Category: Insomnia and Sleep Disorders

  • Perimenopause and Anxiety: Understanding the Connection Between Hormones, Sleep, and Mental Health

    Perimenopause and Anxiety: Understanding the Connection Between Hormones, Sleep, and Mental Health

    Perimenopause is a transitional phase leading up to menopause that can bring significant physical and emotional changes. While hot flashes and irregular periods are widely recognized symptoms, many women are surprised to experience increased anxiety and sleep disruption during perimenopause. Understanding how hormonal shifts affect mood and sleep can help normalize these experiences and guide effective treatment.


    What Is Perimenopause?

    Perimenopause typically begins in a woman’s 40s, though it can start earlier, and may last several years before menopause. During this time, levels of estrogen and progesterone fluctuate unpredictably. These hormonal changes can affect multiple systems in the body, including the brain regions involved in mood regulation and sleep.

    Because these changes occur gradually and inconsistently, symptoms may come and go, making perimenopause difficult to recognize.


    How Perimenopause Contributes to Anxiety

    Anxiety during perimenopause is common—even in individuals with no prior history of anxiety disorders. Hormonal fluctuations can influence neurotransmitters such as serotonin and GABA, which play a key role in emotional regulation. As a result, many women report:

    • Increased worry or feeling on edge
    • Heightened sensitivity to stress
    • Panic-like symptoms or sudden anxiety surges
    • Difficulty concentrating or “brain fog”
    • Irritability or emotional reactivity

    These symptoms can feel unsettling, especially when they appear unexpectedly or seem disproportionate to external stressors.

    Perimenopause, Sleep, and Anxiety

    Sleep problems are one of the most common complaints during perimenopause and are closely linked to anxiety. Hormonal shifts can disrupt sleep directly, while anxiety can make it harder to fall or stay asleep.

    Common sleep concerns include:

    • Difficulty falling asleep due to racing thoughts
    • Frequent nighttime awakenings
    • Early morning awakening
    • Night sweats or temperature dysregulation

    Over time, poor sleep can worsen anxiety, creating a cycle of anxiety and insomnia. Addressing both sleep and anxiety is often necessary for lasting improvement.


    Evidence-Based Treatment for Perimenopausal Anxiety and Insomnia

    Cognitive Behavioral Therapy (CBT)

    CBT is an effective, evidence-based treatment for anxiety that helps individuals identify and change unhelpful thought patterns, reduce worry, and build coping skills. CBT can be particularly helpful during perimenopause, when stress tolerance may feel reduced.

    CBT for Insomnia (CBT-I)

    CBT-I is the gold-standard treatment for chronic insomnia, including sleep problems related to anxiety and perimenopause. CBT-I focuses on improving sleep habits, reducing nighttime anxiety, and restoring healthy sleep patterns without medication.

    Integrative Approaches

    Treatment may also include mindfulness strategies, stress-management techniques, and behavioral interventions to support emotional regulation and sleep quality. In some cases, collaboration with a medical provider regarding hormone therapy or medication may be appropriate.


    Telehealth Therapy for Perimenopause, Anxiety, and Sleep

    Telehealth therapy makes it easier to access specialized care for perimenopausal anxiety and insomnia. Research shows that telehealth CBT and CBT-I are as effective as in-person treatment, allowing individuals to receive care from the comfort of home.

    For women balancing work, caregiving, and health changes, telehealth offers flexibility and continuity of care during a time of transition.


    When to Seek Support

    If anxiety or sleep problems are interfering with your daily life, relationships, or sense of well-being, professional support can help. Perimenopause is a significant biological transition—and you do not need to navigate it alone.

    Working with a psychologist who specializes in anxiety, insomnia, and women’s mental health can help you better understand your symptoms and develop effective, evidence-based strategies for relief.

    Dr. Sara Michelson is a Licensed Psychologist in Chapel Hill N.C.

    I am a doctoral-level licensed psychologist in Chapel Hill North Carolina; I have expertise in various evidence-based treatments for adults and am committed to providing scientifically validated interventions. I work with a diverse population, including trauma, insomnia, mood disorders, anxiety, and relationship problems. I take my work and clinical specializations seriously and continue to devote a considerable amount of time and effort to advance my training and professional development. For your convenience, my services are provided via telehealth.

  • How Winter Weather Affects Insomnia

    How Winter Weather Affects Insomnia

    Many people notice changes in their sleep during the winter months. Shorter days, colder temperatures, and reduced sunlight can significantly impact sleep patterns and contribute to insomnia. Understanding how winter weather affects sleep can help explain why falling asleep or staying asleep often becomes more difficult during this time of year—and what you can do about it.


    Reduced Daylight and Circadian Rhythm Disruption

    One of the most significant ways winter weather affects insomnia is through reduced exposure to natural light. Daylight plays a critical role in regulating circadian rhythms, the internal clock that tells your body when to feel alert and when to feel sleepy. During winter, shorter days and limited sunlight can disrupt melatonin and serotonin production, leading to difficulty falling asleep, staying asleep, or waking feeling unrefreshed.

