Insomnia Study Interest Form
FREE NON-DRUG TREATMENT FOR INSOMNIA
Puget Sound Psychiatric Center is conducting research on the effectiveness of various non-drug treatments for Insomnia.
𝘊𝘳𝘪𝘵𝘦𝘳𝘪𝘢 𝘧𝘰𝘳 𝘐𝘯𝘴𝘰𝘮𝘯𝘪𝘢 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
>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.
𝘞𝘩𝘢𝘵 𝘢𝘳𝘦 𝘵𝘩𝘦 𝘤𝘰𝘮𝘱𝘭𝘪𝘤𝘢𝘵𝘪𝘰𝘯𝘴 𝘰𝘧 𝘪𝘯𝘴𝘰𝘮𝘯𝘪𝘢 𝘰𝘷𝘦𝘳 𝘵𝘪𝘮𝘦?
>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?
How can we be helpful in regards to your sleep health? Any further information can we provide?
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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