Insomnia and Sleep Problems
Insomnia and Sleep Problems Treatment in San Diego
When you are exhausted but cannot fall asleep, stay asleep or return to sleep, the problem can begin to shape your whole day. You may dread bedtime, monitor the clock, cancel plans, struggle to concentrate or feel pressure to find the one thing that will make sleep happen.
Dr. Charles Freeman is a licensed psychologist with over 35 years of clinical experience and a long-standing specialty in insomnia and behavioral sleep treatment. He helps patients understand the patterns maintaining sleep difficulty and uses practical, evidence-based strategies rather than relying only on generic sleep advice.
Treatment at a Glance
- Who may benefit: People with difficulty falling asleep, repeated awakenings, early waking, sleep anxiety, nightmares, CPAP-related claustrophobia or chronic insomnia that has not improved with general sleep advice.
- Treatment focus: The patterns that maintain insomnia, including schedule, time awake in bed, conditioned arousal, sleep-related beliefs and overlapping anxiety, trauma or pain.
- Approaches: Cognitive Behavioral Therapy for Insomnia (CBT-I), individualized sleep scheduling, stimulus control, cognitive strategies and arousal-reduction skills when appropriate.
- Appointments: In person in San Diego and by teletherapy throughout California when clinically appropriate.
- Related care: Cognitive Behavioral Therapy and CBT-I, anxiety treatment, trauma treatment and chronic pain treatment.
Common Forms of Insomnia
Insomnia does not look the same for everyone. A careful assessment considers when the problem occurs, how long it has been present, what happens before and during the night, and how sleep affects daytime functioning.
Difficulty Falling Asleep
You may feel physically tired while your mind remains active. Worry, planning, perfectionism, frustration or fear of not sleeping can keep the nervous system alert.
Waking During the Night
Some people fall asleep but wake repeatedly or remain awake for long periods. Pain, stress, trauma reactions, conditioned alertness and the habits that develop around wakefulness may all matter.
Waking Too Early
Early-morning awakening can leave you unable to return to sleep even when you need more rest. The timing, mood symptoms, schedule and other health factors should be considered rather than assuming one cause.
Sleep That Does Not Feel Restorative
Sleep restriction and individualized scheduling can help consolidate sleep and rebuild a clearer connection between bed and sleeping. Recommendations are adjusted to the patient’s health, daytime demands, safety and response rather than applied as a fixed formula.
Why Insomnia Can Continue After the Original Trigger
Sleep may first be disrupted by stress, illness, grief, trauma, pain or a major life change. Even after the original trigger improves, insomnia can become self-maintaining. The bed may become associated with alertness, frustration and effort rather than sleep.
Understandable attempts to compensate can make the cycle stronger. Going to bed much earlier, sleeping late, taking long naps, staying in bed while awake and repeatedly checking the clock can reduce sleep consistency or increase pressure around bedtime.
Worry also raises arousal. The thought that tomorrow will be impossible without perfect sleep can make the nervous system more alert. Treatment helps identify and change this cycle without blaming you for having developed it.
How CBT-I Treats Chronic Insomnia
Cognitive Behavioral Therapy for Insomnia (CBT-I) is a specialized, evidence-based treatment that addresses the thoughts, behaviors, schedules and conditioned responses that maintain insomnia. It is more than sleep hygiene, and it should be adapted to the individual.
Simplified Sleep Tracking and Assessment
Dr. Freeman generally avoids detailed, highly structured sleep diaries because intensive tracking can increase obsession, performance pressure or catastrophic thinking about sleep. When tracking is useful, he favors simplified broad estimates that provide enough information to guide treatment without making sleep another test to pass.
Sleep Restriction and Individualized Scheduling
A more consistent schedule can strengthen the relationship between time in bed and actual sleep. Recommendations should be made carefully and adjusted for health, safety, work demands and response to treatment.
Stimulus Control
Stimulus-control strategies help rebuild the association between bed and sleep. They address patterns such as spending long periods awake in bed, working or worrying there, and treating the bed as a place of struggle.
Relapse Prevention
Treatment should help you recognize early warning signs and know how to respond when sleep is disrupted again. A difficult night does not have to become another long cycle of insomnia.
