Chronic insomnia, sleep-onset issues, racing thoughts at night, sleep disrupted by anxiety or depression. Evidence-based evaluation and treatment.
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Insomnia is the most common sleep disorder, affecting roughly 1 in 3 adults at some point. Chronic insomnia means trouble falling asleep, staying asleep, or waking too early at least 3 nights a week for 3+ months — and it's affecting your daytime functioning.
From a psychiatric standpoint, insomnia is rarely "just" insomnia. It's often the first sign of an underlying issue — depression, anxiety, PTSD, ADHD, bipolar disorder, substance withdrawal, or a medication side effect — that needs to be addressed for sleep to actually improve.
Chasing sleep with sleeping pills alone often makes things worse over time. Effective treatment means understanding why you can't sleep and addressing the cause.
If symptoms are interfering with daily life — or if you've felt this way for more than two weeks — it's worth a conversation with a psychiatrist.
Effective treatment usually combines medication, therapy, and lifestyle factors. We work with you to find the right combination.
Treating depression, anxiety, PTSD, or ADHD often resolves insomnia. We screen for these at the first visit.
First-line, gold-standard non-medication treatment. We refer to vetted CBT-I therapists or recommend evidence-based apps.
Trazodone, mirtazapine, doxepin, or newer agents like suvorexant — chosen based on whether the issue is sleep onset, maintenance, or both.
Many psychiatric medications can disrupt sleep. We review your full medication list and adjust where possible.
Many "insomniacs" actually have undiagnosed sleep apnea. We refer for sleep studies when indicated.
We're cautious with benzodiazepines and z-drugs (Ambien, Lunesta) for chronic insomnia — they often work short-term but can cause dependence and rebound insomnia when stopped. We use them strategically when appropriate, not as long-term solutions.
The right approach depends on the cause. If you can't sleep because you're depressed, antidepressants that improve sleep (like mirtazapine) often solve both problems. If you're anxious at bedtime, treating anxiety treats sleep. If you have ADHD, evening rumination often improves with stimulant adjustment.
Initial evaluations are 60–90 minutes — we ask about sleep in detail (timing, environment, caffeine, alcohol, screens, exercise, stress) before reaching for medication.
Four California clinics for in-person care, plus TelePsychiatry for patients anywhere in the state.
We can — but we don't lead with them for chronic insomnia. Both can cause dependence and rebound insomnia. We discuss the trade-offs honestly. For some patients, short-term use is appropriate; for most chronic insomnia, there are better long-term options.
Cognitive Behavioral Therapy for Insomnia — a structured, evidence-based therapy program that's first-line for chronic insomnia. It typically runs 6–8 sessions and works as well or better than sleep medication, with effects that last.
Yes. Most insomnia evaluations and follow-ups work well over telehealth across all 58 California counties.
Melatonin works for some types of sleep issues (jet lag, circadian shifts) but not for most chronic insomnia. The next step is figuring out the cause — that's what we do at the first visit.
Yes. We accept Medi-Cal, Medicare, and most major commercial insurance for sleep-related psychiatric evaluation and treatment.
