Putting Sleep at the Center of Mental Health Care at Psych Congress 2026
Key Takeaways for Clinical Practice:
- Sleep-wake disorders may worsen psychiatric symptoms or persist despite improvement in the underlying psychiatric condition, supporting direct assessment and treatment by mental health clinicians.
- In older adults, screening for obstructive sleep apnea (OSA) and restless legs syndrome (RLS), prioritizing cognitive behavioral therapy for insomnia (CBT-I), and carefully deprescribing hypnotic medications may improve safety and care.
- Posttraumatic stress disorder (PTSD)-related insomnia and nightmares may require targeted behavioral, pharmacologic, or digital interventions.
“Sleep is the foundation of mental health,” Craig Chepke, MD, DFAPA, Chief Medical Officer, Psych Congress, told attendees at the 39th annual Psych Congress in New Orleans on Wednesday morning. “Without a good foundation, the whole house will crumble.”
Alongside Steering Committee Partner Philip Gehrman, PhD, CBSM, FAASM, and faculty member Logan Schneider, MD, Chepke explored the bidirectional relationship between mental health and sleep in the session, “The Sleep-Psych Nexus: Understanding and Assessing Sleep Disturbances in Psychiatric Practice.”
The presentation was one of several at this year’s meeting examining sleep symptoms in psychiatric illness, clinical considerations across the lifespan, and the role psychiatric clinicians can play in identifying and treating sleep-wake disorders.
Sleep and Psychiatric Health
Sleep-wake disorders may precipitate or worsen psychiatric symptoms, while psychiatric disorders and their treatments can disrupt sleep, Chepke, Gehrman, and Schneider emphasized during their session. Sleep difficulties affect as many as 90% of patients with major depressive disorder (MDD), according to data presented during the session.
Poor sleep is associated with slower improvement, lower remission rates, reduced quality of life, and faster relapse, independent of depression severity. In approximately one-third of patients, sleep difficulties do not resolve with antidepressant treatment, underscoring the need to assess and address sleep symptoms directly.
Sleep Across the Lifespan
The Congress also highlighted sleep care considerations for older adults. During “Evidence-Based Assessment and Management of Older Patients With Sleep Disorders,” Nery Diaz, DO, DFAPA, DFAAGP, examined age-related changes in sleep architecture, underdiagnosed sleep disorders, and medication safety considerations in this patient population.
Diaz focused on OSA and RLS as frequently missed or misdiagnosed conditions in older adults. The presentation highlighted several practical screeners, including the STOP-BANG and the Epworth Sleepiness Scale, to help identify patients requiring further evaluation.
Medication safety was another central theme. Benzodiazepines and nonbenzodiazepine receptor agonists can increase the risks of falls, cognitive impairment, delirium, motor vehicle accidents, dependence, and withdrawal in older adults, according to the presentation. Rather than relying on pharmacotherapy as first-line care, Diaz emphasized CBT-I and gradual, patient-centered deprescribing when appropriate.
Trauma-Related Sleep Symptoms
During “When Trauma Disrupts Sleep: Practical Interventions for PTSD-Related Sleep Disorders,” Gehrman and William Sauvé, MD, examined evidence-based approaches to targeting trauma-related sleep symptoms.
“I can probably count on one hand the number of PTSD patients who have said they sleep fine,” Gehrman told the audience. In one Veterans Affairs (VA) hospital study cited in the presentation, 60.7% of patients reported severe insomnia symptoms, while 50.7% experienced moderate or severe nightmares.
Gehrman reviewed CBT-I and imagery rehearsal therapy, in which patients rewrite a recurring nightmare and rehearse the revised narrative. Evidence supports imagery rehearsal therapy in sexual assault survivors with PTSD, although findings among veterans have been less consistent.
Sauvé then led the pharmacologic discussion, which centered on prazosin. Although several trials have reported improvements in trauma-related nightmares and sleep, a 304-patient VA trial found no significant benefit for nightmares, sleep quality, or global improvement. The faculty discussed whether adrenergic tone and baseline blood pressure might help explain differences in response while reviewing risks such as hypotension and falls.
They also highlighted NightWare, a prescription digital therapeutic that uses smartwatch data to detect possible nightmare-related arousal and deliver haptic stimulation. In a 72-patient trial, active and sham treatment did not differ significantly overall, although greater improvement emerged among participants who used the device consistently
Implications for Practice
The sleep-focused programming at this year’s meeting encourages clinicians to develop a more well-rounded understanding of sleep across psychiatric diagnoses, patient populations, and treatment settings. Greater familiarity with assessment tools, behavioral and pharmacologic interventions, deprescribing, and specialist referral may help clinicians identify sleep-wake disorders earlier and provide more comprehensive patient care.
For more news and insights from Psych Congress 2026, visit the meeting newsroom.