    This circadian misalignment is especially problematic for individuals who already struggle with insomnia or seasonal mood changes.


    Increased Time Indoors and Irregular Routines

    Cold temperatures and inclement weather often lead to spending more time indoors and reduced physical activity. Less movement during the day can decrease sleep drive at night, making it harder to fall asleep. Additionally, winter schedules may become less consistent due to holidays, travel, or working from home, further disrupting sleep routines.

    Irregular bedtimes and wake times are a common contributor to chronic insomnia.


    Winter Stress and Sleep Anxiety

    Winter can bring increased psychological stress, which directly affects sleep. Financial pressures, holiday demands, end-of-year work stress, and social isolation can all increase anxiety. When stress levels rise, the nervous system remains more activated at night, interfering with the ability to fall asleep or stay asleep.

    Over time, this can lead to conditioned sleep anxiety—where the bed itself becomes associated with frustration and wakefulness.

    Temperature Changes and Sleep Quality

    While cooler temperatures generally support sleep, overly cold or poorly regulated indoor environments can disrupt sleep quality. Dry air from heating systems may cause nasal congestion or throat discomfort, leading to nighttime awakenings. Finding a comfortable sleep environment is especially important during winter months.


    How to Improve Sleep During Winter

    Supporting sleep in winter often requires intentional adjustments. Maintaining consistent sleep and wake times, maximizing morning light exposure, and engaging in regular daytime movement can help regulate circadian rhythms. Creating a calming bedtime routine and limiting evening screen exposure are also important for improving sleep quality.

    For individuals with persistent insomnia, cognitive behavioral therapy for insomnia (CBT-I) is an evidence-based treatment that addresses both the behavioral and psychological factors that maintain sleep difficulties.


    When to Seek Professional Help

    If winter insomnia lasts for weeks or interferes with daytime functioning, working with a psychologist trained in sleep treatment can be helpful. Insomnia is highly treatable, and early intervention can prevent it from becoming chronic.

    Understanding the effects of winter weather on sleep is the first step toward restoring healthier, more restful nights—even during the darkest months of the year.

    Dr. Sara Michelson is a Licensed Psychologist in Chapel Hill N.C.

    I am a doctoral-level licensed psychologist in Chapel Hill North Carolina; I have expertise in various evidence-based treatments for adults and am committed to providing scientifically validated interventions. I work with a diverse population, including trauma, insomnia, mood disorders, anxiety, and relationship problems. I take my work and clinical specializations seriously and continue to devote a considerable amount of time and effort to advance my training and professional development. For your convenience, my services are provided via telehealth.

  • The Psychological Effects of Spring

    The Psychological Effects of Spring

    Spring is often associated with renewal, growth, and fresh starts. Longer days, warmer temperatures, and signs of life returning can have a noticeable impact on mood and energy. While many people experience spring as uplifting, the psychological effects of this season are complex and can vary widely from person to person.


    Increased Light and Mood Changes

    One of the most significant psychological shifts in spring is increased exposure to daylight. Longer daylight hours influence circadian rhythms and the regulation of neurotransmitters such as serotonin and melatonin. For many people, this results in improved mood, greater energy, and better sleep. Individuals who struggle with seasonal affective symptoms during the winter may notice a gradual lifting of low mood and lethargy as spring approaches.

    At the same time, increased energy can feel destabilizing for some. A sudden shift from low energy to heightened activation may exacerbate anxiety, restlessness, or irritability, particularly for individuals who already struggle with anxiety or mood regulation.


    A Season of Pressure and Comparison

    Spring often carries an implicit message of productivity and renewal. Culturally, it is framed as a time to “get back on track,” clean, improve habits, and feel motivated. While this can be inspiring, it can also create pressure. People who do not feel energized or hopeful may experience guilt, self-criticism, or a sense that something is “wrong” with them.

    This seasonal contrast can be especially difficult for individuals dealing with depression, grief, burnout, or chronic stress. Watching the world appear to move forward can intensify feelings of being left behind.

    Transitions and Emotional Reactivation

    Spring is also a time of transition—academic years near completion, work schedules shift, and social expectations increase. Transitions often bring emotional reactivation. Past experiences associated with spring, both positive and painful, can resurface. For some, this season may stir unresolved grief, relationship losses, or reminders of past stressors.

    Additionally, increased social activity can be energizing for some and overwhelming for others, particularly for individuals who are introverted or managing social anxiety.


    Spring and Mental Health Awareness

    It is important to note that shifts in energy and routine can sometimes correspond with increased risk for mood instability. While spring can bring relief, it can also amplify internal states that were subdued during winter. Paying attention to changes in sleep, mood, and anxiety is important during seasonal transitions.


    Supporting Mental Health in Spring

    Supporting psychological well-being in spring often involves balance—embracing increased energy and opportunity while allowing space for rest and self-compassion. Maintaining consistent sleep routines, setting realistic expectations, and noticing emotional responses without judgment can be helpful.

    Therapy can provide a space to process seasonal changes, explore emotional reactions, and develop strategies for navigating transitions in a way that aligns with one’s values rather than cultural pressure.

