Sleep disorders
- Insomnia
Chronic insomnia is trouble falling or staying asleep at least three nights a week for three months with daytime impairment. First-line treatment is cognitive behavioral therapy for insomnia (CBT-I), which outperforms medication long term. Short-term medication options include doxepin, trazodone, ramelteon and newer orexin antagonists, with sedative-hypnotics used sparingly. Treating coexisting depression or anxiety is essential. - Restless Legs Syndrome
Restless legs syndrome is an urge to move the legs with uncomfortable sensations that worsen at rest and in the evening and ease with movement. It is treated by correcting low iron, removing medications that trigger it, and using alpha-2-delta drugs such as gabapentin enacarbil or pregabalin as first-line therapy. Most patients get meaningful relief within a few weeks. - Sleep Paralysis
Sleep paralysis is a temporary inability to move or speak while falling asleep or waking, often with vivid hallucinations, caused by REM sleep muscle paralysis persisting into wakefulness. Occasional episodes are normal; recurrent ones are treated by fixing sleep deprivation and irregular schedules, treating anxiety or PTSD, using CBT techniques, and in frequent cases REM-suppressing antidepressants. - Nightmare Disorder and Sleep Terrors
Nightmare disorder is frequent, distressing dreams that wake you from REM sleep; sleep terrors are episodes of panic from deep non-REM sleep that are not remembered. Nightmares are treated with imagery rehearsal therapy and, when trauma-related, prazosin; sleep terrors are treated by removing triggers, improving sleep and occasionally medication. Both respond well to treatment. - REM Sleep Behavior Disorder
REM sleep behavior disorder is the loss of normal muscle paralysis during dreaming, causing people to act out dreams with potentially injurious movements. It is confirmed by overnight polysomnography and treated with bedroom safety measures and medication, usually high-dose melatonin or low-dose clonazepam. In older adults it warrants neurological follow-up because of its association with Parkinson's disease and related conditions.
You do not have to figure it out alone.
Tell us how to reach you and our scheduling team will help you explore appointment options. Most new patients are seen within one to two weeks, in person or by video. Medicare and most plans accepted; self-pay new-patient visits are $185.