The Call-On-Doc Guide to Insomnia

Insomnia is defined as difficulty falling asleep, staying asleep, or waking too early, despite having adequate opportunity to sleep. Importantly, insomnia is not caused by choosing to stay up late or having an irregular schedule alone—it reflects an inability to obtain restorative sleep.

Insomnia may be:

• Primary (a standalone sleep disorder), or

• Secondary (comorbid) to medical, psychiatric, hormonal, or lifestyle-related conditions

According to the National Heart, Lung, and Blood Institute, insomnia symptoms may include:

• Taking a long time to fall asleep

• Sleeping in short, fragmented periods

• Waking too early and being unable to return to sleep

• Feeling unrefreshed despite adequate time in bed

• Daytime fatigue, poor concentration, or irritability

Yes. Insomnia is frequently a symptom rather than an isolated diagnosis. Conditions commonly associated with insomnia include:

• Anxiety and depression – racing thoughts and hyperarousal interfere with sleep

• Chronic stress or grief – stress hormones disrupt normal sleep cycles

• Chronic pain – discomfort prevents sustained sleep

• Allergies and respiratory conditions – congestion and itching disturb sleep

• Gastrointestinal disorders – reflux, IBS, and abdominal discomfort worsen at night

• Hormonal changes – pregnancy, PMS, menopause

• Neurologic conditions – including dementia

• Irregular sleep schedules – circadian rhythm disruption

• Medications – stimulants, some antidepressants, steroids

Addressing the underlying cause is a core principle of modern insomnia treatment.

According to Stanford Medicine, insomnia may be classified as:

• Transient insomnia – lasting days to weeks, often stress-related

• Short-term insomnia – lasting weeks, often tied to illness or life events

• Chronic insomnia – occurring ≥3 nights per week for ≥3 months

• Primary insomnia – no identifiable underlying cause

• Comorbid insomnia – occurring alongside another medical or mental health condition

Insomnia can also be described by symptom pattern:

• Difficulty falling asleep

• Difficulty staying asleep

• Early-morning awakenings

Insomnia usually results from multiple interacting factors, including:

• Psychological stress or mental health conditions

• Medical illnesses or chronic pain

• Poor sleep hygiene (screen use, caffeine, alcohol)

• Environmental factors (light, noise, temperature)

• Hormonal fluctuations

• Genetic predisposition

Over time, the brain can become conditioned to remain alert at night, perpetuating insomnia even after the original trigger resolves.

Insomnia is diagnosed clinically when sleep difficulty:

• Occurs at least 3 nights per week,

• Persists for 3 months or longer, and

• Causes daytime impairment

Evaluation may include:

• Sleep history and questionnaires

• Review of medications and mental health

• Screening for sleep apnea or circadian rhythm disorders

• Targeted lab testing to identify contributing conditions

Insomnia is considered severe when it:

• Significantly impairs work, relationships, or daily functioning

• Causes persistent fatigue, mood changes, or cognitive difficulty

• Coexists with anxiety, depression, chronic pain, or other disorders

Severe or chronic insomnia warrants medical treatment.

First-Line Treatment: CBT-I

Cognitive Behavioral Therapy for Insomnia (CBT-I) is the gold standard and first-line treatment. It addresses:

• Sleep-related thoughts and behaviors

• Circadian rhythm regulation

• Sleep efficiency and conditioning

Medications

When indicated, medications may be used short-term or adjunctively. Common options include:

• Doxepin (low-dose, sleep maintenance)

• Trazodone

• Ramelteon (melatonin-receptor agonist)

• Hydroxyzine

Medication choice depends on sleep pattern, comorbid conditions, and side-effect profile.

Lifestyle & Sleep Hygiene

• Consistent sleep and wake times

• Reduced screen exposure before bed

• Limiting caffeine and alcohol

• Optimizing sleep environment

• Stress-management strategies

Short-term insomnia may improve once triggers resolve. Chronic insomnia rarely resolves without intervention and can worsen over time if untreated.

If insomnia is affecting your daily life, CallOnDoc offers convenient, evidence-based insomnia care—including evaluation, treatment, and prescriptions—without appointments.

If you’re reading this while unable to sleep, you can start a visit now and have your prescription ready when your pharmacy opens.