Insomnia & Sleep Disorders: Psychiatric Care for Better Sleep

By Riley Guinan, PA-C · Medically reviewed by Sade Savage, PA-C, DMSc
Last updated: July 5, 2026

Sleep problems and mental health feed each other

Insomnia is the most common sleep problem we see, and it rarely shows up alone. About 6 to 10 percent of adults meet criteria for insomnia disorder, and a large research review found that insomnia predicts the later onset of depression and anxiety, while those same conditions make sleep worse. That loop is why a psychiatric practice is a reasonable first stop for sleep trouble. It also means treating one side often improves the other. Some sleep problems, like sleep apnea, belong with a different kind of specialist, and we say so plainly below.

What a sleep psychiatrist does, and which sleep specialist you need

A sleep psychiatrist is a mental health clinician who treats sleep problems that come with conditions like anxiety, depression, or ADHD. A sleep specialist, sometimes called a somnologist, is a physician who runs sleep studies and treats disorders like sleep apnea. Many people with insomnia need the first kind, not a lab.

At Zellig, sleep care is part of psychiatric care. Our practice is led by physician assistants: Riley Guinan, PA-C and Sade Savage, PA-C, DMSc see patients across Pennsylvania, and the practice includes a collaborating psychiatrist trained at Johns Hopkins. If your sleepless nights are tangled up with your mood or your focus, this is the kind of evaluation to book. If the main problem looks like a breathing or movement disorder during sleep, a sleep-lab physician is the better fit, and we will say so.

Sleep problems we treat

Most of the sleep problems that reach us are tied to a mental health condition, a medication, or both. The ones we treat most often:

• Chronic insomnia, whether it started on its own or alongside another condition.
• Anxiety-driven sleep loss, where a racing mind keeps you up. We treat it together with the underlying anxiety.
• ADHD-related sleep issues, including the wired-at-midnight pattern many people with ADHD know well.
• Medication-related sleep disruption, when a needed medication interferes with sleep and the plan needs adjusting.

One thing to be upfront about. If you snore loudly, gasp awake, notice your breathing stopping and starting at night, or fight heavy daytime sleepiness, those are signs of sleep apnea, and apnea is diagnosed with a sleep study. We do not run sleep studies. We refer you to a sleep lab and keep treating the mental health side while you get answers.

When to see a doctor for insomnia

See a doctor for insomnia when trouble sleeping happens three or more nights a week for more than three months, the threshold the National Heart, Lung, and Blood Institute uses for chronic insomnia. Come in sooner if bad nights are wrecking your days, or if mood symptoms are arriving with the sleep loss.

A rough patch after a move or a hard month usually settles on its own. Chronic insomnia is less forgiving. Per the NHLBI, it can affect memory and concentration, and over time it raises the risk of high blood pressure, heart disease, and diabetes. Severe sleep loss that leaves you dozing at the wheel deserves an appointment this week. And if you are in crisis or having thoughts of harming yourself, call or text 988 now.

How insomnia evaluation and treatment work at Zellig

The first visit is a telehealth psychiatric evaluation that takes sleep seriously. It runs 60 to 90 minutes and covers your sleep history, your mental health, your medications, and what you have already tried. From there, the plan is individualized. For chronic insomnia, CBT-I comes first: the American College of Physicians and the American Academy of Sleep Medicine both recommend it as the initial treatment, before medication. CBT-I, short for cognitive behavioral therapy for insomnia, is a brief structured therapy that retrains the habits and thought patterns keeping you awake. We connect patients with CBT-I and handle the psychiatric side. When medication makes sense, for sleep itself or for the anxiety or depression underneath it, that runs through our medication management service with follow-ups to confirm it is working.

Where sleep medication fits

Sleep medication can help, and we prescribe it when it earns its place. It works best as a bridge while the underlying problem gets treated, because every option carries tradeoffs and none of them fixes the reason sleep broke. The prescription options fall into a few distinct groups: zolpidem-class sleep medicines, newer medicines that quiet the brain’s wake signals, low-dose doxepin, and off-label antidepressants such as trazodone and mirtazapine (Remeron). Doxepin stands out as the one antidepressant with FDA approval specifically for trouble staying asleep; trazodone and mirtazapine are approved for depression and used off-label for sleep. Two tradeoffs worth knowing from the FDA’s safety warnings: the zolpidem-class medicines carry a boxed warning for rare complex sleep behaviors like sleepwalking and sleep driving, and any insomnia medicine can leave you impaired the next morning, even when you feel awake. The specifics live in dedicated guides. If you have been offered Seroquel for sleepless nights, start with our Seroquel for sleep guide; our clonidine for sleep guide covers when that blood-pressure medicine gets used at night. And for the supplement route, magnesium for sleep and anxiety looks at what the evidence supports.

Getting insomnia treatment online in Pennsylvania

Most of our insomnia care already happens online: a secure video evaluation, followed by a treatment plan and regular follow-up visits, available statewide across Pennsylvania. If you would rather meet in person, we hold hours in Wayne on the Main Line and in Perkasie in Bucks County.

The most common thing new patients tell us is some version of “I need a sleep specialist near me.” Telehealth quietly solved that problem. Any Pennsylvania resident can book online psychiatry across Pennsylvania with us, whether you are in the Philadelphia metro or a county with no practice nearby. Video visits work well for evaluation and medication follow-up, including coordinating CBT-I. What they cannot do is replace a sleep lab, which is why suspected apnea still gets a referral.

Cost and insurance for insomnia care

We are in-network with many major commercial plans in Pennsylvania, including Aetna, Cigna, and UnitedHealthcare, and we offer transparent private-pay rates if you are uninsured or prefer not to use insurance. Coverage details vary by plan, so check our insurance and fees page or ask when you book.

Frequently asked questions

This page is general information, not medical advice. Decisions about your treatment or medications belong in a conversation with your own clinician.