Sleep Disorders
Insomnia
Insomnia is the most common sleep complaint there is. It's trouble falling asleep, staying asleep, or waking too early, even when you have every chance to rest, and it leaves you dragging through the day. The good news is that the most effective treatment for chronic insomnia isn't a pill at all, and we can help you get there.
Medically reviewed by Shariq Refai, MD, MBA, FAPA, board certified psychiatrist · Published June 7, 2026 · Last reviewed June 8, 2026 · Editorial policy
Understanding it
What is insomnia?
Everyone has the occasional rough night. Insomnia is different. It's persistent trouble falling asleep, staying asleep, or waking earlier than you want, despite having the time and the right conditions to sleep, and it leaves real wreckage in your days.
Insomnia counts as a disorder when it shows up at least three nights a week and the daytime fallout matters, like fatigue, poor focus, low mood, or being on edge. When that pattern runs three months or longer, we call it chronic insomnia, and that's where the most effective, lasting treatment really shines.
Insomnia is common, and it isn't a character flaw or a sign that you're doing something wrong. It's a treatable condition, and for most people the fix doesn't require a controlled sleeping pill.
How it shows up
Common symptoms of insomnia
Insomnia is about more than just the nights. The daytime cost is a big part of what makes it a problem worth treating. People with insomnia often notice several of these:
When worry about sleep becomes the problem
Insomnia has a cruel twist. The harder you try to sleep, the more wired you get, and the bed itself can start to feel like a place of stress rather than rest. Over time, the fear of not sleeping becomes its own engine, keeping the problem going long after whatever first set it off.
If trouble sleeping has lasted more than a few weeks and your days are paying for it, that's a solid reason to talk with a clinician, not something to just tough out.
- Lying awake for a long stretch before falling asleep
- Waking repeatedly through the night and struggling to drift back off
- Waking far too early and not being able to get back to sleep
- Feeling unrefreshed in the morning even after enough hours in bed
- Daytime fatigue, low energy, or sleepiness
- Trouble with focus, memory, or getting things done
- Irritability, anxiety, or low mood that tracks with bad nights
- Dreading bedtime or watching the clock with growing worry
Not one thing
Types and patterns of insomnia
Insomnia isn't all the same, and the pattern tells us something useful. Pinning down your particular shape of it helps point to the right plan. Common patterns include:
Why the pattern matters
These patterns point in different directions. Early morning waking can be a flag for depression worth treating directly. A racing mind at lights out often ties back to anxiety. Sorting out which pattern you have, and what's underneath it, comes before any prescription and shapes the whole plan.
- Sleep onset insomnia: trouble falling asleep at the start of the night, often tied to a racing mind
- Sleep maintenance insomnia: falling asleep fine but waking through the night and struggling to return to sleep
- Early morning waking: waking hours too soon and not getting back to sleep, a pattern that can come with depression
- Short term insomnia: a stretch of bad sleep tied to stress, illness, or a change, lasting under three months
- Chronic insomnia: trouble three or more nights a week for three months or longer
- Comorbid insomnia: insomnia that travels with another condition like anxiety, depression, or chronic pain
Why it happens
What causes insomnia?
Insomnia usually starts with one thing and gets kept alive by another. Stress or a change might set it off, then habits and worry take over and keep it going. Understanding both halves is part of treating it well.
- Stress, worry, or a difficult life change that sets off a stretch of bad sleep
- Anxiety and a mind that won't switch off at bedtime
- Depression, which classically brings early morning waking
- Irregular schedules, shift work, or a body clock that's drifted out of sync
- Habits that backfire, like long daytime naps, late screens, caffeine, or alcohol
- Sleep environments that work against rest, like noise, light, or an uncomfortable room
- Medical issues and some medications, plus conditions like sleep apnea that need their own path
- Conditioned arousal, where the bed itself starts to trigger wakefulness
Getting it right
How insomnia is diagnosed
Diagnosing insomnia starts with your story. We walk through your sleep pattern, when you go to bed, how long it takes to fall asleep, how often and how long you wake, when you get up, and how your days feel as a result. A simple sleep log kept for a week or two makes this much clearer.
Just as important, we look for what's underneath. We screen for anxiety, depression, and stress related conditions, review your habits and schedule, and check for medical contributors and sleep apnea, which needs a sleep study rather than the care we provide. There's no needed lab test for insomnia itself. The diagnosis comes from a careful conversation, and getting it right is what makes the treatment work.
What helps
How we treat insomnia
Here's the part most people don't expect. For chronic insomnia, the most effective treatment isn't a sleeping pill. It's a structured therapy called CBT-I, and the evidence behind it is strong. Our plans are built around it.
