Quick answer
Trouble falling asleep, staying asleep or feeling rested often goes hand in hand with anxiety, depression, bipolar disorder or PTSD. Each can make the other worse, so we look at sleep and mental health together. Cognitive behavioral therapy for insomnia (CBT-I) is the recommended first treatment for long-term insomnia, and we use sleep strategies in visits, treat the condition underneath, and consider medication when it fits.
Key takeaways
- Depression, anxiety, bipolar disorder and PTSD commonly disrupt sleep, and poor sleep can make them harder to manage.
- CBT-I is the recommended first treatment for long-term insomnia. We help you find it.
- Good sleep habits help, but on their own they're usually not enough for long-term insomnia.
- Loud snoring or gasping for air at night can point to sleep apnea, which needs a medical sleep evaluation.
What it looks like
Everyone has a bad night now and then. insomnia: Trouble falling asleep, staying asleep or getting good-quality sleep, even when you have the time and a good place to sleep. is different: the trouble keeps happening even when you have the time and a good place to sleep, and it affects your days. When it happens at least 3 nights a week for more than 3 months, it's called chronic (long-term) insomnia.
Common signs, in plain language
- Lying awake for a long time before falling asleep
- Waking during the night and struggling to get back to sleep
- Waking much earlier than you want to
- Feeling tired, moody or low on energy during the day
- Nightmares, or dreading going to bed
These signs are a general guide, not a checklist for diagnosis.
How sleep and mental health connect
Insomnia is often driven by another problem, and mental health conditions are a frequent cause:
- Depression often brings trouble falling or staying asleep, or sleeping too much.
- Anxiety makes it hard to switch off and fall asleep.
- In bipolar disorder, sleep changes with mood. Needing much less sleep than usual can be a sign of a high period.
- With PTSD, insomnia and nightmares are part of the condition itself, and feeling on alert makes restful sleep hard.
Stress, caffeine, alcohol, irregular schedules and some medications, including some antidepressants, can also disrupt sleep. Worrying about sleep and watching the clock can make insomnia worse.
How it's evaluated
A careful evaluation looks at your sleep and everything around it:
- When you go to bed and get up, how long it takes to fall asleep, and how often you wake
- How long the trouble has lasted and how it affects your days
- Your mood, anxiety, trauma history and stress
- Caffeine, alcohol and other substances, and all your medications, including over-the-counter ones
A two-week sleep diary can help a lot. This is part of a comprehensive psychiatric evaluation.
If there are signs of sleep apnea: A breathing problem during sleep, where breathing stops and starts, which disrupts sleep. or another medical sleep disorder, such as loud snoring, gasping for air or breathing that stops and starts, please talk with your primary care provider or a sleep medicine provider. A sleep study may be needed, and we don't provide primary care or sleep studies.
How we help
Treating what's underneath. When anxiety, depression, bipolar disorder or PTSD is driving poor sleep, treating that condition is central, and it can help your sleep too.
Time to talk about sleep. Depending on your clinician, visits may include sleep hygiene and CBT-informed strategies, such as a steady wake-up time, a wind-down routine, and getting out of bed when you can't sleep. Good habits help, but on their own they're usually not enough for long-term insomnia.
CBT-I. CBT-I: A structured, usually 6- to 8-week program that changes the thoughts and habits that keep you from sleeping well. is the recommended first treatment for chronic insomnia, and it can be done by video or online. We refer you to a CBT-I provider when it fits. We don't offer standalone weekly therapy, but we're happy to help you find a therapist and, with your permission, we'll coordinate with them.
Medication, when appropriate. Sometimes medication helps, for the underlying condition, for sleep, or both. We explain the options and side effects so you can decide together.
Regular follow-ups. We check how you're sleeping and feeling, and adjust carefully over time.
Is it this or that?
Is it insomnia or something else?
| Insomnia with anxiety or depression | Possible sleep apnea | A shift in bipolar disorder | |
|---|---|---|---|
| What you notice | Trouble falling or staying asleep, or waking too early, along with worry or low mood. | Loud snoring, gasping for air, or breathing that stops and starts. You may not notice it until someone tells you. | Needing much less sleep than usual without feeling tired, with more energy or racing thoughts. |
| During the day | Tiredness, moodiness, trouble focusing. | Daytime sleepiness, headaches, waking up not feeling rested. | Feeling wired, unusually important or able to do many things at once, or talking fast. |
| Who to see | A psychiatric provider, and a CBT-I provider. | Your primary care provider or a sleep medicine provider. A sleep study may be needed. | Your psychiatric provider, soon. A much lower need for sleep can be a sign of mania or hypomania. |
Insomnia with anxiety or depression
- What you notice
- Trouble falling or staying asleep, or waking too early, along with worry or low mood.
- During the day
- Tiredness, moodiness, trouble focusing.
- Who to see
- A psychiatric provider, and a CBT-I provider.