Reducing Arousal
Relaxation, breathing, imagery, mindfulness or other arousal-reduction strategies may help when they fit the pattern. They are used as tools, not as tests you must pass in order to sleep.
Changing Unhelpful Sleep Beliefs
CBT-I helps you examine catastrophic predictions, rigid rules and performance pressure around sleep. The goal is not positive thinking. It is a more accurate, less activating way of responding to an imperfect night.
Why Sleep Hygiene May Not Be Enough
A dark room, comfortable temperature, thoughtful caffeine use and a regular wind-down routine can support sleep. Many patients, however, have already tried these steps. Chronic insomnia often requires direct work on conditioned wakefulness, time in bed, sleep-related beliefs, anxiety and the patterns surrounding the night.
Sleep Medication Concerns
Dr. Freeman does not prescribe medication. When appropriate, he coordinates with primary-care and prescribing clinicians, including gradual reduction of benzodiazepines or other sedative-hypnotics when the prescriber determines that reduction is appropriate. He supports appropriate psychiatric medication when it contributes to the patient’s broader care.
Medication may be useful for some patients, but it does not always address the learned thoughts, behaviors, habits and nighttime arousal that can maintain chronic insomnia. Some patients report rebound sleep difficulty or sleep that does not feel fully restorative. Those concerns should be discussed with the prescribing clinician rather than used as a reason to change medication without medical guidance.
CBT-I can be used whether or not a patient currently takes sleep medication. If a patient and prescriber decide that a medication reduction is appropriate, Dr. Freeman can coordinate the behavioral side of care while the prescriber directs every medication decision.
Insomnia With Anxiety, Trauma or Chronic Pain
Insomnia may occur alongside anxiety, Post-Traumatic Stress Disorder (PTSD), nightmares, depression, chronic pain or medical stress. Poor sleep can increase emotional reactivity and pain-related distress, while anxiety, trauma and pain can increase nighttime arousal.
These concerns may need coordinated treatment. The plan may combine CBT-I with trauma-focused work, anxiety strategies, behavioral medicine or medical care. Treating insomnia directly can remain important even when another condition helped start the sleep problem.
CPAP Claustrophobia and Acclimation
Some people who have been prescribed continuous positive airway pressure (CPAP) understand why it is medically important but feel trapped, panicked or intensely uncomfortable when wearing the mask. Dr. Freeman’s Psychology Today profile identifies CPAP-related claustrophobia as an area of experience.
Psychological treatment may use gradual acclimation, relaxation, cognitive strategies and manageable behavioral practice to reduce fear and avoidance. This work complements care from the sleep clinician, respiratory therapist or equipment provider; it does not diagnose sleep apnea, select pressure settings or replace medical follow-up.
Review American Thoracic Society patient resources for becoming accustomed to CPAP and addressing mask-related claustrophobia.
Treatment begins with a review of the patient’s sleep pattern, health, stress, current routines, previous treatment and goals. Dr. Freeman explains what may be maintaining the insomnia and recommends a starting plan. The patient may use broad sleep estimates, test behavioral changes or practice a cognitive strategy between sessions.
At follow-up appointments, Dr. Freeman and the patient review the result and adjust the plan. Treatment is structured, but it should not feel punitive. The purpose is to build a more stable sleep system and reduce the struggle surrounding sleep.
Dr. Freeman's Clinical Perspective
Chronic insomnia is not always a sign that a person lacks information or discipline. A person may follow reasonable sleep habits and still remain caught in a cycle of wakefulness, monitoring, frustration and pressure to sleep. The original trigger may be gone while the learned nighttime pattern continues.
Dr. Freeman examines when the sleep problem occurs, what the patient does while awake, how much time is spent in bed, what the patient predicts about the next day and whether anxiety, trauma, pain, grief, health or life stage is contributing. Treatment is then adjusted to the pattern rather than forcing every patient into the same schedule.
Durable improvement usually requires more than temporary symptom relief. Cognitive Behavioral Therapy for Insomnia (CBT-I) works directly with sleep-related thoughts, behaviors, habits and conditioned arousal. Medication may remain an appropriate part of care for some patients, but behavioral treatment can address patterns that medication or sleep-hygiene advice alone may not change.