    Spring may bring light and growth, but it also invites reflection. Honoring both can support emotional resilience and mental health year-round.

    Dr. Sara Michelson is a Licensed Psychologist in Chapel Hill N.C.

    I am a doctoral-level licensed psychologist in Chapel Hill North Carolina; I have expertise in various evidence-based treatments for adults and am committed to providing scientifically validated interventions. I work with a diverse population, including trauma, insomnia, mood disorders, anxiety, and relationship problems. I take my work and clinical specializations seriously and continue to devote a considerable amount of time and effort to advance my training and professional development. For your convenience, my services are provided via telehealth.

  • Perimenopause and Insomnia: How Hormonal Changes Affect Sleep—and How CBT-I Can Help

    Perimenopause and Insomnia: How Hormonal Changes Affect Sleep—and How CBT-I Can Help

    Many women begin to experience sleep difficulties years before menopause itself. Perimenopause—the transitional phase leading up to menopause—can significantly disrupt sleep and is a common yet often overlooked cause of insomnia. For many, these sleep problems are compounded by anxiety, nighttime rumination, and increased sensitivity to stress. Understanding the connection between perimenopause and insomnia is an important step toward effective, lasting treatment.


    Why Perimenopause Disrupts Sleep

    Perimenopause typically begins in the late 30s to 40s and can last several years. During this time, levels of estrogen and progesterone fluctuate unpredictably. These hormonal changes affect sleep in multiple ways.

    Estrogen plays a role in regulating body temperature, mood, and circadian rhythms. When estrogen levels drop or fluctuate, women may experience night sweats, hot flashes, and frequent awakenings. Progesterone has a calming, sleep-promoting effect; declining progesterone can make it harder to fall asleep and stay asleep.

    However, insomnia during perimenopause is not only physiological. Many women notice that once sleep becomes disrupted, anxiety about sleep quickly follows. Worrying about whether you will sleep, how tired you will feel the next day, or how poor sleep affects your health can activate the nervous system and further interfere with rest.


    The Role of Anxiety in Perimenopausal Insomnia

    Anxiety and insomnia are closely linked during perimenopause. Hormonal fluctuations can increase emotional reactivity and stress sensitivity, making it harder to “turn off” the mind at night. Racing thoughts, anticipatory anxiety about sleep, and heightened awareness of bodily sensations often become part of the bedtime experience.

    Over time, this can lead to conditioned insomnia, where the bed itself becomes associated with wakefulness and frustration. Even on nights without hot flashes or physical symptoms, sleep remains elusive because the brain has learned to stay alert.

    This is why treating perimenopausal insomnia effectively requires addressing both sleep behaviors and anxiety—not just hormones.

    Why CBT-I Is the Gold-Standard Treatment

    Cognitive Behavioral Therapy for Insomnia (CBT-I) is the most effective, evidence-based treatment for chronic insomnia, including insomnia related to perimenopause. CBT-I works by targeting the patterns that keep insomnia going, even when the original trigger was hormonal.

    CBT-I helps individuals:

    • Rebuild a strong association between bed and sleep
    • Reduce sleep-related anxiety and nighttime rumination
    • Regulate sleep schedules and circadian rhythms
    • Challenge unhelpful beliefs about sleep and fatigue
    • Calm the nervous system through behavioral and cognitive strategies

    Importantly, CBT-I does not require medication and has been shown to produce long-lasting improvements in sleep. For women in perimenopause, CBT-I can be especially helpful because it treats insomnia directly, rather than waiting for hormonal stability to return.


    Telehealth CBT-I for Perimenopause and Anxiety

    Telehealth therapy makes CBT-I accessible and convenient, especially for women juggling work, caregiving, and changing energy levels. Research shows that CBT-I delivered via telehealth is just as effective as in-person treatment.

    Working with a psychologist via telehealth allows for personalized treatment that addresses:

    • Sleep disruption related to night sweats or awakenings
    • Anxiety and hyperarousal at bedtime
    • Stress, perfectionism, or burnout that worsens insomnia
    • Emotional changes associated with perimenopause

    Telehealth also allows clients to apply strategies in their real-world sleep environment, which can enhance treatment effectiveness.


    When to Seek Professional Help

    Occasional sleep disruption during perimenopause is common. However, if insomnia occurs three or more nights per week, lasts for several months, or causes daytime fatigue, irritability, or anxiety, professional treatment can help.

    Insomnia does not need to be endured as an inevitable part of perimenopause. With the right support, sleep can improve—even during hormonal transitions.


    A Path Toward Restful Sleep

    Perimenopause can be a time of significant physical and emotional change, but chronic insomnia does not have to define this phase of life. CBT-I offers a structured, compassionate, and highly effective approach to restoring sleep and reducing anxiety.

    If you are experiencing perimenopause-related insomnia, working with a psychologist trained in CBT-I through telehealth can help you regain confidence in your ability to sleep and feel more rested, resilient, and balanced.

    Dr. Sara Michelson is a Licensed Psychologist in Chapel Hill N.C.

