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What is insomnia?

Nearly everyone experiences trouble sleeping from time to time and knows the feeling of slogging through the next day. Unfortunately, for people with insomnia—a medical condition that affects up to 10% of adults—things are much tougher than surviving a single bad night’s sleep. Insomnia can affect nearly every aspect of life, making even the most basic tasks challenging. Sometimes, the worry and stress it causes can worsen the condition itself, leading to a damaging spiral.
If you think you have insomnia, you don’t have to suffer alone. Insomnia is treatable, and help is available. The first step is getting a clinical diagnosis from a qualified mental healthcare professional, like a psychiatrist. There are many tools available to manage your symptoms and help you start sleeping better.
Insomnia is a sleep disorder that can make it hard to fall asleep, stay asleep, or get back to sleep after waking. If you have insomnia, you may have poor quality sleep and never feel well-rested. That exhaustion can affect your waking hours and have a damaging impact on your health, work, relationships, and overall quality of life.
There are several different types of insomnia. First, insomnia is categorized by duration (i.e., how long you’ve been experiencing sleep issues):
  • Acute insomnia, also known as short-term insomnia, can last for a few days to a week. It often has an identifiable cause, like a particular stressor or change in your environment or schedule.
  • Chronic insomnia, also known as long-term insomnia, is insomnia that occurs at least three nights a week, lasts more than three months, and cannot be explained by another health problem.
Insomnia is also categorized by the cause:
  • Primary insomnia is insomnia that occurs on its own.
  • Secondary insomnia is a symptom or side effect of another condition.
Depending on what type of insomnia you have, treatment options vary. For example, secondary insomnia may be cured by treating the original condition, whereas primary insomnia may need to be addressed directly.
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What are the symptoms of insomnia?

Symptoms of insomnia fall into a few categories. The first category includes what you experience at night:
  • Difficultly falling asleep
  • Frequently waking up during the night
  • Being unable to fall back asleep after wakeups
  • Waking up too early
The second category of insomnia symptoms are the daytime effects of poor sleep:
  • Daytime sleepiness
  • Feeling anxious, depressed, or easily irritable during the day
  • Difficulty with memory or recall
  • Difficulty focusing
  • Increases in errors or accidents
Both categories also include an additional symptom: being increasingly worried about not sleeping. Unfortunately, worrying about being able to sleep can make insomnia worse, which is why it’s so important to work with a qualified healthcare professional to break the cycle.
Sleep is a vital function for your overall health and wellbeing. While the exact amount of sleep you need varies, most experts agree that the average adult needs around 7-9 hours a night. If insomnia is keeping you from getting that much, it can have far-reaching effects on your physical and mental health. Chronic insomnia, for example, can lead to anxiety and depression and raises your risk of high blood pressure, coronary heart disease, diabetes, and cancer. Fortunately, professional help can make a major difference in your symptoms. Many therapeutic options exist to restore sleep and minimize your risk of any adverse side effects.
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What causes insomnia?

The cause of insomnia depends on the type. Secondary insomnia (meaning your insomnia is a side effect of another condition) can have a range of causes:
  • Mental health conditions: Conditions such as anxiety or depression can cause secondary insomnia if left untreated.
  • Medications: Certain drugs can sometimes cause insomnia as a side effect. Examples include certain antidepressants, stimulants, blood pressure medications, or asthma medications. In addition, many over-the-counter medications contain caffeine or stimulants, which can disrupt sleep.
  • Other medical conditions: Cancer, heart disease, diabetes, chronic pain, thyroid conditions, Alzheimer’s disease, Parkinson’s disease, restless leg syndrome, and sleep apnea can cause secondary insomnia.
  • Drug and alcohol use: Substance use issues, as well as withdrawal from drugs and alcohol, can disrupt sleep and cause secondary insomnia.
The main feature of primary insomnia is that it doesn’t have an identifiable external cause, but some risk factors include:
  • Age: Older adults tend to be more likely to have insomnia
  • Sex: Women tend to be more likely to have insomnia
  • Chronic stress: Living with major, long-term stress increases your risk for insomnia
  • A disrupted, irregular schedule: People who travel often or do night shift work, which can result in disruptions to their circadian rhythm, tend to be more prone to insomnia.
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How does Talkiatry treat insomnia?

