# Insomnia > Insomnia is the night shift nobody applied for: exhausted at eleven, wide awake at three, negotiating with the ceiling. Sleep is recoverable, and the best treatment is rarely a stronger pill. **Source:** https://www.uniquembhs.com/insomnia-treatment **Practice:** Unique Minds Behavioral Health Services, LLC. Baltimore, MD: 6810 Park Heights Ave, Suite C6, Baltimore, MD 21215 · Washington, DC: 1402 North Capitol St NW, #1, Washington, DC 20002 · Delaware, OH: 1 W Winter St, Suite 211, Delaware, OH 43015 **Phone:** (443) 538-8400 **Clinically reviewed by:** Dr. Barbara Clement Njoku, DNP, MSN, APRN, PMHNP-BC **Last reviewed:** 2026-08-11 ## Quick answer Insomnia is persistent difficulty falling asleep, staying asleep or waking too early, with daytime costs in mood, focus and energy. Unique Minds treats insomnia across Maryland, Washington, D.C. and Ohio using cognitive behavioral therapy for insomnia (CBT-I), careful review of medications and habits, and treatment of the anxiety or depression that so often keeps sleep broken. ## What insomnia actually is [MedlinePlus](https://medlineplus.gov/insomnia.html) defines insomnia as trouble falling asleep, staying asleep, or getting good-quality sleep, with the daytime bill that follows: fatigue, low mood, poor concentration and irritability. Short bouts around stress are universal. Chronic insomnia, three nights a week for three months or more, is a condition in its own right, and it rarely fixes itself, because the habits and dread that grow around bad nights become the thing maintaining them. Insomnia also keeps notorious company. Anxiety, depression, trauma and pain all break sleep, and broken sleep feeds each of them back. Treating the pair together is usually the answer; treating sleep alone while worry runs free is bailing with the tap on. ## The three shapes it takes Insomnia is not one complaint, and which one you have changes the plan: - **Sleep-onset insomnia**: lying awake at the start of the night, mind running. Most often paired with anxiety, or with a body clock that runs late. - **Sleep-maintenance insomnia**: getting off fine, then waking at two or three and failing to return. Frequently linked to alcohol, pain, depression, or a sleep window that has drifted longer than your actual sleep need. - **Early-morning waking**: surfacing hours before you intend to, unable to get back. Classically associated with depression, and worth mentioning explicitly at your evaluation. The other axis is time. **Short-term insomnia** arrives with an identifiable stressor and resolves with it: normal, and usually needs no treatment. **Chronic insomnia** is roughly three nights a week for three months or more, and it is the one that will not resolve on its own, because by then the original cause has been replaced by the habits built around it. ## What keeps insomnia going after the stress has passed This is the most useful thing to understand about the condition, because every item on the list feels like sensible coping: - **Spending longer in bed** to catch up. This dilutes your sleep across more hours and teaches your brain that bed is a place for lying awake. - **Napping and lie-ins**, which discharge the sleep pressure you need for the following night. - **Trying harder.** Sleep is the one performance that fails when you concentrate on it. Effort is arousal, and arousal is the opposite of sleep. - **Clock-watching and arithmetic** at 3am, which converts an ordinary wakeful hour into an emergency. - **Dreading bedtime**, until the bedroom itself becomes a cue for alertness rather than sleep. - **Alcohol as a sedative.** It shortens the time to sleep and then fragments the second half of the night. Reliably worsening the exact problem it was recruited to fix. ## How insomnia is diagnosed By history, and rarely by machine. A [psychiatric evaluation](/psychiatry-practices/psychiatric-evaluation) establishes which shape it takes, how many nights a week, for how long, what the daytime cost is, and, crucially, what else is in the room: - **Mental health**: anxiety, depression, trauma and bipolar disorder all disturb sleep, and sleep disturbance is often the earliest warning sign of an episode. - **Substances and medications**: caffeine timing, alcohol, nicotine, cannabis, stimulants, steroids, decongestants and several prescribed psychiatric medications. - **Medical causes**: pain, reflux, thyroid disease, menopausal symptoms, prostate symptoms. - **Other sleep disorders**, which need a different specialist. Loud snoring with witnessed pauses in breathing, choking awakenings, or heavy daytime sleepiness despite adequate hours point at **sleep apnoea**; an irresistible urge to move the legs in the evening points at **restless legs syndrome**. We screen for both and refer on, because treating those as insomnia does not work. A sleep diary kept for a week or two before your appointment is genuinely more useful than any test. Bedtime, wake time, night wakings, naps, caffeine and