Overview
Insomnia is ongoing trouble falling asleep, staying asleep, or waking too early, even when there is enough time and opportunity to sleep. It becomes a clinical concern when it happens regularly and affects daytime energy, mood, concentration, or daily functioning.
Insomnia can be short-term, often triggered by stress, illness, or schedule changes, or it can become long-standing. It frequently coexists with other conditions, including anxiety, depression, chronic pain, and sleep-related breathing disorders such as sleep apnea.
Norelle Health evaluates sleep complaints with attention to the upper airway and breathing during sleep, since untreated snoring or sleep apnea can masquerade as or worsen insomnia. When insomnia is the primary problem, treatment usually centers on behavioral approaches, and we coordinate with sleep medicine as needed.
Symptoms
People with insomnia may struggle to fall asleep, wake repeatedly, or wake too early and be unable to fall back asleep. The daytime effects are an important part of the problem and can include fatigue, low mood, irritability, and trouble concentrating.
Worry about sleep itself can become a cycle that makes insomnia worse, which is one reason behavioral approaches are central to treatment.
Causes and risk factors
Common contributors include stress and anxiety, irregular schedules, caffeine or alcohol, screen use at night, and napping. Medical conditions such as chronic pain, reflux, and hormonal changes can interfere with sleep, as can some medications.
Other sleep disorders, especially sleep apnea and restless legs, can fragment sleep and present as insomnia. Identifying these is important because treating them changes the plan.
Living with insomnia? The next step is a quiet, unhurried conversation.
How it is diagnosed
Insomnia is diagnosed mainly from a careful history, often supported by a sleep diary. The clinician asks about sleep timing, habits, stress, medications, and daytime effects, and screens for other sleep disorders.
A formal sleep study is not required for typical insomnia, but it may be recommended when snoring, witnessed pauses in breathing, restless legs, or other symptoms suggest an additional sleep disorder.
Treatment options
Cognitive behavioral therapy for insomnia (CBT-I) is generally considered the first-line treatment for chronic insomnia and addresses the habits and thoughts that keep sleep disrupted. Other steps may include:
- A consistent sleep-wake schedule and improved sleep habits
- Stimulus-control and relaxation techniques
- Limiting caffeine, alcohol, and late screen use
- Treating contributing conditions such as reflux, pain, or mood disorders
- Evaluating and treating coexisting sleep apnea or nasal obstruction
Medication may be used briefly and selectively, but it is generally not a long-term solution on its own.
When to seek care
Consider an evaluation when sleep problems occur most nights for several weeks, when daytime function suffers, or when self-help steps have not worked. Seek medical attention sooner if insomnia is accompanied by loud snoring and witnessed breathing pauses, severe daytime sleepiness, or significant mood changes.
Living with insomnia? The next step is a quiet, unhurried conversation.
Clinical references
- American Academy of Sleep Medicine: https://sleepeducation.org
Medical review
This page is a patient-education resource reviewed by the responsible Norelle Health clinician before publication. It does not replace an in-person evaluation. If symptoms are severe or rapidly worsening, seek immediate medical care.
Common Symptoms
Living with insomnia? The next step is a quiet, unhurried conversation.
Treatment Approach
Treatment for insomnia is individualized based on the severity of symptoms, anatomical considerations, and patient goals. Our specialists may consider:
- 01Cognitive behavioral therapy for insomnia (CBT-I)
- 02Improved sleep habits and a consistent sleep schedule
- 03Stimulus-control and relaxation techniques
- 04Treating contributing conditions such as reflux, pain, or mood disorders
- 05Evaluating and treating coexisting sleep apnea or nasal obstruction
- 06Short-term, carefully selected medication when appropriate
Specialists who treat insomnia
Dr. Adrian Ong
MD
Board-Certified Facial Plastic & Reconstructive and Head & Neck Surgeon
Dr. Adrian Ong is a board-certified surgeon who practices exclusively on the face, head, and neck, with expertise spanning rhinoplasty, sinus surgery, facial trauma, reconstruction, and sleep surgery.
- Functional and aesthetic rhinoplasty (including revision)
- Sinus surgery and complex revision sinus surgery
- Facial trauma and nasal fractures
- Head and neck cancer surgery and microvascular reconstruction
Also caring for this area
Not sure who to see? Our patient coordination team can help match you with the right specialist.
(212) 444-8006Frequently Asked Questions
Cognitive behavioral therapy for insomnia (CBT-I) is generally considered the first-line treatment. It targets the habits, schedules, and thoughts that maintain poor sleep and can produce lasting improvement without relying on medication.
Sometimes. Sleep apnea can fragment sleep and cause frequent awakenings that feel like insomnia. If you snore, have witnessed pauses in breathing, or wake unrefreshed, an airway-focused evaluation and sleep testing may be worthwhile.
Medication may help briefly during a stressful period, but it is generally not recommended as a long-term solution on its own. Behavioral treatment tends to be more durable and avoids dependence and side effects.
Many people notice improvement over several weeks with consistent changes to schedule and habits. CBT-I is typically delivered over a few sessions, and gains often continue after treatment ends.
Yes. Caffeine, alcohol, large late meals, and nicotine can all disrupt sleep. Timing and quantity matter, and adjusting them is often part of a treatment plan.
Long or late naps can make nighttime insomnia worse by reducing sleep drive. If a nap is needed, keeping it short and earlier in the day is usually better.
A sleep diary covering one to two weeks, a list of medications and supplements, and notes on caffeine, alcohol, stress, and daytime symptoms are all helpful for a focused visit.
Seek care sooner if insomnia comes with severe daytime sleepiness, loud snoring with breathing pauses, or significant changes in mood, as these may point to another treatable condition.
Related Procedures
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