Integrative treatment for insomnia.

What this actually is

Insomnia is difficulty falling asleep, staying asleep, or waking too early, persisting for three or more nights a week for three months or longer. It comes in flavors — sleep-onset, sleep-maintenance, early-morning awakening — each with somewhat different causes. It also often hides another condition: sleep apnea, restless legs, depression, anxiety, perimenopause, medication side effects.

Why the standard approach often falls short

The standard approach is a sleep aid — often a benzodiazepine, Z-drug, or trazodone. These can work short-term but rarely address underlying causes and carry risks with long-term use. The gold-standard treatment for chronic insomnia is CBT-I — Cognitive Behavioral Therapy for Insomnia.

The Elevae approach

Biology

Labs when appropriate — thyroid, iron/ferritin (low iron is a common cause of restless legs and sleep fragmentation, especially in women), vitamin D, hormonal panel. Screening for sleep apnea.

Mind

Evaluation for underlying anxiety, depression, PTSD, or ADHD that may be driving sleep disruption.

Lifestyle

Consistent wake time, morning light, caffeine cutoff, alcohol limits, screen timing, cool room.

Relationships

A co-sleeper with untreated sleep apnea, young children, shift work, or a bedroom that doesn't support sleep all need honest conversation.

Meaning

For some clients, insomnia is anxiety about insomnia — a feedback loop where fear of not sleeping prevents sleep.

What treatment typically looks like

Detailed sleep evaluation, lab workup where indicated, and a sleep diary for 1–2 weeks. Treatment combines CBT-I principles with targeted medical workup and, when appropriate, time-limited medication. Most clients see substantial improvement in 4–8 weeks.

When medication helps, and when it doesn't

Short-term sleep medication has a role. Long-term sleep medication is rarely the right answer. Benzodiazepines and Z-drugs carry dependence and cognitive risks. Trazodone, melatonin, and doxepin at low doses have better long-term safety profiles.

Lifestyle interventions that actually work

• Consistent wake time — the most powerful lever.
• Morning light — 10–20 minutes outdoors within an hour of waking.
• Caffeine — none after noon for most people with insomnia.
• Alcohol — disrupts the second half of sleep.
• Screen timing — reduce bright light 60–90 minutes before bed.
• Room temperature — cool, around 65–68°F.
• Sleep restriction — counterintuitively, restricting time in bed can reset sleep efficiency.

Frequently asked questions

Do I need a sleep study?

Sometimes. If there's any indication of sleep apnea — snoring, observed pauses, unrefreshed sleep — or restless legs, we recommend a study. Often done at home.

Is melatonin effective?

For specific sleep-phase problems, yes. For general sleep, evidence is modest. Dose matters — 0.3–1 mg is typically more effective than the 5–10 mg tablets common in pharmacies.

How long does CBT-I take to work?

Most people see real improvement within 4–8 weeks of consistent application.

Can I do CBT-I without a therapist?

Yes, via structured apps (CBT-i Coach, Somryst). We often combine app-based CBT-I with clinical support.

Is chronic insomnia linked to depression and anxiety?

Very strongly. Treating sleep often improves mood and anxiety — sometimes dramatically.

Book a free consultation