    I am a doctoral-level licensed psychologist in Chapel Hill North Carolina; I have expertise in various evidence-based treatments for adults and am committed to providing scientifically validated interventions. I work with a diverse population, including trauma, insomnia, mood disorders, anxiety, and relationship problems. I take my work and clinical specializations seriously and continue to devote a considerable amount of time and effort to advance my training and professional development. For your convenience, my services are provided via telehealth.

  • The Health Effects of Insomnia: Why Sleep Matters More Than We Realize

    The Health Effects of Insomnia: Why Sleep Matters More Than We Realize

    Most people experience a sleepless night now and then—stressful deadlines, travel, or an overactive mind can keep anyone awake. But when sleep difficulties become persistent, they can take a toll on both physical and emotional well-being. Insomnia isn’t just about feeling tired—it can affect how we think, feel, and function throughout the day. Understanding the broader impact of insomnia can help us take sleep more seriously and seek support when needed.


    What Is Insomnia?

    Insomnia involves difficulty falling asleep, staying asleep, or waking up too early with trouble returning to sleep. Nighttime struggles are only part of the picture—insomnia also affects how we feel during the day. Many people describe exhaustion, irritability, brain fog, or the sense of running on empty.

    When insomnia lasts for months or becomes a nightly pattern, it can have measurable effects on health.


    How Insomnia Affects the Body and Mind

    1. Daytime Fatigue and Cognitive Challenges

    Even one poor night of sleep can affect concentration, memory, and decision-making. When insomnia is chronic, these difficulties accumulate. Tasks take longer, mistakes increase, and it’s harder to stay focused or recall information. Many people also notice increased emotional sensitivity or difficulty coping with everyday stress.

    2. Mood and Emotional Health

    Sleep and mood are deeply connected. Insomnia can increase irritability, stress reactivity, and feelings of overwhelm. Research shows that chronic insomnia is associated with a higher risk of anxiety and depression. The relationship is bidirectional—insomnia can worsen mood, and low mood can make sleep more difficult—creating a cycle that can feel exhausting. 

    3. Physical Health and Immune Function

    Sleep is when the body restores, repairs, and recharges. Without regular deep sleep, the immune system may not function optimally, making us more susceptible to illness and slower to recover. Over time, chronic insomnia is associated with increased inflammation and may contribute to elevated risk for conditions such as high blood pressure and metabolic concerns.

    4. Hormones and Metabolism

    Sleep influences hunger hormones, including ghrelin and leptin, which regulate appetite. When sleep is disrupted, hunger signals can increase and satiety signals decrease, which may contribute to cravings and changes in eating patterns. Some research suggests that long-term sleep disruption may affect glucose regulation and weight management.

    5. Cardiovascular and Long-Term Health

    While occasional poor sleep isn’t dangerous, chronic insomnia may place strain on the cardiovascular system. Over time, difficulty sleeping has been associated with increased risk for hypertension and cardiovascular concerns. Quality sleep is essential for heart health, blood pressure regulation, and nightly recovery of the nervous system.

    Why Addressing Insomnia Matters

    Sleep isn’t a luxury—it’s a foundational part of health. When insomnia persists, many people begin to adjust their lives around fatigue: skipping social plans, relying on caffeine, napping during the day, or worrying hours before bedtime. These coping patterns are understandable, but they often reinforce the sleep struggle.

    The good news: insomnia is highly treatable, and people often see significant improvement with the right support.

    Approaches like Cognitive Behavioral Therapy for Insomnia (CBT-I) are considered the gold standard treatment. CBT-I helps retrain the brain to sleep naturally by addressing habits, sleep schedules, and thought patterns that maintain insomnia. Many individuals notice improvement within a few weeks.


    Moving Toward Restful Nights

    If you’ve been struggling with sleep, you’re not alone—and you don’t have to push through it indefinitely. Sleep is a skill that can be relearned. Addressing insomnia can improve energy, mood, focus, emotional resilience, and overall health.

    Quality sleep supports the body and mind in countless ways. When we sleep better, everything feels a little more manageable.


    What Is CBT-I? A Proven Approach to Treating Insomnia

    Struggling to fall asleep, stay asleep, or wake feeling unrefreshed can affect every part of life—mood, focus, energy, work, and relationships. Many people try to cope by scrolling late at night, forcing themselves to lie in bed awake, relying on naps, or turning to sleep aids for relief. Yet the frustration often continues.

    Cognitive Behavioral Therapy for Insomnia (CBT-I) is one of the most effective treatments for chronic insomnia, backed by decades of research. Unlike medication, which may offer short-term relief, CBT-I addresses the thoughts, behaviors, and habits that maintain sleep difficulties. It helps retrain the body and mind to sleep naturally again.


    What Is Cognitive Behavioral Therapy for Insomnia (CBT-I)?

    CBT-I is a structured, evidence-based therapy designed specifically to improve sleep. It focuses on identifying patterns—such as worry about sleep, inconsistent routines, or time spent awake in bed—that interfere with restful sleep. Through targeted strategies, CBT-I helps reset the sleep system, reduce nighttime wakefulness, and build confidence in one’s ability to sleep.

