Insomnia Study Interest Form

Puget Sound Psychiatric Center is conducting research on the effectiveness of various non-drug treatments for Insomnia.

š˜Šš˜³š˜Ŗš˜µš˜¦š˜³š˜Ŗš˜¢ š˜§š˜°š˜³ š˜š˜Æš˜“š˜°š˜®š˜Æš˜Ŗš˜¢ š˜Ŗš˜Æš˜¤š˜­š˜¶š˜„š˜¦š˜“ š˜¢ š˜±š˜³š˜¦š˜„š˜°š˜®š˜Ŗš˜Æš˜¢š˜Æš˜µ š˜¤š˜°š˜®š˜±š˜­š˜¢š˜Ŗš˜Æš˜µ š˜°š˜§ š˜„š˜Ŗš˜“š˜“š˜¢š˜µš˜Ŗš˜“š˜§š˜¢š˜¤š˜µš˜Ŗš˜°š˜Æ š˜øš˜Ŗš˜µš˜© š˜“š˜­š˜¦š˜¦š˜± š˜²š˜¶š˜¢š˜Æš˜µš˜Ŗš˜µš˜ŗ š˜°š˜³ š˜²š˜¶š˜¢š˜­š˜Ŗš˜µš˜ŗ, š˜¢š˜“š˜“š˜°š˜¤š˜Ŗš˜¢š˜µš˜¦š˜„ š˜øš˜Ŗš˜µš˜© 1 š˜°š˜³ š˜®š˜°š˜³š˜¦ š˜°š˜§ š˜µš˜©š˜¦ š˜§š˜°š˜­š˜­š˜°š˜øš˜Ŗš˜Æš˜Ø:
>Difficulty initiating sleep
>Difficulty maintaining sleep, characterized by frequent awakenings or problems returning to sleep after
>Early morning awakening with inability to return to sleep

This includes a predominant complaint of dissatisfaction with sleep quantity or quality, associated with 1 or more of the following: Difficulty initiating sleep, Difficulty maintaining sleep, characterized by frequent awakenings or problems returning to sleep after awakenings, Early morning awakening with inability to return to sleep.

š˜žš˜©š˜¢š˜µ š˜¢š˜³š˜¦ š˜µš˜©š˜¦ š˜¤š˜°š˜®š˜±š˜­š˜Ŗš˜¤š˜¢š˜µš˜Ŗš˜°š˜Æš˜“ š˜°š˜§ š˜Ŗš˜Æš˜“š˜°š˜®š˜Æš˜Ŗš˜¢ š˜°š˜·š˜¦š˜³ š˜µš˜Ŗš˜®š˜¦?
>The impacts on physical health are higher blood pressure, impaired immune system, higher risk of diabetes,
and/or weight control issues.

>The impacts on mental health are increased anxiety, depression, and/or emotional dysregulation. There can
also be slowed reaction time and poorer job performance.

If interested, please fill out the information below to get in touch with the Principal Investigator. They will be getting in touch with you as soon as possible to discuss your options for treatment. We encourage you to look at our website to learn more about our clinic, and insomnia as a disorder.
Your Name (first and last) *
How would you prefer to be contacted? *
Email Address
Phone Number
How can we be helpful in regards to your sleep health? Any further information can we provide?
Further Information:
Please Remember to click submit, and we will get in touch with you as soon as possible.

Disclosure: This is a non-paid study and your participation is appreciated, the treatment methods used are not 100% effective however the intention is to provide you with suitable treatment to meet your sleep health needs.
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