This client is, in fact, experiencing significant life stress... a child with special behavioral needs who often exasperates her, a recent move, employment uncertainty etc... (her presenting problem focused on these issues the sleeplessness was raised as an aside...) she still denies experiencing anxiety or tension and claims that the problem with morning insomnia predated these current stressors. If the medical exam turns up nothing I may want to explore the classical conditioning angle and maybe work to get her to pinpoint relevant thoughts- which she denies that she has except for "noticing that I'm still awake one hour later" and not knowing what to do about it. she also did tell me that her attempts at visualization / relaxation etc. do not seem to help.
Thank you all so much for your input!