Sleep Disorder Care in Southlake, TX

Poor sleep gets treated with a prescription far too often and worked up far too rarely. We find out which sleep problem you actually have, because insomnia, sleep apnea, restless legs and a shifted body clock all look like tiredness and none of them respond to the same treatment.

Sorting out which problem this is

The history does most of the work. We ask when you go to bed, how long it takes to fall asleep, how often you wake, what time you finally get up, what you do when you cannot sleep, and what your weekends look like compared to weekdays.

That last question matters more than people expect. Someone who sleeps perfectly well from 2am to 10am on weekends does not have insomnia. They have a delayed circadian rhythm, and the treatment is light timing, not a sedative.

We screen everyone for sleep apnea, because it is common, treatable, and frequently coexists with insomnia. Treating the insomnia alone in someone with untreated apnea leaves them just as tired.

Insomnia

Chronic insomnia means difficulty falling or staying asleep at least three nights a week for three months or more, with daytime consequences.

The first-line treatment is cognitive behavioral therapy for insomnia, not medication. This is not a soft recommendation, it is what the evidence supports: CBT-I outperforms sleeping pills in direct comparisons and its effect persists after the program ends.

It runs six to eight weeks and works through a therapist or a validated app. The core pieces are stimulus control, keeping the bed for sleep only, and sleep restriction, which sounds counterintuitive and is the most effective single element.

We do prescribe when it is warranted, usually short term and alongside CBT-I rather than instead of it. We avoid benzodiazepines and are cautious with the z-drugs, particularly in older adults where they raise fall and confusion risk substantially. Low-dose doxepin and the newer orexin antagonists are better tolerated options.

Restless legs

An urge to move the legs, worse at rest and in the evening, relieved by movement.

The first thing we check is ferritin, and the target here is higher than the standard lab range flags: below 75 or so is worth treating with iron. Correcting iron stores resolves a substantial share of cases without any other medication.

We also review medications, since several antidepressants and antihistamines make it markedly worse. Dopamine agonists are used less than they once were because of augmentation, where the condition worsens over time on treatment. Gabapentinoids are often the better choice.

Circadian problems

Shift work, jet lag and delayed sleep phase are treated with light and timing, not sedatives.

Bright light in the morning and avoiding it in the evening shifts the clock forward. Low-dose melatonin taken several hours before target bedtime does the same. Most people take melatonin at bedtime in doses ten times higher than needed, which is the wrong time and the wrong amount.

What we ask you to change

Consistent wake time every day, including weekends. Caffeine cut off by early afternoon, since it has a half-life of five or six hours. Alcohol reduced, because it helps you fall asleep and reliably wrecks the second half of the night. Screens dimmed in the evening.

None of this is novel and all of it works better than people expect when actually done.

Sleep problems and mood are tightly linked in both directions. See anxiety and depression. Persistent tiredness despite adequate sleep is covered on our fatigue page.

Sleep is followed through our chronic condition management program. See our primary care Southlake practice overview.