    Most people complete CBT-I in six-eight sessions and experience lasting improvements.


    Why CBT-I Works

    Insomnia is rarely just one problem. It is often a cycle: Difficulty sleeping leads to anxiety about sleep, which leads to habits like going to bed early, sleeping in, or checking the clock—patterns that inadvertently make sleep worse. CBT-I breaks this cycle.

    Research shows that CBT-I:

    • Improves sleep onset and sleep maintenance
    • Reduces nighttime awakenings
    • Enhances sleep quality and next-day functioning
    • Works as well as or better than sleep medication for chronic insomnia
    • Provides long-term benefits after treatment ends

    What Happens in CBT-I?

    CBT-I includes several components that work together to reset the sleep-wake rhythm:

    1. Sleep Education

    You learn how sleep works—what drives sleepiness, how circadian rhythms operate, and which daytime choices influence nighttime rest. Understanding the science helps make each strategy feel logical and purposeful.

    2. Sleep Scheduling (Sleep Restriction Therapy)

    This is one of the most powerful tools in CBT-I. It temporarily limits time spent in bed to match actual sleep time. This builds healthy sleep pressure so that when bedtime arrives, the brain is ready for sleep. Over time, sleep becomes deeper and more consolidated.

    3. Stimulus Control

    The bed becomes a cue for sleep—not worry, wakefulness, or scrolling. This means:

    • Going to bed only when sleepy
    • Getting out of bed if unable to sleep
    • Using the bed only for sleep and intimacy
    • Waking up at a consistent time

    This retrains the brain to associate bed with sleep rather than frustration.

    4. Cognitive Strategies

    Insomnia often comes with thoughts like “I’ll never fall asleep,” “I won’t function tomorrow,” or “Something’s wrong with me.” These thoughts increase arousal and make sleep more elusive. CBT-I helps challenge worry-based thinking and replace it with more balanced, realistic expectations about sleep.

    5. Relaxation Techniques

    Breathing exercises, mindfulness, and muscle relaxation help calm the nervous system and reduce nighttime tension—especially helpful for those who feel “tired but wired.”

    6. Sleep Hygiene

    Lighting, screen use, caffeine, naps, and evening routines all matter. While sleep hygiene alone rarely fixes insomnia, refining habits can support the other CBT-I strategies.


    Who Can Benefit?

    CBT-I is effective for:

    • Difficulty falling asleep or staying asleep
    • Early morning awakening
    • Middle-of-the-night rumination
    • Light, nonrestorative sleep
    • Insomnia connected to stress, anxiety, or life transitions
    • Individuals reducing or hoping to stop long-term sleep medication

    Even long-term insomnia can improve—sleep is a skill the brain can relearn.


    A Path Toward Restful Sleep

    Living with insomnia can feel isolating and exhausting, but it is highly treatable. CBT-I empowers individuals to rebuild trust in their ability to sleep naturally, without relying heavily on medication. Most people notice improvement within just a few weeks, and gains often continue well beyond treatment.

    If you are struggling with sleep, you don’t have to navigate it alone. CBT-I offers a structured, research-backed path forward—and restful nights are possible.

    Dr. Sara Michelson is a Licensed Psychologist in Chapel Hill N.C.

    I am a doctoral-level licensed psychologist in Chapel Hill North Carolina; I have expertise in various evidence-based treatments for adults and am committed to providing scientifically validated interventions. I work with a diverse population, including trauma, insomnia, mood disorders, anxiety, and relationship problems. I take my work and clinical specializations seriously and continue to devote a considerable amount of time and effort to advance my training and professional development. For your convenience, my services are provided via telehealth.

  • How Sleep Changes Across the Lifespan

    How Sleep Changes Across the Lifespan

    Sleep is a biological necessity, but it’s not a one-size-fits-all experience. The amount and type of sleep we need shifts naturally as we move through different life stages—from newborns who sleep most of the day to older adults who may wake more frequently during the night. Understanding how sleep evolves across the lifespan can help us set realistic expectations, reduce worry, and support healthy rest through every chapter of life.


    Infancy and Early Childhood: Building the Foundation

    Newborns and infants spend much of their time asleep—often 14–17 hours scattered throughout the day and night. Sleep occurs in short cycles, and it’s normal for babies to wake frequently to eat and seek comfort. As the brain matures, sleep gradually consolidates into longer stretches, especially overnight.

    By preschool age, children typically sleep 10–13 hours, including naps. Sleep plays a key role in growth, memory consolidation, and emotional development, which is why routines, consistency, and calming bedtime rituals are especially helpful for young children.

    What to expect during early years:

    • Frequent nighttime waking (especially in infancy)
    • Regular naps that decrease gradually over time
    • Importance of routines for healthy sleep habits

    School-Age Children: Consolidation and Development

    Children ages 6–12 usually need 9–12 hours of sleep. Sleep supports learning, behavior, mood regulation, and physical growth. Many children experience a shift toward independence during bedtime, and structure remains important.

