Patient handout

Insomnia

You have been diagnosed with insomnia. This page explains what that means, how it is treated, and what you can do now.

Prepared by Alice Tran, PMHNP-BC, FNP-BC · Alice Tran Psychiatric Care · Updated October 2026

What it is

Insomnia is trouble falling asleep, staying asleep, or waking too early, at least three nights a week for three months or more, with daytime effects such as fatigue, irritability, or poor concentration. It is common, it usually has learnable causes, and the most effective treatment is a short structured program rather than a pill.

Common signs

• Lying awake thirty minutes or more at bedtime
• Waking in the night and struggling to get back to sleep
• Waking early and unable to return to sleep
• Dreading bedtime, watching the clock
• Daytime fatigue, fog, irritability, or low mood
• Sleeping better away from home or on the couch than in your own bed

Why it happens

Insomnia usually comes down to three things: a body clock out of sync with your schedule, too little built-up sleep pressure from naps, late mornings, or long hours in bed, and a brain stuck in alert mode because the bed has become a place of effort and worry. Anxiety, depression, pain, and some medications add to it.

How it is treated

• CBT-I (cognitive behavioral therapy for insomnia) is the first-line treatment in every major guideline. Over four to eight sessions it resets the body clock, rebuilds sleep pressure, and breaks the bed-worry link. Gains last after it ends.
• Medication has a role when sleep is severely disrupted or while CBT-I takes hold: usually short term, at the lowest dose. Options include trazodone, low-dose doxepin, newer orexin medications, and melatonin for timing problems.
• Treating the cause: anxiety, depression, pain, sleep apnea, or restless legs are addressed directly.
• Follow-up: a sleep diary for two weeks is the most useful thing you can bring.

What you can do now

• Fix your wake time, seven days a week, and get daylight within an hour of waking.
• No naps, and no caffeine after noon.
• Get into bed only when sleepy, and if you are awake more than twenty minutes, get up and do something quiet until sleepy again.
• Keep the bed for sleep and intimacy only. No phone, no work, no worrying in bed.
• Write tomorrow's list and your worries on paper early in the evening, not at bedtime.

Get help right away if

Good to know

• Spending less time in bed, not more, is the counterintuitive core of treatment, and it works.
• Alcohol helps you fall asleep and then fragments the second half of the night.
• Over-the-counter sleep aids such as diphenhydramine are not a good long-term plan; tell us if you use them regularly.

This handout is for education and is not a substitute for the instructions you received at your visit. Follow the dose on your prescription label. If anything here differs from what you were told, call the office. In an emergency, call 911. If you are in crisis, call or text 988.

Related: Insomnia treatment at Alice Tran Psychiatric Care · All patient resources