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Insomnia Treatment in Telemedicine
Insomnia is more than just a bad night of sleep. It is a sleep disorder that can make it hard to fall asleep, stay asleep, or wake up too early in the morning, even when there is enough time and opportunity to sleep. It becomes Insomnia Disorder when it happens at least 3 nights per week for 3 months or longer and causes daytime impairment such as fatigue, poor concentration, or reduced performance, and it does not occur exclusively in the context of another sleep, psychiatric or medical disorder or the effect of a substance or medicine.
Insomnia is common, and many adults experience symptoms at some point. When daytime impairment and chronicity are included, insomnia disorder affects a smaller portion (6%) of the population [1]. It is also more common in women than in men. The right Insomnia Treatment can restore both restful sleep and daytime functioning.
What insomnia feels like
People with insomnia may notice:
- Trouble falling asleep
- Waking up during the night
- Waking too early and not being able to fall back asleep
- Feeling unrefreshed in the morning
- Daytime sleepiness or fatigue
- Trouble focusing or thinking clearly
For many patients, insomnia also becomes frustrating and stressful, especially when poor sleep starts affecting work, mood, and daily life.
Common causes of insomnia
Anxiety and depression are frequent contributors. Other medical or sleep-related problems, including sleep apnea and restless legs syndrome, may also present with insomnia symptoms. Perimenopause and chronic medical illness are additional common associations.
Development of Insomnia Disorder
Insomnia disorder is accompanied by evidence of increased physiological arousal. Average heart rate is higher [2], there is increased cortisol in the urine [3], PET scans show increased glucose use in wake and non-rapid eye movement sleep [4]. These findings are indicators of increased arousal, not causes of increased arousal. The increased neurophysiological arousal might explain these findings as well as the insomnia.
There are two ways to think about the development of Insomnia Disorder:
Worrying about stressors in life disturbs sleep. When sleep is disturbed, these patients start worrying about their ability to sleep and the daytime effects of insomnia. This further increases their feelings of stress. They especially worry and catastrophize about poor sleep and its effects when they are in bed. This worsens and prolongs the insomnia.
The increased physiological arousal is neurophysiological or neuroendocrine. A predisposition to insomnia (perhaps genetic), life circumstances, an aging brain, hormonal changes in menopause, etc., singly or in combination, may lead to neurohormonal changes causing the increased arousal and insomnia.
Insomnia Treatment options
Treatment works best when it addresses both the cause of insomnia and the insomnia pattern itself.
If another condition is contributing to poor sleep, that condition should be treated. Examples include anxiety, depression, sleep apnea, restless legs syndrome, and chronic medical illness.
For chronic insomnia disorder, cognitive behavioral therapy for insomnia (CBT-I) may help. CBT-I may include:
- Sleep scheduling
- Stimulus control
- Sleep restriction therapy
- Cognitive strategies to reduce worry about sleep
- Relaxation methods
A common mistake is spending extra time in bed in an effort to “catch up” on sleep. For many people with insomnia, this actually makes the condition worse. Carefully limiting time in bed can improve sleep drive and help reset the sleep pattern.
Medicines may be beneficial. Most FDA-approved medicines for insomnia are controlled substances. Certain medicines that are FDA-approved for other disorders but not specifically for insomnia (off-label use), and have been shown to decrease arousal [5,6] may help Insomnia Disorder.
Why insomnia matters
Chronic insomnia can affect mood, memory, concentration, and day-to-day functioning. It may also worsen health over time and should not be dismissed as “just stress” or something a person has to live with.
How our practice can help
Our self-pay telemedicine practice provides individualized care for patients with insomnia and related sleep concerns. We can help with:
- Evaluation of insomnia symptoms
- Identification of contributing causes
- Medication management (using medicines that are not controlled substances)
Take the next step
If you have trouble falling asleep, staying asleep, or waking too early, and it is affecting how you feel during the day, a telemedicine visit can be a practical first step. A structured treatment plan can help improve sleep without relying on guesswork.
Schedule a telemedicine visit today to discuss your insomnia and treatment options.
Frequently asked questions
Insomnia is difficulty falling asleep, staying asleep, or waking too early despite enough opportunity for sleep, along with daytime impairment. Chronic insomnia occurs at least 3 nights per week for 3 months or longer.
Yes. Insomnia symptoms are common in adults, and insomnia disorder is less common but still affects a meaningful portion of the population.
Insomnia disorder may be a disorder of increased neurophysiological arousal. Other common causes of insomnia include anxiety, depression, sleep apnea, restless legs syndrome, medical illness, and hormonal changes such as perimenopause.
Yes. We do not prescribe controlled substances such as sleeping pills. Medicines that are FDA-approved for other disorders but also decrease arousal, used off-label, may help treat insomnia disorder.
References
- Ohayon MM. Prevalence of DSM-IV diagnostic criteria of insomnia: distinguishing insomnia related to mental disorders from sleep disorders. J Psychiatr Res. 1997;31:333–46. https://pubmed.ncbi.nlm.nih.gov/9306291/ PubMed
- Bonnet MH, Arand DL. Heart rate variability in insomniacs and matched normal sleepers. Psychosom Med. 1998;60:610–5. https://pubmed.ncbi.nlm.nih.gov/9773766/ PubMed
- Vgontzas AN, Bixler EO, Lin HM, Prolo P, Mastorakos G, Vela-Bueno A, Kales A, Chrousos GP. Chronic insomnia is associated with nyctohemeral activation of the hypothalamic-pituitary-adrenal axis: clinical implications. J Clin Endocrinol Metab. 2001;86:3787–94. https://pubmed.ncbi.nlm.nih.gov/11502812/ PubMed
- Nofzinger EA, Buysse DJ, Germain A, Price JC, Miewald JM, Kupfer DJ. Functional neuroimaging evidence for hyperarousal in insomnia. Am J Psychiatry. 2004;161:2126–8. https://pubmed.ncbi.nlm.nih.gov/15514418/ PubMed
- Munday B, Kendall MJ, Mitchard M. A single dose study of trazodone with an assessment of its effect on mood and arousal. Br J Clin Phamacol. 1975;2:19-24. https://pubmed.ncbi.nlm.nih.gov/1234484/ PubMed
- Heinzer RC, White DP, Jordan AS, et al. Trazodone increases arousal threshold in obstructive sleep apnoea. Eur Respir J. 2008;31:1308-1312. https://pubmed.ncbi.nlm.nih.gov/18256066/ PubMed
Take the next step
A telemedicine visit with Dr. Sangal can be a practical first step toward answers and a plan.
Self-pay · Telemedicine for residents of California, Massachusetts & Michigan