Possible sleep apnea
- What you notice
- Loud snoring, gasping for air, or breathing that stops and starts. You may not notice it until someone tells you.
- During the day
- Daytime sleepiness, headaches, waking up not feeling rested.
- Who to see
- Your primary care provider or a sleep medicine provider. A sleep study may be needed.
A shift in bipolar disorder
- What you notice
- Needing much less sleep than usual without feeling tired, with more energy or racing thoughts.
- During the day
- Feeling wired, unusually important or able to do many things at once, or talking fast.
- Who to see
- Your psychiatric provider, soon. A much lower need for sleep can be a sign of mania or hypomania.
These can overlap: insomnia can also be a symptom of sleep apnea. This comparison is general information, not a diagnosis. Sources: AASM: Insomnia · NHLBI: Sleep apnea symptoms · VA: Sleep problems and PTSD · NIMH: Bipolar disorder
Medication quick facts
Medications FDA-approved for insomnia
These are the medications FDA-approved for insomnia. FDA approval reflects which uses a manufacturer chose to study and submit, not the only medications that help. Providers often use other medications off-label when research supports them. Your provider will talk with you about what fits you.
Browse by name. Your provider will talk with you about which options fit you.
Low-dose doxepin (Silenor)
A tricyclic antidepressant, used at a very low dose for sleep
- FDA-approved for
- Insomnia with trouble staying asleep.
- How it's taken
- Shortly before bedtime, at least 3 hours after a meal. For insomnia it's used at a very low dose (3 to 6 mg).
- Good to know
- It can't be taken with MAOI antidepressants, and it usually isn't recommended for people with severe sleep apnea. Tell your provider if your mood gets worse.
- Antidepressant warning
- In short-term studies, antidepressants increased suicidal thoughts and behaviors in people up to age 24. Anyone taking one should be watched closely for worsening, especially during the first few months and at times of dosage changes. Don't stop suddenly; talk with your provider first.
Source: FDA label (DailyMed): Silenor
General information, not medical advice; talk with your provider.
Ramelteon (Rozerem)
A melatonin receptor agonist (it acts on the brain's melatonin receptors)
- FDA-approved for
- Insomnia with trouble falling asleep.
- How it's taken
- Shortly before bedtime.
- Watch for
- Dizziness and tiredness. Rarely, serious allergic reactions. Tell your provider if your mood gets worse.
- Interactions
- Some medications raise its levels, and one can't be taken with it at all, so tell your provider everything you take.
Source: FDA label (DailyMed): Rozerem · NHLBI: Insomnia treatment
General information, not medical advice; talk with your provider.
Trazodone
An antidepressant. Off-label for sleep.
- FDA-approved for
- Depression in adults. Not FDA-approved for insomnia; sometimes used off-label at low doses for sleep.
- Evidence
- The American Academy of Sleep Medicine's 2017 guideline suggests not using trazodone to treat insomnia on its own. Your provider will explain when it might still make sense, such as when depression and sleep trouble come together.
- Watch for
- Dizziness or fainting when standing up. Rarely, a painful erection that won't go away, which needs emergency care.
- Antidepressant warning
- In short-term studies, antidepressants increased suicidal thoughts and behaviors in people up to age 24. Anyone taking one should be watched closely for worsening, especially during the first few months and at times of dosage changes. Don't stop suddenly; talk with your provider first.
Source: Cochrane review: antidepressants for insomnia (2018) · AASM guideline (2017), which suggests not using trazodone for insomnia · FDA label (DailyMed): Trazodone · AASM guideline: medications for chronic insomnia (2017)
General information, not medical advice; talk with your provider.
Mirtazapine (Remeron)
An antidepressant. Off-label for sleep.
- FDA-approved for
- Depression in adults. Not FDA-approved for insomnia.
- How it's taken
- Once a day, usually in the evening before sleep.
- Watch for
- Sleepiness, increased appetite and weight gain, and higher cholesterol.
- Antidepressant warning
- In short-term studies, antidepressants increased suicidal thoughts and behaviors in people up to age 24. Anyone taking one should be watched closely for worsening, especially during the first few months and at times of dosage changes. Don't stop suddenly; talk with your provider first.
Source: DREAMING trial, 2025 (randomized trial; benefit at 6 weeks only) · FDA label (DailyMed): Mirtazapine
General information, not medical advice; talk with your provider.
Benzodiazepines: temazepam, triazolam, estazolam, flurazepam and quazepam are also FDA-approved for insomnia. These are controlled medications with an FDA boxed warning about misuse, addiction, dependence and withdrawal. They can be helpful in some situations but are generally meant for short-term use. Controlled medications are considered only case by case (see our FAQ). Other controlled sleep medications are FDA-approved for insomnia too: zolpidem (Ambien), eszopiclone (Lunesta), zaleplon, and the orexin receptor blockers suvorexant (Belsomra), lemborexant (Dayvigo) and daridorexant (Quviviq). Zolpidem, eszopiclone and zaleplon carry an FDA boxed warning about complex sleep behaviors, such as sleepwalking and sleep-driving.