The first step to treating insomnia is getting a diagnosis from a qualified mental healthcare professional, like a psychiatrist. While it can be easy to dismiss your symptoms, it’s important to remember that insomnia is a treatable medical condition. Help is available and many options exist to help you sleep better.
Secondary insomnia, such as insomnia caused by an anxiety disorder, is often resolved by treating the root cause. Primary insomnia requires its own treatment plan and is often managed with a combination of medication and therapy.
Your psychiatrist will ask you questions and may recommend additional testing to determine if your insomnia is primary or secondary. For example, they’ll ask about your sleep habits, as well as how long your insomnia has lasted. It may be helpful to keep a sleep diary for a few weeks before your visit. Writing down when you go to sleep, wake up, take naps during the day, exercise, and drink caffeine or alcohol can help your psychiatrist determine the nature of your sleep problems.
With Talkiatry, you can see a psychiatrist from the comfort of home and you can schedule your first appointment in a matter of days.
Here’s what to expect in your first visit:
Evaluation: During your first visit with a Talkiatry psychiatrist, you’ll get to meet each other and answer questions about your current symptoms, personal history, medical history, and mental health goals.
Diagnosis: Based on the information you’ve shared, your psychiatrist will be able to provide a diagnosis of your condition, if you have one. Getting a diagnosis can feel scary, but it can also feel validating to finally put a name to what you've been experiencing. Your psychiatrist will help you navigate any emotions that come up and work with you on a path to move forward.
Treatment plan: You’ll collaborate with your psychiatrist on the best way to manage your symptoms. If medication is appropriate, you’ll discuss your options, including the benefits and potential side effects of each medication. Your psychiatrist will provide supportive therapy throughout your session, and may also recommend working with one of our therapists. Our therapists partner with our psychiatrists to provide collaborative care.
To get started, take our free online assessment, to see if Talkiatry is right for you and get matched with a psychiatrist.  
Medication management
There are a range of prescription sleep aids available to treat insomnia. These drugs target different neurotransmitters, or chemicals in the brain that control different body functions.
  • Benzodiazepines, like lorazepam or temazepam, help calm and slow activity in the brain by enhancing the effects of the a naturally occurring chemical in your brain called GABA. These medications belong to a class of drugs called benzodiazepine receptor agonists which are generally recommended for short-term use.
  • Z drugs,” like zaleplon, zolpidem, and eszopiclone, have a different chemical structure than benzodiazepines, but work similarly to enhance the effects of GABA. They tend to be quicker-acting and not last as long in the body as benzodiazepines.
  • DORAS (dual orexin receptor antagonists) aid in falling asleep by blocking the effects of a wakefulness-promoting chemical called orexin.
  • Melatonin receptor agonists enhance the effects of melatonin, a naturally occurring chemical that regulates your sleep-wake cycle (i.e it tells your body when it’s time to rest and wake).
  • Sometimes, sedating antidepressants or antiseizure medications can also be prescribed to treat insomnia, especially if you have other conditions like depression or restless leg syndrome.
Not all of these medications are appropriate for everyone with insomnia. That’s why it's important to work closely with a qualified healthcare professional, like a psychiatrist, who can monitor your response to a given medication and make changes to your treatment plan as needed.
Lifestyle changes and therapy
Your psychiatrist may additionally recommend supportive therapy (also called “talk therapy") to treat your depression. If your psychiatrist thinks this could be effective for you, we have therapists on staff to work with patients who are seeing our psychiatrists. Talk therapy may help you challenge destructive thought patterns and develop healthy coping skills to manage your depression symptoms.
Cognitive behavioral therapy (CBT): If your insomnia is rooted in another mental health condition or stressful situation, your psychiatrist may also recommend talk therapy to help manage your insomnia. Typically offered by a therapist, this treatment may include CBT, a type of targeted therapy that's considered a first-line treatment for insomnia.
Cognitive behavioral therapy for insomnia (or CBT-i) aims to help you control or eliminate negative thoughts and actions that keep you awake. Stimulus control therapy is a CBT technique that helps you remove inputs that condition your mind to stay awake. For example, you may be coached to avoid naps, use the bed only for sleep, or impose other sleep restrictions that can paradoxically improve your sleep. Relaxation techniques may also be a part of your CBT-i treatment, which can help you decompress and ready your body for sleep.
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How to get started

If you think you might have insomnia, Talkiatry can help. The best way to start is to take our free assessment, and see if Talkiatry is the right fit for you. Based on your needs, you’ll be matched with one of our expert psychiatrists and you’ll be ready to schedule your first appointment in days.
In patients with insomnia, a treatment plan at Talkiatry may look like this:
Expect to hear a bit about your psychiatrist’s background and availability, and then to share exactly what brought you in. You may be asked about your medical history, day-to-day life, and goals and expectations for treatment. If you’re nervous about a particular element of treatment—say, taking medication—we want to hear about that, too! Your Talkiatry psychiatrist knows that the best treatment plan is the one you’ll stick to, so they’ll work with you to make sure Talkiatry is the best fit for you and come up with a plan you're comfortable with.
Tip #3
Receive your personalized treatment plan, which may include a combination of medication and supportive therapy.
Tip #4
Continuous care will include adjusting your treatment plan as needed.
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About Talkiatry

Talkiatry is a national psychiatry practice that provides in-network, virtual care. Co-founded by a patient and a triple-board-certified psychiatrist, Talkiatry has over 300 doctors, 100 insurance partners, and first visits available in days. We treat patients with a range of mental health conditions, including insomnia. Get started with a short online assessment.
The information in this article is for educational purposes only and should never be substituted for medical advice, diagnoses, or treatment. If you or someone you know may be in danger, call 911 or the National Suicide and Crisis Lifeline at 988 right away.
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