    Screens, extracurricular activities, and increasing academic demands can begin to compete with sleep. Creating a consistent bedtime routine and limiting stimulating activities in the evening can help protect sleep during this stage.


    Adolescence: A Shifted Internal Clock

    Teenagers often struggle with sleep, but not because they’re lazy or resisting bedtime. During adolescence, biological rhythms naturally shift later, making it harder to fall asleep early and wake early for school. Most teens need 8–10 hours of sleep, yet many get far less due to early school start times, social activities, technology use, and increased responsibilities.

    Chronic sleep deprivation in teens is linked to mood changes, difficulty concentrating, and increased risk-taking—highlighting the importance of advocating for healthy sleep habits and reasonable sleep schedules when possible.

    Common patterns in teens:

    • Naturally later sleep and wake times
    • Sleep loss on weekdays, catch-up sleep on weekends
    • Increased sensitivity to screen light in evenings

    Adulthood: Balancing Sleep with Life Demands

    Most adults function best with 7–9 hours of sleep each night, though individual needs vary. Work stress, parenting demands, and technology use can all impact sleep. Insomnia is relatively common in adulthood and may arise during life transitions, stress, or periods of change.

    Prioritizing regular routines—consistent bed/wake times, limited caffeine later in the day, and boundaries around work and screens—can support more reliable rest.

    Older Adulthood: Lighter Sleep and More Awakenings

    Sleep architecture changes again in later life. Deep sleep (slow-wave sleep) decreases, and sleep may become lighter and more fragmented. Many older adults find that they fall asleep earlier and wake up earlier than they once did. Nighttime awakenings may increase due to changes in circadian rhythm, medical conditions, or medications.

    While total sleep time may remain similar, the experience of sleep can feel different, leading some to believe they “sleep worse” even when they’re getting adequate rest across 24 hours.

    Common changes in later life:

    • More awakenings throughout the night
    • Less deep sleep
    • Earlier bedtimes and wake times
    • Increased likelihood of daytime napping

    Not all sleep changes are problematic, but persistent difficulty sleeping may warrant support—especially when it leads to daytime fatigue or distress.


    Understanding Sleep Across Life Helps Set Realistic Expectations

    Sleep isn’t static—it grows, shifts, lightens, and reorganizes as our bodies and brains develop. Recognizing these patterns can reduce worry, normalize experience, and guide healthy sleep habits.

    Across every stage of life, the foundations of restorative sleep include:

    • Consistent sleep and wake times
    • Exposure to natural light during the day
    • Limited bright screens before bedtime
    • A calming pre-sleep routine
    • A sleep environment that feels safe and comfortable

    If sleep becomes a persistent struggle, especially in adulthood, treatments like Cognitive Behavioral Therapy for Insomnia (CBT-I) can help retrain sleep and reduce nighttime wakefulness.


    Final Thought

    Sleep needs and patterns shift as we age—but the importance of rest remains constant. By understanding how sleep changes over the lifespan, we can meet ourselves (or our children or aging parents) with patience, realistic expectations, and supportive habits that promote quality rest at every stage of life.

    Dr. Sara Michelson is a Licensed Psychologist in Chapel Hill N.C.

    I am a doctoral-level licensed psychologist in Chapel Hill North Carolina; I have expertise in various evidence-based treatments for adults and am committed to providing scientifically validated interventions. I work with a diverse population, including trauma, insomnia, mood disorders, anxiety, and relationship problems. I take my work and clinical specializations seriously and continue to devote a considerable amount of time and effort to advance my training and professional development. For your convenience, my services are provided via telehealth.

  • Managing Holiday Anxiety and Insomnia: How to Maintain a Positive Mood During the Holiday Season

    Managing Holiday Anxiety and Insomnia: How to Maintain a Positive Mood During the Holiday Season

    The holiday season can be emotionally demanding, particularly for individuals who struggle with anxiety and insomnia. While the holidays are often associated with joy and connection, they also bring disrupted routines, increased expectations, travel, and social pressures—all of which can worsen anxiety symptoms and interfere with sleep. For many people, maintaining a positive mood during the holidays requires intentional mental health support rather than simply “pushing through.”


    Why Anxiety and Insomnia Often Worsen During the Holidays

    From a psychological perspective, the holiday season creates a perfect storm for anxiety and sleep difficulties. Changes in daily structure, later bedtimes, irregular meals, and increased alcohol use can disrupt circadian rhythms. When sleep becomes inconsistent, emotional regulation suffers, making worry, irritability, and rumination more likely.

    Anxiety also tends to increase during periods of heightened expectations. Family dynamics, financial stress, social obligations, and pressure to feel happy can activate anxious thought patterns and perfectionism. For individuals prone to insomnia, this mental arousal often leads to difficulty falling or staying asleep.


    Using CBT-I Principles to Protect Sleep and Mood

    Cognitive Behavioral Therapy for Insomnia (CBT-I) is the gold-standard, evidence-based treatment for chronic insomnia. CBT-I emphasizes consistency, sleep regulation, and reducing sleep-related anxiety—skills that are especially helpful during the holidays.

