Almost everyone who comes here is sleeping badly, and almost nobody mentions it in the first ten minutes. It gets treated as a consequence rather than a cause, which it is, but it is also the thing that is keeping the rest of it in place.
Four or five hours a night for months makes you more anxious, lower and less able to do anything about either. It is also, of everything on the list, the one most likely to shift inside a month with practical work.
So we ask early and in detail: what time you go up, what time the light goes off, what happens at three, and what you do about it. It is a tedious conversation and it earns its place.