Online insomnia treatment
in California.
Insomnia is rarely just insomnia. Most chronic sleep problems have an underlying psychiatric driver — anxiety, depression, ADHD, or PTSD. Treating the right thing makes more difference than any sleep aid.
Request an AppointmentInsomnia and its psychiatric roots
Most insomnia presenting to a psychiatric practice is not primary — it's a symptom of something else. Anxiety keeps the brain in vigilance mode past the point where sleep is possible. Depression disrupts sleep architecture, causing frequent awakenings or early morning waking. ADHD leads to delayed sleep phase — difficulty winding down, racing thoughts at night, and late-to-bed patterns. PTSD causes hyperarousal and nightmares that fracture sleep. Bipolar disorder, substance use, and even unmanaged chronic pain all affect sleep significantly.
Treating the underlying condition often resolves the insomnia. Treating insomnia without identifying the underlying cause results in dependence on sleep aids that don't address the root.
Primary insomnia
When insomnia persists even after treating co-occurring conditions, or when no clear psychiatric cause is identified, insomnia is evaluated as a primary condition. Primary insomnia is a diagnosis of exclusion — it requires ruling out other explanations first. Medical causes (sleep apnea, restless legs, thyroid, chronic pain) and medications are also considered.
CBT-I (Cognitive Behavioral Therapy for Insomnia) is the gold standard treatment for primary insomnia and produces more durable results than medication alone. It involves sleep restriction, stimulus control, and cognitive restructuring. Finding a CBT-I trained therapist can be difficult, but the approach is worth seeking out.
Medication for insomnia
The goal with sleep medication is to address the specific mechanism at play — not to provide a general sedative indefinitely. Non-habit-forming options are preferred whenever possible.
Non-habit-forming options
- Hydroxyzine: an antihistamine with sedating properties, no dependency risk, commonly used for anxiety-driven sleep onset difficulty
- Mirtazapine (low dose): an antidepressant that at low doses (7.5–15 mg) has pronounced sedating and appetite-stimulating effects; often chosen when depression, anxiety, or low appetite co-occur
- Trazodone: an antidepressant widely used off-label for insomnia; not habit-forming and generally well-tolerated
- Low-dose quetiapine: an atypical antipsychotic used off-label for insomnia at doses well below its antipsychotic range; useful when anxiety or mood instability also contribute
Medications approached with caution
Benzodiazepines (lorazepam, temazepam) and Z-drugs (zolpidem, eszopiclone) are effective short-term but carry real risks of tolerance, dependence, and withdrawal with continued use. They suppress normal sleep architecture with chronic use. These are not prescribed as long-term solutions.
Melatonin and supplements
Melatonin is available over-the-counter and can help with sleep timing — particularly for delayed sleep phase. It is not a sedative. The evidence supports its use for circadian rhythm issues more than for typical insomnia.
ADHD and sleep timing
ADHD is commonly associated with delayed sleep phase — difficulty initiating sleep at a conventional time, often combined with difficulty waking in the morning. Stimulant dosing timing matters: taking stimulants too late in the day can significantly worsen sleep onset. This is one reason ADHD management and insomnia cannot always be addressed separately.
Medication decisions are individualized and depend on diagnosis, medical history, current medications, and clinical appropriateness. This page is educational and does not replace individualized medical advice. If you are in crisis, call 988 or go to the nearest emergency room.
Insurance and cost
Accepted plans: Aetna, Cigna, Quest Behavioral Health, Carelon Behavioral Health, Anthem Blue Cross California. See insurance details or call (323) 970-2625.
Insomnia that has been going on for months is worth evaluating properly.
Request an AppointmentInsomnia questions,
answered plainly.
Insomnia can be primary, but it's more often a symptom of anxiety, depression, ADHD, PTSD, or bipolar disorder. A psychiatric evaluation identifies whether insomnia is primary or driven by something else — which determines the treatment approach.
Non-habit-forming options are preferred: hydroxyzine, mirtazapine, trazodone, low-dose quetiapine. Benzodiazepines and Z-drugs (zolpidem) are effective short-term but carry dependency risks with long-term use and are not prescribed as ongoing solutions.
Yes. CBT-I (Cognitive Behavioral Therapy for Insomnia) is the gold standard and produces more durable results than medication alone. Treating the underlying psychiatric condition also often resolves insomnia without dedicated sleep medication.
Treating the primary condition often improves or resolves the insomnia. The evaluation and treatment plan will address both together — not as separate issues requiring separate solutions.
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