When Medical or Additional Care May Be Needed
Psychological insomnia treatment does not replace medical evaluation for possible sleep apnea, movement disorders, medication effects or other health conditions. Loud snoring, gasping or choking during sleep, marked daytime sleepiness, unusual nighttime behavior or a sudden major change in sleep should be discussed with an appropriate medical professional.
Dr. Freeman can address behavioral and psychological factors while coordinating with a prescribing clinician, primary-care clinician or sleep specialist when appropriate and authorized. Medication changes remain the responsibility of the prescriber.
Frequently Asked Questions
Is CBT-I just sleep hygiene?
No. Sleep hygiene can support healthy sleep, but CBT-I directly addresses schedules, time awake in bed, conditioned arousal, behavior and beliefs that maintain chronic insomnia.
Can Treatment Help When Anxiety or Trauma Affects Sleep?
Yes. Insomnia can be addressed directly while treatment also considers anxiety, trauma, nightmares or hypervigilance. The balance depends on the patient’s symptoms and treatment priorities.
Does Insomnia Treatment Require Stopping Sleep Medication?
No medication change should be made without the prescribing clinician. Therapy can help you develop non-medication skills, and any reduction plan must be coordinated with the prescriber.
Does Dr. Freeman treat sleep problems in children and adolescents?
Yes, when the child’s or adolescent’s age, symptoms and treatment setting fit Dr. Freeman’s scope. A parent or caregiver can use the consultation to discuss the sleep concern and whether his services are appropriate.
Is insomnia treatment available online?
Telehealth is available throughout California when it is clinically appropriate and consistent with current licensure requirements.
How long does treatment take?
Many focused courses of insomnia treatment fall within approximately 8 to 12 sessions. More time may be appropriate when sleep problems occur with complex psychiatric or medical conditions. The treatment plan and pace are individualized, and no outcome is guaranteed.
Related Services
Cognitive Behavioral Therapy (CBT) and Cognitive Behavioral Therapy for Insomnia (CBT-I)
Anxiety
Treatment
Trauma and Post-
Traumatic Stress Disorder (PTSD) Treatment
Chronic Pain
and Behavioral
Medicine
Related Reading From Dr. Freeman’s Blog
For a deeper explanation of insomnia patterns and treatment, these articles provide practical background before or between appointments.
- Insomnia and Sleep Problems
What Causes Chronic Insomnia? By Dr. Charles R. Freeman, Ph.D. Chronic insomnia is usually caused by more than one issue....
When Should You Seek Help for Insomnia? By Dr. Charles R. Freeman, Ph.D. You should seek help for insomnia when...
Sleep anxiety can keep insomnia going because the fear of not sleeping activates the same nervous system response that prevents...
Authoritative Information
Read the National Heart, Lung, and Blood Institute’s overview of insomnia treatment. This federal resource explains why CBT-I is commonly recommended as a first treatment option for long-term insomnia.
Review the 2025 VA/DoD clinical guidance for chronic insomnia and obstructive sleep apnea. The guidance describes evidence-based behavioral treatment and does not replace an individualized assessment.
About Dr. Charles R. fFreeman, Ph.D.
Dr. Freeman is a California-licensed psychologist in San Diego with over 35 years of clinical experience. His practice specializes particularly in insomnia and sleep problems and also includes anxiety, trauma and PTSD, chronic pain and behavioral medicine, CBT, CBT-I and Eye Movement Desensitization and Reprocessing (EMDR). Appointments are available in person in San Diego and by teletherapy throughout California when clinically appropriate.
View California psychology license PSY #25414 or learn more about Dr. Freeman’s background and clinical approach.
Clinical Content Information
Clinical content by Dr. Charles R. Freeman, Ph.D., a California-licensed psychologist with over 35 years of clinical experience. View California psychology license PSY #25414.
Learn more about Dr. Freeman’s professional background and clinical approach.
Discuss Your Sleep Concerns
If you have tried generic advice and still feel trapped in a cycle of poor sleep, a focused assessment can help clarify what is maintaining the problem and which treatment approach may fit.