Chronic Insomnia: Treatment, Symptoms, Diagnosis, and Online Care

At Talkiatry, we know that navigating mental health can feel overwhelming. Our mission is to make it easier—starting with information you can trust. As a national mental health practice with over 600 psychiatrists and other providers, we combine clinical excellence with real-world understanding to deliver incredible care and reliable information. This article has been medically reviewed by the same doctors who treat our patients every day, ensuring it meets the highest standards. Whether you’re seeking care now or simply looking to learn more, we’re here to help.

Chronic insomnia can feel like a relentless cycle of sleepless nights and exhausting days—but it doesn’t have to be permanent. Whether your insomnia is short-term or chronic, tied to another condition or seemingly out of the blue, understanding the symptoms, causes, and treatment options is the first step toward getting the rest you need.

What is insomnia?

Nearly everyone experiences trouble sleeping occasionally 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, 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. Many tools are available to manage your symptoms and help you start sleeping better.

Insomnia is a sleep disorder that can make it hard to fall, stay, 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 damage your health, work, relationships, and overall quality of life.

Types of insomnia

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 up to 3 months. It often has an identifiable cause, like a particular stressor, changes 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 consequence 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.

What are the symptoms of insomnia?

Symptoms of insomnia fall into a few categories. The first category includes what you experience at night:

• Difficulty 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 is 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—a pattern that can contribute to nighttime anxiety or even anxiety attacks that make it harder to fall asleep.

Sleep is vital for your overall health and well-being. 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 raise 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.

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.

How a psychiatrist can help

A psychiatrist does more than just treat symptoms—they work with you to understand what’s really going on. That means getting to the root cause of your sleep issues, whether it’s stress, anxiety, depression, or something else entirely.

From there, they’ll create a personalized treatment plan that feels right for you. That could include medication, lifestyle changes, therapy, or a mix of approaches—always with your input and comfort in mind.

As you move forward, your psychiatrist will check in regularly, tracking your progress and making adjustments as needed. It’s a supportive, ongoing partnership designed to help you truly heal—not just get by.

Insomnia diagnosis

Diagnosing insomnia starts with a conversation. A psychiatrist or other healthcare provider will ask about your sleep habits, daily routine, mental health, and overall lifestyle. They’ll want to know how long you’ve had trouble sleeping, what your nights typically look like, how long it takes you to fall asleep, what gets in the way of sleep, and how your sleep issues are affecting your mood, focus, or daily functioning.

There’s no single test for insomnia, so diagnosis is based on a thorough evaluation. Most often, this includes:

• A detailed sleep history: You may be asked to keep a sleep diary or describe your sleep patterns over the past few weeks.
  
• Questions about mental health: Because insomnia is often tied to conditions like anxiety or depression, your provider may ask about stress, mood changes, or other emotional symptoms.
  
• Medical screening: They’ll check for other possible causes, such as chronic pain, medications, or underlying health issues that can interfere with sleep.
  
• Sleep questionnaires or scales: Tools like the Insomnia Severity Index (ISI) may be used to better understand how your symptoms are showing up and how severe they are.
  

Sometimes, if another sleep disorder is suspected—like sleep apnea—a provider may recommend a sleep study (polysomnography), especially if you have frequent snoring or apneic episodes.

Diagnosing acute vs. chronic insomnia

The approach to diagnosis is similar for both types, but the timeline matters. Acute insomnia is short-term, often triggered by a specific stressor or life change. Chronic insomnia, on the other hand, means symptoms have been going on at least three nights a week for three months or longer. This distinction helps your provider decide how to move forward with treatment.

How Many Visits Does It Take?

For many people, insomnia can be diagnosed in just one or two visits. If your symptoms are clear and fit the diagnostic criteria, your provider can usually make a diagnosis quickly. In more complex cases, or if other conditions need to be ruled out, it might take a bit longer.

Psychiatry v. Therapy

When it comes to treating insomnia, you don’t have to choose between psychiatry and therapy. In fact, the two often work best when they work together.

Psychiatrists focus on the biological and medical side of sleep problems. They can assess whether your insomnia is linked to something like anxiety, depression, or a physical health condition. If needed, they can prescribe medications to help in the short term. (In the long term, therapies like CBT-I remain the gold standard.)

Therapists, on the other hand, help you work through the mental and behavioral patterns that affect your sleep. A gold-standard approach called Cognitive Behavioral Therapy for Insomnia (CBT-I) is especially effective. It helps you reframe anxious thoughts about sleep, build healthier routines, and reset unhelpful habits that may be interfering with rest.

Chronic insomnia treatment options

Medication management

There is 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, temazepam, or Xanax, help calm and slow activity in the brain by enhancing the effects of the 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, due to risks of dependence or addiction.

“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. They still carry some risks of dependence and addiction, as well as rebound insomnia and parasomnias.

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—like mirtazapine—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.

Therapy

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.

Online chronic insomnia treatment: How Talkiatry can help

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.