Insomnia
Chronic insomnia has a first-line treatment and it is CBT-I rather than medication, with cortisol, glucose, hormones and ferritin deciding whether it holds.
For chronic insomnia, cognitive behavioral therapy for insomnia outperforms medication in durability and is the recommended first-line treatment. Anyone offering a supplement protocol before mentioning CBT-I is skipping the most effective intervention available. What assessment adds is the physiology that determines whether it holds.
Disrupted cortisol rhythm, particularly a raised evening slope. Nocturnal glycemic dips, which wake you at three in the morning and are visible on continuous glucose monitoring. Perimenopausal progesterone decline. Hyperthyroidism. Low ferritin, iron and magnesium. Sleep-disordered breathing. And alcohol, which fragments the second half of the night.
CBT-I principles first: stimulus control, sleep restriction, a fixed wake time. Then the physiology — evening glycemic support where nocturnal dips are documented, magnesium and glycine, progesterone where perimenopause is the driver, ferritin repletion, and light exposure timed to anchor the circadian phase.
Cortisol rhythm across the day, including an evening value. Continuous glucose monitoring where waking is consistent and unexplained. Complete thyroid function. Ferritin, iron studies and magnesium. Hormone status in women over forty. And apnea screening, since untreated sleep-disordered breathing makes every other intervention fail.
Ready to start with a clear clinical picture?
Start with the fifteen-minute consultation. No cost, and a straight answer on whether this model fits your case.