Brand names are listed for recognition only. Off-label means a medication is used for something the FDA hasn't specifically approved it for. Sleep medications can make it unsafe to drive or do tasks that need full alertness after taking them, and rarely cause complex sleep behaviors such as sleep-driving. Don't combine them with alcohol.
What to expect
What to expect
1Start your intake packet
Fill out our secure intake packet. Once it's submitted, we'll verify your insurance and call you to schedule your appointment.
2A careful evaluation
A longer video visit about your sleep, your mood and stress, your health, your medications and your goals.
3Understanding the picture
We explain what we think is disrupting your sleep, whether that's anxiety, depression, a mood shift, trauma, habits, or a medical sleep problem that needs a sleep evaluation, and why.
4Your plan
We talk through sleep strategies, CBT-I, treatment for the underlying condition and, if it fits, medication, and decide together.
5Regular follow-ups
We check how you're sleeping and feeling, and adjust carefully over time.
Bring this to your visit
Questions to ask your provider
Tick the ones you want to ask, then copy your list. Nothing is saved or sent.
Before your first visit
Information your provider will want to know
Tick what you have ready, then copy the list to fill in your notes. Nothing is saved or sent.
Frequently asked questions
What is CBT-I, and where do I get it?
CBT-I is a structured program, usually 6 to 8 weeks, that changes the thoughts and habits that keep you from sleeping. It can be done with a trained therapist, by video or through online programs. Depending on your clinician, visits may include CBT-based sleep strategies, and we can help you find a CBT-I provider.
Do I need a sleep study?
Usually not for insomnia. A sleep study is used when sleep apnea or another sleep disorder is suspected. If that's a question, please see your primary care provider or a sleep medicine provider; we don't provide sleep studies.
Will I need a sleeping pill?
Not always. Treatment depends on what's driving your sleep problem. CBT-I and treating the underlying condition come first, and medication is one option your provider may talk through with you.
Does melatonin help?
Research hasn't shown that melatonin supplements are an effective treatment for insomnia, and the American Academy of Sleep Medicine suggests not using it for long-term insomnia. Tell your provider about any supplements you take.
Can you treat sleep problems by video?
Most visits are by secure video, anywhere in New Jersey. Our office is in Mount Laurel, NJ, and in-person visits there are limited and by appointment only; ask our office.
Is a psychiatric nurse practitioner the same as a psychiatrist?
Both diagnose psychiatric conditions and prescribe psychiatric medication. Ours are board-certified psychiatric nurse practitioners (PMHNP-BC), focused on careful evaluation and medication management.
Check your understanding
Three quick questions
1What's the recommended first treatment for long-term insomnia?
CBT-I is recommended as the first treatment for chronic insomnia in adults.
2Which can be a sign of sleep apnea?
Loud snoring, gasping and breathing that stops and starts can point to sleep apnea, which needs a medical sleep evaluation.
3In bipolar disorder, what sleep change can be a warning sign?
A much lower need for sleep can be a sign of a high period, so it's worth telling your provider soon.
Myth or fact? Sleep and mental health
Choose an answer for each to see the explanation. Nothing is saved.
1Good sleep habits alone fix long-term insomnia.
Myth. Habits help, but on their own they're usually not enough. CBT-I is the recommended first treatment.
2Sleep problems can be part of PTSD itself.
Fact. Insomnia and nightmares are symptoms of PTSD.
3A nightcap helps you sleep better.
Myth. Alcohol may help you fall asleep, but it makes sleep lighter and you're more likely to wake during the night.
The science: how we checked this
Sources
- AASM (sleepeducation.org): Insomnia
- NHLBI: Insomnia
- NHLBI: Insomnia causes and risk factors
- NHLBI: Insomnia treatment
- NHLBI: Sleep apnea symptoms
- VA National Center for PTSD: Sleep problems and PTSD
- NIMH: Bipolar disorder
- Edinger et al. Behavioral and psychological treatments for chronic insomnia: AASM guideline (2021)
- Sateia et al. Medications for chronic insomnia in adults: AASM guideline (2017)
- Qaseem et al. Management of chronic insomnia disorder: American College of Physicians guideline (2016)
- FDA label (DailyMed): Silenor (doxepin)
- FDA label (DailyMed): Rozerem (ramelteon)
- FDA label (DailyMed): Trazodone
- FDA label (DailyMed): Mirtazapine
How we checked this
- Written in our own words from the American Academy of Sleep Medicine, NHLBI, the VA National Center for PTSD, NIMH, published guidelines and the FDA labels on DailyMed, checked October 25, 2026.
- Signs are described in plain language and aren't a diagnostic checklist.