alcohol. A scruffy handwritten one is fine. ## How treatment works here A [psychiatric evaluation](/psychiatry-practices/psychiatric-evaluation) sorts the picture first: what kind of broken, since when, and what else is in the room: mood, worry, substances, medications, and signals (like heavy snoring) that belong with a medical sleep study rather than with us. The core treatment is [CBT-I](/therapy-services/cognitive-behavioral-therapy): consolidating your sleep window so the pressure to sleep rebuilds, breaking the bed-equals-awake association, retiring the compensations (naps, lie-ins, the 9pm anxiety about 11pm), and giving the 3am mind somewhere to stand down. [Relaxation and lifestyle work](/therapy-services/relaxation-and-life-style-changes) supports it, and [medication decisions](/psychiatry-practices/medication-management): starting something, adjusting something, or carefully stepping off something: are made alongside, with you. ## When to reach out If bad nights have become the rule for a month or more, or daytime you is paying visibly for nighttime you, it is time. Bring your remedies list: all of it, including the ones that did not work. Failed experiments are data, and they shorten the road. ## What it can look like - Lying awake at bedtime while your mind holds meetings. - Waking at 3 or 4am and failing to negotiate a return. - Sleep that happens but does not refresh. - Dreading bedtime, the bed itself now a cue for being awake. - Days run on caffeine, naps and apology. - Irritability, foggy focus and a shorter fuse than you recognise. - A rotation of remedies (supplements, apps, early nights) that each worked for a week. - Watching the clock and calculating how much sleep is still possible. - Falling asleep easily on the sofa, then wide awake the moment you reach bed. ## How we treat it - [Cognitive Behavioral Therapy](https://www.uniquembhs.com/therapy-services/cognitive-behavioral-therapy) - [Medication Management](https://www.uniquembhs.com/psychiatry-practices/medication-management) - [Relaxation & Lifestyle Changes](https://www.uniquembhs.com/therapy-services/relaxation-and-life-style-changes) - [Psychiatric Evaluation](https://www.uniquembhs.com/psychiatry-practices/psychiatric-evaluation) ## Frequently asked questions ### What is CBT-I, and does it really beat sleeping pills? CBT for insomnia is a short, structured programme that retrains the systems insomnia has scrambled: your sleep drive, your body clock, and the learned link between bed and wakefulness. For chronic insomnia it is the recommended first-line treatment, and unlike medication its results tend to last after it ends. It is work, and it works. ### Will you prescribe me something to sleep? Sometimes, thoughtfully, and rarely as the whole plan. Sleep medications have real short-term uses, and just as real limitations: tolerance, dependence and next-day fog among them. Part of our job is also reviewing what you already take, prescribed or otherwise, because plenty of insomnia has a stimulant, an alcohol pattern or a medication timing issue hiding inside it. ### My insomnia started with stress that has since passed. Why am I still awake? Because insomnia learns to run without its starter motor. A stressful season breaks sleep; then the worrying about sleep, the naps, the early nights and the lie-ins keep it broken. That self-sustaining loop is precisely what CBT-I is built to dismantle, which is why it can succeed long after the original stress is history. ### How is insomnia diagnosed: do I need a sleep study? Usually not. Insomnia is diagnosed from your history: what kind of broken (getting to sleep, staying asleep, waking too early), how many nights a week, for how long, and what it costs you in the daytime. Three nights a week for three months is the usual marker for chronic insomnia. A sleep study is for when something else is suspected: loud snoring with pauses in breathing, unrefreshing sleep despite enough hours, or restless legs. ### What else can cause insomnia besides stress? A long list, which is why the evaluation asks broadly. Anxiety, depression and trauma are the most common companions. Then medications and substances. Stimulants, some antidepressants, steroids, decongestants, caffeine later than you think, and alcohol, which brings sleep on and then fragments the second half of the night. Then medical causes: pain, reflux, thyroid disease, prostate and menopausal symptoms, sleep apnoea and restless legs. ## Sources - Insomnia. MedlinePlus, U.S. National Library of Medicine. https://medlineplus.gov/insomnia.html ## Related pages - [Generalized Anxiety](https://www.uniquembhs.com/anxiety-disorders-treatments/generalized-anxiety-disorder) - [Depression](https://www.uniquembhs.com/depression-treatment) - [Trauma & PTSD](https://www.uniquembhs.com/trauma-ptsd-treatment) --- This page is general health information, not medical advice. In a crisis, call or text 988 (988 Suicide & Crisis Lifeline) any hour, or call 911 in an emergency.