    Maintaining consistent sleep and wake times, even during travel or time off, supports mood stability. Morning light exposure, limiting naps, and practicing a structured wind-down routine can help counteract holiday-related sleep disruption. Reducing time spent worrying about sleep is also critical, as sleep anxiety often perpetuates insomnia.

    Reducing Holiday Anxiety Through Cognitive and Behavioral Strategies

    Anxiety treatment during the holidays often involves identifying and challenging unrealistic expectations. Many people hold beliefs about how the holidays “should” feel, which can increase distress when reality doesn’t match the ideal. Cognitive-behavioral strategies help individuals notice these patterns and replace them with more flexible, compassionate thinking.

    Behavioral strategies—such as setting limits around social commitments and scheduling intentional downtime—can also significantly reduce anxiety. Avoidance may provide short-term relief, but learning to approach the season with realistic boundaries supports long-term emotional well-being.


    Setting Boundaries to Support Mental Health

    For individuals managing anxiety or insomnia, boundaries are essential. This may mean limiting the number of gatherings attended, shortening visits, or declining invitations altogether. Protecting emotional energy is not selfish—it is a key component of mental health care and sleep regulation.

    Boundaries also help reduce overstimulation, which can otherwise interfere with the ability to relax and sleep at night.


    Telehealth Therapy for Anxiety and Insomnia

    If anxiety or insomnia reliably worsen during the holiday season, working with a licensed psychologist can be helpful. Therapy provides tools to manage worry, improve sleep, and navigate emotionally charged situations with greater ease.

    Telehealth therapy offers flexibility and continuity of care during a busy season. For individuals located in North Carolina, New York, or PSYPACT-participating states, telehealth allows access to specialized anxiety and insomnia treatment—even while traveling for the holidays.


    Supporting Mental Health During the Holidays

    Maintaining a positive mood during the holidays does not mean eliminating stress or forcing happiness. It means prioritizing sleep, reducing anxiety, and approaching the season with self-compassion. Evidence-based treatments such as CBT-I and anxiety-focused therapy can help make the holidays more manageable—and more restorative.

    Dr. Sara Michelson is a Licensed Psychologist in Chapel Hill N.C.

    I am a doctoral-level licensed psychologist in Chapel Hill North Carolina; I have expertise in various evidence-based treatments for adults and am committed to providing scientifically validated interventions. I work with a diverse population, including trauma, insomnia, mood disorders, anxiety, and relationship problems. I take my work and clinical specializations seriously and continue to devote a considerable amount of time and effort to advance my training and professional development. For your convenience, my services are provided via telehealth.

  • The Mental Health Benefits of Exercise: More Than Just a Mood Boost

    The Mental Health Benefits of Exercise: More Than Just a Mood Boost

    Most of us know that exercise is good for our bodies—stronger muscles, better cardiovascular health, improved energy, but the benefits extend beyond physical wellness. As a psychologist, I often see how movement can be a powerful and accessible tool for emotional regulation, stress relief, and overall mental well-being. You don’t need hours at the gym or intense training plans; even minor, consistent steps can make a meaningful difference.


    How Exercise Supports Mental Well-Being

    1. A Natural Stress-Reducer

    Physical activity helps regulate cortisol—the body’s primary stress hormone—and stimulates the production of endorphins, chemicals that naturally enhance mood. Many people notice that after a walk, yoga session, or bike ride, the world feels a little bit lighter.

    2. Improved Mood and Reduced Symptoms of Anxiety & Depression

    Research consistently shows that regular exercise can help reduce symptoms of anxiety and depression. Movement increases serotonin and dopamine, neurotransmitters involved in mood and motivation. Over time, exercise can be a valuable complement to therapy, helping individuals manage low mood, irritability, and worry.

    3. Better Sleep

    Quality sleep is essential for emotional health, focus, and resilience. Exercise—especially earlier in the day—can help regulate circadian rhythms, reduce nighttime restlessness, and improve sleep depth. Better sleep often leads to improved mood, less reactivity, and greater capacity to cope with stress.

    4. Cognitive Benefits

    Movement increases blood flow to the brain, supporting concentration, executive functioning, and memory. Even a brief midday walk can sharpen focus and boost productivity. For older adults, regular exercise is associated with slower cognitive decline and enhanced brain health.

    5. Increased Self-Esteem and Sense of Mastery

    Setting and achieving movement goals—no matter how small—can strengthen confidence and agency. Exercise offers regular opportunities to experience success, progress, and a sense of accomplishment.

    Getting Started: Small Steps Matter

    You don’t need to run a marathon to experience psychological benefits. Start with activities you enjoy or that feel manageable:

    • A 10–15 minute walk
    • Gentle stretching or yoga
    • Gardening
    • Light strength training
    • Swimming or cycling

    The best exercise routine is the one you can maintain. Aim for consistency over intensity.


