Nadia Okonkwo

Clinician Response Notes:

The clinician reflected back the client's account of lying awake rehearsing worst-case health outcomes, and named the exhaustion that follows a broken night as an expected physiological cost rather than a personal failing. Psychoeducation was offered on the sleep-anxiety loop, in particular how checking symptoms at 3am reinforces the alarm response. Two immediate levers were introduced: a fixed wake time regardless of sleep quality, and a written worry window earlier in the evening so the bedroom stops doubling as a problem-solving space.

Initial Clinical Impression:

The presentation — sleep-onset difficulty averaging 90 minutes, frequent night waking, daytime fatigue, and recurrent body-scanning for signs of illness — is consistent with chronic insomnia maintained by health-focused anxiety. This is a provisional working formulation; structured measures will be administered before any diagnosis is recorded.

Plan & Next Steps:

Next session will begin with a sleep diary review covering seven consecutive nights, alongside a brief anxiety inventory. We will map the triggers that precede late-night checking and test whether the urge fades without reassurance-seeking. The early focus is on stimulus control — bed for sleep only, out of the room after twenty minutes awake — paired with a wind-down routine the client can keep on shift weeks. Next session is booked for the same slot in seven days.

Note prepared 11 December 2025, reviewed by M. Vega