Sleep — the input that shapes everything.

Sleep architecture shapes attention, memory consolidation, mood regulation, autonomic balance, and immune function. A patient arriving with brain fog, low mood, or attention loss who has eight hours on the Fitbit but fragmented architecture underneath has a different problem from a patient with the same complaint and intact sleep — and a different programme.

We don't do polysomnography. We don't diagnose sleep apnoea. Where those are indicated, we refer to sleep physicians. What we do is examine the cortical and autonomic contributors and work the levers we have — sleep timing, autonomic regulation, evening cognitive load, light-and-temperature management.

• Difficulty falling asleep — autonomic over-arousal at the bedtime transition.
• Early waking — often correlated with mood patterns; sometimes a stress-cortisol picture.
• Fragmented sleep — feeling unrested despite adequate hours.
• Shift-work and irregular schedule effects — cognitive consequences of disrupted circadian rhythm.
• Sleep after head injury, illness, or major life event — recovery picture rather than a stand-alone sleep problem.

We ask every patient with a sleep complaint to keep a 14-day sleep journal before their qEEG. The pattern that journal reveals is often more useful than any single night's recording. From there, we examine the brain at rest and the autonomic markers, and the formulation tends to point clearly at one or two levers.

If the picture suggests obstructive sleep apnoea, narcolepsy, or a circadian-rhythm disorder, we refer. We work alongside the sleep physician's plan; we don't duplicate it.