Insomnia Treatment at Feel August
Chronic insomnia affects roughly one in three adults and is rarely a stand-alone condition. Underneath most cases is anxiety, depression, ADHD, trauma, perimenopause, or a primary sleep disorder that needs a different specialist. At Feel August, insomnia care begins by identifying the root cause — not by reflexively prescribing a hypnotic.
Understanding Insomnia
Insomnia is the persistent difficulty falling asleep, staying asleep, or waking too early — accompanied by daytime fatigue or impairment. Acute insomnia is short-term and usually traceable to a stressor. Chronic insomnia (more than three months) is almost always layered on top of another condition: anxiety, depression, untreated ADHD, trauma, hormonal changes, or sleep apnea.
Sedative-hypnotic medications can paper over the symptom, but they rarely solve chronic insomnia and often create new problems (tolerance, rebound, daytime sedation). The more durable approach is to identify the underlying driver and treat that — combined with cognitive behavioral therapy for insomnia (CBT-I), which is the gold-standard non-pharmacologic treatment.
Recognizing the Signs
- Persistent difficulty falling asleep within 30 minutes
- Frequent nighttime awakenings or early-morning waking
- Sleep that does not feel restorative
- Daytime fatigue, low concentration, or irritability
- Worry about sleep that itself interferes with sleep
- Symptoms occurring three or more nights per week for three or more months
Our Approach
Treatment at Feel August
Insomnia treatment at Feel August begins with a careful evaluation of what is keeping you up — anxiety, depressive ruminations, hyperarousal, hormonal shifts, or signs that point toward a primary sleep disorder requiring a sleep specialist. Treating the underlying driver often resolves the sleep itself.
When a sleep aid is appropriate, we favor evidence-based options with a favorable risk profile (e.g., trazodone, doxepin, melatonin agonists) over benzodiazepines or Z-drugs. We coordinate with CBT-I-trained therapists, and we revisit the medication plan regularly so you are not on a sedative longer than clinically necessary.
What to Expect at Your First Appointment
Your first appointment is 60 minutes. Come prepared to describe your sleep pattern in detail — when you go to bed, how long it takes to fall asleep, how often you wake, what you notice in your mind during those wakeful periods. A sleep diary covering the prior week is helpful if you can keep one.
Your provider will assess for psychiatric drivers of insomnia and screen for primary sleep disorders. You will leave with a plan that may include treating an underlying condition, a referral for sleep study if indicated, CBT-I referral, and — if appropriate — an evidence-based sleep medication.
Frequently Asked Questions
- Should I see a psychiatrist or a sleep specialist?
- It depends on the cause. If your insomnia is driven by anxiety, depression, trauma, or ADHD, a psychiatric provider can address the root condition. If you have signs of obstructive sleep apnea, restless legs syndrome, or another primary sleep disorder, a sleep medicine specialist (and often a sleep study) is the right path. We screen for both at the first visit and refer when appropriate.
- Will you prescribe a sleep medication?
- Sometimes — but it is not our default. We prefer to identify and treat the underlying driver first. When a sleep aid is clinically appropriate, we favor evidence-based options with a favorable safety profile and revisit the plan regularly so the medication is not used longer than necessary.
- What is CBT-I?
- Cognitive behavioral therapy for insomnia is a structured, short-term therapy proven more effective than medication for chronic insomnia in head-to-head studies. It addresses sleep-incompatible thoughts and behaviors directly. We can refer you to CBT-I-trained therapists in California.
- Are sleep medications safe long-term?
- Some are, some are not. Benzodiazepines and Z-drugs (zolpidem, eszopiclone) carry meaningful long-term risks including tolerance, dependence, and increased fall and cognitive risk in older adults. Other options (trazodone, doxepin, melatonin agonists) have more favorable long-term profiles. Your provider will discuss the tradeoffs of any medication recommended.
- Can online psychiatry treat insomnia?
- Yes. Insomnia evaluation and medication management is well-suited to telehealth. Feel August provides care via secure video throughout California.
Related Conditions
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