    A Mind-Body Approach to Well-Being

    Exercise isn’t a replacement for therapy when someone is struggling with anxiety, depression, or stress—but it can be a meaningful part of a comprehensive wellness plan. Movement nourishes both body and brain, enhances emotional resilience, and supports overall quality of life.

    If you are considering incorporating exercise into your mental health routine, start small, be kind to yourself, and notice how you feel over time. You might be surprised by how even simple movement can shift your day.

    Dr. Sara Michelson is a Licensed Psychologist in Chapel Hill N.C.

    I am a doctoral-level licensed psychologist in Chapel Hill North Carolina; I have expertise in various evidence-based treatments for adults and am committed to providing scientifically validated interventions. I work with a diverse population, including trauma, insomnia, mood disorders, anxiety, and relationship problems. I take my work and clinical specializations seriously and continue to devote a considerable amount of time and effort to advance my training and professional development. For your convenience, my services are provided via telehealth.

  • Can Exercise Help Insomnia? Exploring the Connection Between Movement and Sleep

    Can Exercise Help Insomnia? Exploring the Connection Between Movement and Sleep

    When sleep becomes difficult, many people reach for familiar solutions—cutting out caffeine, dimming lights, trying relaxation apps, or lying in bed hoping tonight will be different. While these strategies can help, one approach is often overlooked despite strong evidence behind it: Exercise.

    Movement isn’t just good for our bodies—it affects our sleep drive, mood, stress levels, and even the body’s internal clock. For many, physical activity can be a meaningful step toward improving insomnia and promoting more restorative sleep.


    How Exercise Supports Sleep

    Exercise works on insomnia through several pathways, both biological and psychological. Here are some of the key ways movement aids better sleep:

    1. Builds Sleep Pressure

    When we move, the body expends energy, and sleep becomes a natural way for the body to restore itself. Regular physical activity increases homeostatic sleep pressure, making falling asleep easier and nighttime sleep deeper.

    2. Helps Regulate the Circadian Rhythm

    Our internal clock thrives on routine and exposure to light and movement. Exercising—especially in the morning or afternoon—can help anchor sleep-wake cycles, making it easier to feel alert during the day and sleepy at night.

    3. Reduces Stress and Anxiety

    Stress and rumination are among the most common culprits behind insomnia. Movement releases endorphins, reduces cortisol levels, and provides an outlet for physical and emotional tension. Many people notice that after exercise, the mind feels quieter and the body more relaxed.

    4. Improves Sleep Quality

    Exercise increases slow-wave (deep) sleep—the most restorative stage—while reducing time spent awake at night. People often report fewer nighttime awakenings and feeling more refreshed in the morning.

    5. Enhances Mental Health and Mood

    Insomnia and mental health challenges often reinforce one another. Physical activity can help reduce symptoms of anxiety and depression, which may in turn help improve sleep.


    What Types of Exercise Help Most?

    There isn’t a single best exercise for insomnia. The most effective approach is often the one a person can do consistently. Research suggests that both aerobic and strength-based activities can improve sleep.

    Examples include:

    • Brisk walking or light jogging
    • Swimming or cycling
    • Strength or resistance training
    • Yoga, pilates, or stretching routines
    • Dancing, sports, or group fitness classes

    Gentle evening activities (like stretching or yoga) may help transition the body toward rest, while more vigorous workouts are often best from morning to late afternoon to allow time for the nervous system to wind down.


    How Much Exercise Is Needed for Sleep Benefits?

    Small steps matter. You don’t need hours in the gym to see improvement.

    Even 20–30 minutes of moderate exercise most days can make a difference. Improvement may build gradually over several weeks, much like training a muscle. What matters most is consistency rather than intensity.

    If you’re new to movement or managing fatigue, start with something manageable—like a 10-minute daily walk—and increase slowly.


    A Helpful Tool, not a Standalone Cure

    Exercise can meaningfully support better sleep, but it doesn’t always resolve insomnia on its own—especially chronic or long-standing insomnia. In these cases, comprehensive treatment such as Cognitive Behavioral Therapy for Insomnia (CBT-I) is highly effective.

    Exercise can be an excellent component of a bigger sleep plan, helping:

    • build natural sleepiness
    • reduce nighttime tension
    • stabilize the sleep-wake cycle
    • support overall mental and physical health

    When paired with CBT-I, many people see faster and more lasting improvement.


    Final Thought

    Movement is more than exercise—it’s an invitation to reconnect with the body, release tension, and support the rhythms that make sleep possible. You don’t need perfection or intense training to benefit. Start small, move gently, and notice how your sleep responds over time.Better sleep doesn’t always require doing more—sometimes it begins with simply moving.

    Dr. Sara Michelson is a Licensed Psychologist in Chapel Hill N.C.

    I am a doctoral-level licensed psychologist in Chapel Hill North Carolina; I have expertise in various evidence-based treatments for adults and am committed to providing scientifically validated interventions. I work with a diverse population, including trauma, insomnia, mood disorders, anxiety, and relationship problems. I take my work and clinical specializations seriously and continue to devote a considerable amount of time and effort to advance my training and professional development. For your convenience, my services are provided via telehealth.