT. They will often refer the patient to a health professional with specific training and experience in CBT-Insomnia for this treatment.

Difficulty falling asleep (in children, this may be difficulty sleeping alone)

Difficulty returning to sleep after nocturnal awakenings

Waking earlier/later than desired in the morning

Daytime tiredness and reduced functioning (eg poor concentration and/or memory, disengagement from daily activities and obligations)

Worry about lack of sleep

Low mood / stress / irritability / anxiety associated with sleep difficulties

You feel that your patient/student should reduce their reliance on sleeping tablets

Your patient expresses a preference to not use sleeping pills

You would like to offer a long-term solution for insomnia and related sleep problems

Your patient/student/child requires support in managing mood, stress and/or anxiety

Your patient/student/child has some motivation to work towards improving their sleep

For straightforward insomnia cases, between four and six consultations of 50 minutes each is common. The gap is $92.90-$136.35 per consultation (from July 1, 2023).

CBT-I can work well when combined with sleep medication. A short course of sleeping tablets can provide immediate relief. Then the CBT-I brings about lasting benefit which allows for the medication to be gradually withdrawn. At Sleep Matters, we often work with GPs or sleep physicians to implement CBT-I in this context.

Insomnia and sleep problems are valid referrals under the Medicare Better Access to Mental Healthcare scheme (mental health plans). Conditions covered by Mental Health Treatment Plans is informed by diagnoses in the ICD-10 Diagnostic and Management for Mental and Disorders in Primary Care (eg., Insomnia: F51.01-F51.05). Insomnia that occurs as part of another condition is eligible as well as Insomnia that occurs in isolation. The relevant section is: ICD10 code F51.0 Sleeping Problems. Please see here for RACGP clarification on the validity of Insomnia Disorder as a referral under the Better Access initiative: https://www1.racgp.org.au/newsgp/clinical/does-insomnia-fall-under-mental-health-treatment-p