CBT-I, the first line treatment
CBT-I, cognitive behavioral therapy for insomnia, retrains the patterns that keep insomnia going. It reshapes the link between your bed and sleep, sets a consistent sleep window, and quiets the worry that builds around bedtime. Research shows it works as well as sleep medication in the short term and, unlike a pill, keeps working after treatment ends. That's why every major guideline names it the first line for chronic insomnia, and why we make it the center of the plan.
We coordinate CBT-I as the foundation and add other pieces around it, rather than reaching for a sedative first.
Why we don't use controlled sleeping pills
shrinkMD does not prescribe controlled substances, and that includes controlled sedative hypnotics for sleep. Those medications carry real risks of tolerance, dependence, and rebound insomnia, and they don't fix what's driving the problem. When medication has a role, we choose non controlled options and pair them with CBT-I and treatment of any underlying condition, so the gains actually last.
- A thorough evaluation that screens for anxiety, depression, and medical contributors
- CBT-I as the first line treatment for chronic insomnia, which we coordinate for you
- Treating any underlying condition, since fixing the anxiety or depression often restores the sleep
- Non controlled medication when it genuinely helps, never controlled sedative hypnotics
- Practical sleep habit changes around schedule, light, caffeine, and the bedtime wind down
Care at shrinkMD
What insomnia care looks like here
Your first visit is a full evaluation by secure video, as clinician availability allows. You'll meet a certified clinician, a psychiatrist or a psychiatric nurse practitioner, who takes the time to understand your nights, your days, and anything underneath the sleeplessness before building a plan with you.
Expect honest guidance toward CBT-I as the foundation, not a quick prescription for a sedative. CBT-I takes a few weeks to take hold, and the early steps can feel counterintuitive, so we stay in close contact and adjust as you go. If we treat an underlying anxiety or depression, you may notice your sleep improve as that lifts.
Care is virtual, so you can be seen from home, which fits a problem that's all about your own bedroom and routine. You stay with a clinician who knows your history over time, so the plan keeps moving forward instead of starting over at every visit.
“People come in convinced they just need a stronger sleeping pill. What they usually need is the right plan, and CBT-I gives most of them their nights back without the risks that come with controlled sedatives.”
Shariq Refai, MD, MBA, Founder of shrinkMD
Myths and facts
Clearing up common insomnia myths
Myth: A sleeping pill is the best fix for insomnia.
Fact: For chronic insomnia, CBT-I works better over time and keeps helping after it ends. Controlled sedatives carry risks of dependence and don't treat the cause, which is why we don't use them.
Myth: If I lie in bed long enough, I'll eventually sleep.
Fact: Staying in bed awake actually teaches your brain that the bed is a place to be alert. CBT-I rebuilds the link between bed and sleep, which is more effective than just waiting it out.
Myth: Insomnia is just a bad habit, not a real condition.
Fact: Chronic insomnia is a recognized disorder with real daytime consequences. It's treatable, and it deserves a proper evaluation rather than being brushed off.
Keep exploring
Related care and next steps
Related conditions
Frequently asked questions
Good questions, clear answers
What is the best treatment for insomnia?
For chronic insomnia, the first line treatment is CBT-I, cognitive behavioral therapy for insomnia. It works as well as medication in the short term and keeps helping afterward, so we build the plan around it and add non controlled medication only when it's truly needed.
Do you prescribe sleeping pills for insomnia?
Not controlled ones. shrinkMD doesn't prescribe controlled sedative hypnotics. We lead with CBT-I, treat any underlying condition, and use non controlled medication when it genuinely helps.
What exactly is CBT-I?
CBT-I retrains the habits and thoughts that keep insomnia going. It rebuilds the link between your bed and sleep, sets a consistent sleep window, and eases the worry that builds around bedtime. It's the proven first line for chronic insomnia.
How is insomnia diagnosed?
Through a careful conversation about your sleep pattern and daytime function, often helped by a sleep log, plus screening for anxiety, depression, and medical contributors. There's no required lab test for insomnia itself.
Why do I keep waking at the same early hour?
Early morning waking is a classic pattern, and it can point to depression worth treating directly. We look at what's underneath the waking rather than just the waking itself, because that's what guides the fix.
Can my anxiety or depression be causing my insomnia?
Very often, yes. Anxiety keeps the mind racing at bedtime, and depression brings early waking. When that's the driver, treating the condition is frequently what finally restores sleep, sometimes alongside CBT-I.
Is online care effective for insomnia?
Yes. Evaluation, CBT-I coordination, and medication management all work well by secure video, and being seen from home fits a problem that's centered on your own nights and routine.
How long until I sleep better?
CBT-I usually takes a few weeks to take hold, and the early steps can feel counterintuitive before they pay off. We stay in close contact and adjust the plan so you keep moving toward calm, restful nights.
Sources
Sources and further reading
Get started with insomnia care
You can sleep again, and you don't need a controlled sleeping pill to get there. Choose your state, complete the intake, and book your evaluation online, often as soon as availability allows.
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