Most people experience occasional difficulty sleeping, especially during periods of stress or major life changes. However, when problems falling asleep, staying asleep, or waking too early become persistent and begin affecting daily functioning, they may represent insomnia or another sleep disorder.

At Ficus Psych, Gregory Sayer, MD provides comprehensive psychiatric evaluations for children, adolescents, and adults experiencing insomnia and other sleep-related concerns. Rather than focusing solely on improving sleep, the evaluation seeks to understand the biological, psychological, behavioral, and environmental factors contributing to sleep difficulties so that treatment can be individualized.

What Is Insomnia?

Insomnia is characterized by persistent difficulty falling asleep, remaining asleep, waking earlier than intended, or experiencing poor-quality sleep despite having adequate opportunity to sleep.

Sleep problems may occur occasionally, but chronic insomnia can affect concentration, mood, memory, productivity, physical health, and overall quality of life.

Although insomnia is common, it is not simply an unavoidable part of aging or a condition that should be accepted without evaluation.

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Common Symptoms of Insomnia

People with insomnia may experience:

Nighttime Symptoms

• Difficulty falling asleep

• Frequent awakenings during the night

• Waking earlier than intended

• Difficulty returning to sleep

• Light or restless sleep

• Feeling that sleep is not restorative

Daytime Symptoms

Poor sleep often affects daytime functioning, including:

• Fatigue

• Difficulty concentrating

• Memory problems

• Irritability

• Reduced motivation

• Increased anxiety

• Low mood

• Reduced work or academic performance

Some individuals also become increasingly worried about sleep itself, creating a cycle in which anxiety about not sleeping further interferes with the ability to fall asleep.

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What Causes Insomnia?

Insomnia often develops through a combination of biological, psychological, and environmental factors.

Common contributors may include:

• Anxiety disorders

• Depression

• Stressful life events

• Trauma

• ADHD

• Medical conditions

• Chronic pain

• Substance use

• Shift work

• Irregular sleep schedules

• Certain medications

• Poor sleep habits

For many people, more than one factor contributes to persistent insomnia.

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Different Types of Insomnia

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Duration based 

​Some individuals experience sudden and or brief episodes that may be related increased stress, illness, travel, or significant life changes.

Symptoms may improve once the underlying stressor resolves.

Other individuals may experience chronic sleep difficulties occurring multiple nights each week over several months or even years 

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Sleep Maintenance Insomnia

Some individuals fall asleep easily but wake repeatedly throughout the night or awaken much earlier than intended.

Sleep Onset Insomnia

Others primarily struggle with falling asleep, often lying awake for extended periods despite feeling tired.

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Insomnia Can Be a Symptom of Another Condition

Difficulty sleeping does not necessarily mean that insomnia is the primary diagnosis.

Sleep disturbances commonly occur alongside:

• Anxiety disorders

• Depression

• Bipolar disorder

• ADHD

• Post-traumatic stress disorder (PTSD)

• Obsessive-compulsive disorder (OCD)

• Substance use disorders

Medical conditions such as sleep apnea, restless legs syndrome, thyroid disorders, chronic pain, and certain neurological conditions can also interfere with sleep.

Because treatment differs depending on the underlying cause, a comprehensive evaluation is an important first step.

How Insomnia Is Evaluated

Effective treatment begins with understanding why sleep has become disrupted.

A comprehensive psychiatric evaluation may include discussion of:

• Current sleep patterns

• Bedtime routines

• Daytime functioning

• Medical history

• Psychiatric history

• Medications

• Substance use

• Stressors

• Mood and anxiety symptoms

• Family history

• Previous sleep treatments

When appropriate, referral for additional medical evaluation or a formal sleep study may be recommended if another sleep disorder is suspected.

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Treatment for Insomnia

Treatment recommendations are individualized based on the underlying causes of sleep difficulties.

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Cognitive Behavioral Therapy for Insomnia (CBT-I)

CBT-I is often considered the first-line treatment for chronic insomnia by many professional organizations.

This structured therapy helps individuals by addressing the thoughts, feelings, and behaviors around sleep to:

• Develop healthier sleep habits

• Reduce behaviors that unintentionally worsen insomnia

• Address unhelpful beliefs about sleep

• Improve long-term sleep quality

When appropriate, referrals for CBT-I may be discussed as part of a comprehensive treatment plan.

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Psychotherapy

For some individuals, insomnia may be connected to anxiety, depression, trauma, relationship stress, or other emotional concerns.

Psychotherapy may help address these underlying factors while improving overall emotional well-being.

Treatment recommendations may include psychodynamic psychotherapy, supportive psychotherapy, or other evidence-based approaches depending on each person's needs.

Medication

For some individuals, medication may be appropriate as part of treatment.

Medication decisions are made collaboratively after discussing:

• Potential benefits

• Possible risks

• Side effects

• Duration of treatment

• Medical history

• Other treatment options

Medication is not recommended for everyone with insomnia, and the choice to use medication depends on the individual's symptoms and overall clinical picture. There are multiple classes of sleep medication with different mechanisms, side effect profiles, duration of action, and tolerability profiles. 

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Lifestyle Factors

Sleep may also improve by addressing sleep hygiene factors such as:

• Consistent sleep schedules

• Limiting caffeine late in the day

• Reducing alcohol before bedtime

• Regular physical activity

• Managing stress

• Optimizing the sleep environment

Lifestyle recommendations are individualized rather than applied uniformly to every patient.

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Frequently Asked Questions

When should I see a psychiatrist for insomnia?

If sleep difficulties have persisted for several weeks, interfere with daytime functioning, or continue despite improving sleep habits, a psychiatric evaluation may help identify contributing factors and discuss treatment options.

Is medication always necessary?

No. Many individuals benefit from psychotherapy, CBT-I, lifestyle changes, treatment of underlying psychiatric conditions, or a combination of approaches. Medication is only one potential treatment option.

Can anxiety or depression cause insomnia?

Yes. Anxiety disorders and depression can contribute to sleep difficulties. Treating the underlying condition may help the sleep difficulty, itself, improve. 

Can children and adolescents develop insomnia?

Yes. Sleep difficulties can occur at any age and may affect emotional regulation, academic performance, attention, and overall development. Evaluation considers developmental, behavioral, and family factors in addition to sleep itself.

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Insomnia Treatment at Ficus Psych

Ficus Psych provides comprehensive evaluation and treatment for insomnia and sleep-related concerns in children, adolescents, and adults.

Gregory Sayer, MD is board certified in both adult psychiatry and child & adolescent psychiatry. His approach emphasizes careful diagnosis, evidence-based treatment, and understanding the underlying factors contributing to sleep difficulties rather than focusing only on nighttime symptoms.

Treatment is available through in-person appointments in Beverly Hills and telepsychiatry for patients throughout California and New York.

If insomnia has begun to affect your mood, concentration, work performance, relationships, or overall quality of life, a comprehensive psychiatric evaluation can help clarify the underlying causes and identify treatment options that fit your individual needs.

👉 Contact Ficus Psych today to schedule an introductory phone call.

Ficus Psych | 8500 Wilshire Blvd, Beverly Hills CA 90211