A good share of the people who book with us come for their sleep and find, a session or two in, that the thing underneath the sleep is a low mood that has been there for months. The reverse happens just as often: someone starts therapy for depression and it turns out the 4 a.m. waking is doing half the damage. Depression and insomnia run in a loop — poor sleep is both a symptom of depression and one of the better-documented risk factors for developing it. Our North Carolina clinicians treat both ends of that loop, and this page explains how.
Book An AppointmentMost people picture depression as sadness. In practice it is more often flatness: the things that used to be worth getting up for stop registering, and getting up itself becomes a negotiation. It shows up in the body as much as the mind, and it very rarely leaves sleep alone.
If several of these have been true most days for two weeks or more, the questionnaire below is a reasonable next step. It takes about two minutes.
The PHQ-9 is the nine-question screen most primary care practices in North Carolina use, published by Kroenke, Spitzer and Williams in 2001 and free to reproduce. It is a screening aid, not a diagnosis: a high score tells you it is worth talking to a clinician — one of ours, or any licensed clinician you trust — and a low score does not rule depression out. Your answers are scored in this browser and are never sent anywhere.
Over the last two weeks, how often have you been bothered by any of the following problems?
You answered that you have had thoughts of being better off dead or of hurting yourself. Whatever the rest of your score says, that answer matters on its own, and it is worth talking to someone today. Call or text 988 to reach the 988 Suicide & Crisis Lifeline, free, 24 hours a day, or chat at 988lifeline.org. If you are in immediate danger, call 911.
A self-score is a screening aid, not a diagnosis. The only way to know what it means for you is to talk it through with a licensed clinician — for example one of ours.
Talk to a North Carolina clinician about your scoreIf you are having thoughts of harming yourself, you do not need to finish a questionnaire first: call or text 988 (the 988 Suicide & Crisis Lifeline) any time, or call 911 if you are in immediate danger.
The clinicians on our North Carolina roster who work with depression are trained in cognitive behavioral therapy — the structured, present-focused approach with the strongest track record for depression — and most of them bring mindfulness, solution-focused work or motivational interviewing alongside it, depending on who you see. In plain terms that means sessions with an agenda: noticing the thinking habits that keep the mood low, testing them against what is actually happening, and rebuilding the daily structure that depression quietly dismantles.
What is different about doing this at a sleep clinic is that nobody has to guess about the nights. Every clinician here is also trained in Cognitive Behavioral Therapy for Insomnia. If your sleep is part of the picture — early waking, bedtime rumination, sleeping the day away — the CBT-I techniques go into the same treatment plan instead of being referred somewhere else, and in our experience the mood work moves faster once the nights are steadier. If you want the sleep side on its own, that is what ourtreatment process page describes; the full picture of what we treat alongside sleep is on our therapy and counseling page.
Our clinicians are therapists, not prescribers. Antidepressants are neither a requirement for working with us nor something we steer people away from; plenty of our clients are on one, plenty are not, and for moderate-to-severe depression the evidence favors therapy and medication together. If a prescriber conversation looks warranted we will say so and coordinate with your primary care doctor or psychiatrist, and if you already have one, we are glad to work in parallel.
We see most patients via telehealth with North Carolina-licensed clinicians, and a limited number of clinicians also see patients in person. The clinicians who take on depression work here are spread across the state — Charlotte, the Triad, the northeast coast — so a video session from Wilmington or Boone is with someone who knows North Carolina, not a call center. Sessions run weekly to start, most of them 50 to 60 minutes.
Three of the North Carolina clinicians whose work centers on mood as well as sleep. Thefull roster lists everyone, with licenses and credentials.
Randiesa Spires helps clients navigate relationship dynamics, past trauma, anxiety, depression, and other mood complexities, working collaboratively to build coping tools, strengthen relationships, and foster greater self-understanding. In addition to her broader clinical work, Randiesa has completed specialized training in Cognitive Behavioral Therapy for Insomnia (CBT-I), equipping her to support clients whose sleep difficulties may be connected to stress, anxiety, or emotional challenges. Her approach is warm and personalized, focused on helping clients gain clarity, develop practical strategies, and move toward healing at their own pace. Whether you're facing relationship struggles, emotional hurdles, or sleep concerns, Randiesa is ready to listen and guide you on your path to well-being.
MaryBeth Borreca is a Licensed Mental Health Counselor (LMHC) in Florida with more than five years of counseling experience and a Master of Science in Clinical Mental Health Counseling from the University of North Florida. She has completed specialized training in Cognitive Behavioral Therapy for Insomnia (CBT-I). MaryBeth is known for remaining fully present with each client, forming a unique therapeutic relationship and creating a space that feels both comfortable and appropriately challenging. She tailors sessions to individual needs while drawing on evidence-based treatment approaches. New clients can expect their first session to focus on getting acquainted, collaboratively setting treatment goals, and determining together whether the therapeutic fit feels right.
Jasmine Chesson is an active, engaged therapist who believes in being fully present in the work alongside her clients. Her style is steady, honest, and compassionate. She listens not only to what is said, but to the feelings, patterns, and pauses around it. Jasmine brings structure when it's helpful and spaciousness when clients need room to breathe, moving at a pace that honors each person's nervous system and real-life circumstances. She has completed specialized training in Cognitive Behavioral Therapy for Insomnia (CBT-I). Clients often describe feeling seen, grounded, and less alone in their work with her. Jasmine's goal is not to judge, but to help clients understand themselves more clearly and support them as they grow.
Therapy for depression is standard outpatient behavioral health care, which means it is covered by most North Carolina plans the way a specialist visit is. The plans we currently work with are Aetna, Blue Cross Blue Shield, Cigna / Evernorth, Medicare, UnitedHealthcare / Optum, UnitedHealthcare Medicare Advantage and Veterans Affairs Community Care Network. If you are a veteran using community care, or on a Medicare Advantage plan, tell us when you book so we can confirm the referral or authorization before your first session rather than after it.
Not on one of those plans, or not sure what yours covers? Get in touch and we will check your benefits for you before you commit to anything.
Yes, and for many North Carolinians that is the right plan. When low mood and broken sleep have been feeding each other for months, treating only one of them tends to leave the other pulling it back. Your clinician can run cognitive behavioral therapy for the depression and CBT-I for the sleep in the same course of care, and will tell you honestly which one to lead with.
For most adults it works as well as sitting in an office. Cognitive behavioral therapy delivered by telehealth has been compared with in-person delivery in controlled trials, with comparable results, and it removes the two obstacles that stop depressed people from getting help at all: getting to an appointment, and being seen walking into one. Everyone on our roster is licensed in North Carolina, so it does not matter whether you are in Asheville or Elizabeth City.
Structured therapy for depression is usually measured in months, not years. A common course is somewhere between twelve and twenty weekly sessions, with the first few spent on assessment and goals and the rest on the actual work. If sleep is part of the picture the CBT-I component typically runs six to eight sessions inside that. Your clinician will give you a realistic estimate after your first appointment rather than an open-ended commitment.
Treat it as a reason to talk to someone this week, not as a verdict. A score of twenty or more means your symptoms are heavy enough that you should be evaluated by a licensed clinician, and possibly by a prescriber as well; it does not on its own mean any particular diagnosis. If you answered anything other than "not at all" on the last question, or you are thinking about hurting yourself, call or text 988 now. For anything else, book an appointment with one of our North Carolina clinicians and bring your score with you.