@grammato3 Thank you for the recommendation. My hesitation with CBT‑I‑based approaches comes from some of the messaging I’ve encountered, such as the idea that all “management strategies” are habit‑forming and that sedating medications inevitably stop working. The medications I’m currently on are not considered habit‑forming, and my concern is that if they lose effectiveness, I become too sleep‑deprived to advocate for myself or clearly describe my symptoms. Because of past experiences, I now carry detailed medical ID information to avoid being routed to settings that are not equipped to evaluate neurological symptoms.

I’m also seeking further diagnostic clarity because several findings in my past evaluations were attributed to anxiety, psychiatric causes, medication effects, or medication non‑compliance, even though they were biological in nature. These included elevated blood pressure (at stage 2 hypertension), REM sleep without atonia, somnambulism, mild sleep apnea, Romberg signs, mild cognitive impairment, elevated white blood cell counts, Elevated albumin
Elevated A/G ratios and very mild T2‑FLAIR white matter hyperintensities. The timing of these findings was often overlooked, and some symptoms that appeared only during specific episodes were later attributed to medication side effects, despite not occurring outside those episodes. Sure they did work ups, but they were either ignored, or never done punctually. I understand that medical workups were performed at different points, but many of them were either interpreted through a psychiatric lens or were not done during the period when the symptoms were actually present, or "being managed". Standard clinical guidance emphasizes ruling out medical causes before assuming a psychiatric origin. In my case, the sequence was reversed, which repeatedly delayed appropriate diagnostic evaluation.

I’ve also had significant adverse reactions and limited benefit from multiple antipsychotics and mood stabilizers, which was interpreted as treatment non‑compliance rather than a clinical finding. My goal is not to avoid treatment but to understand whether there may be an underlying neurological or sleep‑related process that has not been evaluated during an active episode.

During my initial ER visit, symptoms such as confusion, disorientation, and reduced speech were documented, noted as having a sub acute on set and an atypical psychosis [consistent with the effects of sleep deprivation] but no neurological workup was performed at that time, just drug and alcohol test, I later came across guidance stating that clinicians should consider autoimmune or synaptic causes in cases of first‑onset, out‑of‑the‑blue psychiatric symptoms, and that early evaluation is important. This is part of why I am seeking further clarity now.

I’m open to contacting the psychologist mentioned, but I want to make sure my concerns are understood clearly and not misinterpreted. For context, “CPR” in my records refers to Crisis Psychiatric Response. I have also reviewed records from my first hospitalization, where elevated blood pressure and involuntary movements were documented but not evaluated neurologically.
“In my case, CBT‑I would be retrograde. I already attempted CBT‑I principles during the crisis itself, and the issue wasn’t behavioral insomnia it is a complete inability to sleep, with a host of neurological symptoms. Asking me to use CBT‑I during that period would have been like asking someone having a grand mal seizure to stop shaking, or an absence seizure, to snap out of it.

My concern is simply that when a basic biological function like sleep and sleep drive vanishes entirely in an instant, it can produce symptoms that are difficult to categorize, or don't have language to express severity, insomnia is really not appropriate language, as the treatment algorithm goes, okay sleep hygiene hand out and CBT-i. I’m trying to understand the underlying cause so I can pursue the most appropriate care.
Maybe I am just not worthy of any more treatment, maybe I am just destined to die in a psych hospital.
The architectural separation of psychiatric hospitals from the rest of medicine doesn’t just inconvenience patients: it endangers them. It creates blind spots where medical conditions masquerading as psychiatric ones go uninvestigated. It delays care, to the point of brain damage, amputations, permanent disability and sometimes death. It fractures responsibility. It turns treatable crises into chronic damage. And for all its prestige, is not exempt from this design flaw, the original thesis was "all specialties under one roof, apparently expect for psychiatry) My story is not an exception. It is an example.