My Psychiatrist and My Insomnia

Not too long ago, I shared an article about who to ask for help when it comes to medical providers and managing insomnia. I talked about how I've struggled with sleep my whole life and how the conversations have transitioned over time from my parents speaking to my pediatrician, to me reaching out to my primary care physician, to exploring the specialists I saw and how they could help, to finally finding what I needed at my psychiatrist's office.

Psychiatrist, you say?

Yes. My current psychiatrist has become the best fit for a professional managing my insomnia. Let me explain!

I began working with a psychiatrist back in 2014 when I was at the height of struggling with depression and anxiety. My first few psychiatrists were in private practices and only managed my depression medication, fluoxetine, and would spend our short periodic appointments checking in on my mental health.

In the fall of 2017, I experienced some significant trauma related to my medical care for Crohn's disease, and I switched to a psychiatrist who was part of the hospital system I admired. That season, I moved all of my care providers to that same system, ensuring they could share records and communicate as needed. This psychiatrist was fine, but hardly personable or kind. She made me feel defensive about everything, including my struggles with sleeping.

Searching for a new psychiatrist

Early 2020, when the pandemic began to rage and my anxiety and insomnia were in full force, I knew that I could no longer work with my current psychiatrist. To find another one, I used the search engine available on psychologytoday.com. I entered my insurance information, location, the requirement to use telehealth (nearly all providers now offer this), and what I was specifically looking for in a psychiatrist/patient relationship.

I was recommended to a male psychiatrist as part of a clinic practice, and I saw him once before he went on medical leave. His replacement, his PA, took over for my next appointment, and she was fantastic.

What I like about my psychiatrist

For nearly 2 years now, she and I have worked so well together.

For starters, she is genuine and kind. It feels like she really cares about how I am doing, what is bothering me, how my mental health manifests into physical symptoms, and how she can help. In some seasons, we see each other virtually pretty often, like every 2 to 3 weeks, and during other seasons it's less frequent, like every 2 to 3 months.

Conversation, not dictation

We start each appointment with a check-in, discussing how things have been since our last visit. We talk about any life events, good or bad, and how I feel overall – physically, mentally, and emotionally. Finally, we discuss the medications I'm on – the ones prescribed by other specialists and the ones she prescribes for my depression, anxiety, and insomnia. She asks me about side effects, functionality, dose, frequency, if I feel like anything needs to change, and if I need any refills.

I don't like taking medication to sleep or manage my insomnia, but major flare-ups of insomnia prevent me from being a fully functioning person, which isn't really something I can afford either. I find that her honesty and understanding make everything a conversation, not a dictation.

What makes my psychiatrist the best fit to medically manage my insomnia

For example, my current sleeping medication prescription has a flexible dose. I can take 1, 2, or 3 pills per night. I have found that most often, 2 pills is a good dose for me. But often, I only take 1, and sometimes, I do take 3. I have never had to feel bad about assessing what works best for me on a nightly basis and sharing those observations with my psychiatrist because she gives me the flexibility, autonomy, and safety to do so.

This give-and-take environment, the conversation, and the teamwork – it's what makes my psychiatrist the best fit as a provider to medically manage my insomnia.

Who manages your insomnia? Have you used a psychiatrist for this function before?