Behavioral Sleep Medicine works with the patterns, thoughts, and rhythms that get in the way of sleep, using evidence-based approaches with a documented track record. Available via telehealth across North Carolina.
Behavioral Sleep Medicine (BSM) is the clinical specialty focused on identifying and working with the behavioral, psychological, and physiological factors that cause and maintain sleep concerns. It is the non-pharmacological standard of care for insomnia and several other sleep conditions.
Medication can mask what is happening with sleep. BSM works with the patterns keeping it stuck. Sessions are structured, time-limited, and built around your specific sleep profile. Most people complete a full course in 4 to 8 weeks.
BSM works with the learned patterns, arousal systems, and circadian misalignments that keep sleep stuck, not just what shows up on the surface.
Sessions follow a clear protocol. Most people complete a full course in 4 to 8 sessions, not months or years of open-ended work.
CBT-I is recommended as the first-line approach for chronic insomnia by the American Academy of Sleep Medicine, ahead of sleep medication.
Medication decisions stay with your prescriber. BSM complements pharmacological approaches and in many cases reduces dependence on them over time.
Select any condition below to learn more about what it is, how it shows up, and how we work with it.
Chronic insomnia is the most common sleep concern, affecting roughly 10 to 15% of adults. It is defined as difficulty initiating or maintaining sleep, or non-restorative sleep, occurring at least 3 nights per week for at least 3 months, even when adequate opportunity for sleep exists. The daytime effects are what make it clinically significant: fatigue, mood disturbance, cognitive impairment, and reduced quality of life.
Circadian rhythm sleep-wake disorders (CRSWDs) occur when your internal clock is misaligned with your desired or required sleep schedule. The most common type is Delayed Sleep-Wake Phase Disorder (DSWPD), where the body clock runs late, making it nearly impossible to fall asleep before 1 to 3am and wake at conventional times. Shift work disorder and social jetlag are also extremely prevalent.
Nightmare Disorder is characterized by repeated occurrences of extended, dysphoric, well-remembered dreams that typically involve threats to safety or survival. Upon waking, the person becomes fully alert and oriented. The nightmares cause clinically significant distress or impairment, including avoidance of sleep, anticipatory anxiety, and daytime intrusion. Nightmare Disorder frequently co-occurs with PTSD, anxiety, and trauma history, but can also occur independently.
Pediatric behavioral sleep concerns are among the most common issues raised in primary care. Behavioral insomnia of childhood typically falls into two patterns: sleep-onset association disorder, where a child requires specific conditions such as a parent's presence, nursing, or rocking to fall and return to sleep, and limit-setting disorder, which shows up as bedtime resistance, stalling, and refusal. These patterns respond well to behavioral approaches, often in just a few sessions, without medication.
Every approach used here has a research base. Select a modality below to learn what it is, what it is used for, and what to expect in sessions.
CBT-I is the gold-standard, first-line approach for chronic insomnia recommended by the American Academy of Sleep Medicine, the American College of Physicians, and the NIH. It works with both the behavioral and cognitive patterns that maintain insomnia through a structured, time-limited protocol, typically 4 to 8 sessions.
Results tend to last. Unlike sleep medications, which lose effectiveness when stopped, gains from CBT-I often continue and build after sessions end.
IRT is the leading evidence-based approach for nightmare disorder and trauma-related nightmares. It involves selecting a recurring or representative nightmare, changing the content in any chosen way during waking hours, and rehearsing the new version mentally each day. The brain responds to repeated imaginal rehearsal by shifting the stored dream script.
IRT is typically brief, 3 to 5 sessions, and does not require detailed trauma processing. It can significantly reduce nightmare frequency and intensity and works for both trauma-related and idiopathic nightmare disorder.
Circadian therapies address the timing of sleep rather than sleep quality or quantity. The goal is to systematically shift the internal body clock to align with the desired sleep schedule using behavioral tools: strategic light exposure, darkness management, anchor sleep timing, and social rhythm stabilization.
This approach is highly individualized based on your chronotype, current schedule, and the degree of misalignment. A comprehensive circadian case includes a detailed rhythm history and often actigraphy review before a plan is developed.
Acceptance and Commitment Therapy adapted for insomnia addresses the psychological inflexibility and experiential avoidance that keeps the insomnia cycle going. Where CBT-I works directly with behavioral and cognitive patterns, ACT-I shifts the relationship with sleep-related thoughts and sensations, reducing the struggle that amplifies arousal.
ACT-I is often used alongside CBT-I, particularly when sleep-related anxiety is high, fear of sleeplessness is prominent, or there is a history of perfectionism around sleep. It can also serve as the primary approach for people who find CBT-I's structured protocols difficult to work with.
Pediatric behavioral sleep concerns are almost entirely workable with behavioral approaches, without medication, and often in just a few sessions. Work is parent-led for young children and shifts to direct child involvement for school-age kids and adolescents. The goal is independent, consolidated sleep and restored rest for the whole family.
Answer five questions to get a sense of what pattern may be at play and whether Behavioral Sleep Medicine is a good fit for what you are experiencing.
5 questions. Takes about 60 seconds. Results are not a diagnosis.
This screener is for informational purposes only and does not constitute a clinical assessment or diagnosis. Results are educational and should not replace professional evaluation.
This is not a diagnosis. It is an educational summary based on your answers. A full clinical assessment is needed to confirm what is going on and determine the right path forward.
The process is straightforward. Most people move from inquiry to first session within one week.
Fill out the brief intake form below. No phone tag. No referral required. You will hear back within one business day.
A short pre-session conversation by phone or email confirms your concern is a good fit for BSM and your preferred schedule. Insurance and self-pay options are discussed here.
Before your first session, you will track sleep for 1 to 2 weeks using a standardized daily diary. This data shapes your entire treatment plan.
A comprehensive 60 to 75 minute assessment covers sleep history, daytime function, relevant health and psychiatric history, and your goals. Your personalized plan is built from this session.
Weekly sessions follow the protocol for your specific pattern. You will have between-session practice, and adjustments are made based on your sleep diary data.
Final sessions consolidate gains, build your personal relapse prevention plan, and prepare you to maintain and continue improving after sessions end.
All sessions are via telehealth using a HIPAA-compliant video platform. Available to residents of North Carolina only.
Sessions are 20 to 40 minutes depending on session type. Assessment sessions are longer.
Some insurance plans reimburse behavioral health telehealth services. Confirmation of your specific plan coverage is done before your first session.
A Good Faith Estimate will be provided before services begin, as required under the No Surprises Act.
Telehealth services are available to residents of North Carolina only, per licensure requirements. If you are located outside of NC, please contact a BSM provider in your state. The SBSM provider directory is a good starting point.
Complete the short intake form below. You will hear back within one business day to confirm fit and schedule your first session.
Pay per session. Good Faith Estimate provided before first appointment.
Coverage will be verified before your first session. Copay or deductible may apply.
Thank you. You will hear back within one business day to confirm fit and schedule your first session.
Questions in the meantime? Call or text (336) 756-2063 or email [email protected].
Benefits estimates are provided by Thrizer and are not a guarantee of payment. Actual reimbursement depends on your specific plan, deductible status, and the services rendered. Contact your insurance provider to confirm your OON mental health benefits before your first session.