Expert Telehealth Care for Insomnia in New York
Insomnia is the most prevalent sleep disorder in the United States, affecting an estimated 30–35% of adults with short-term symptoms and approximately 10% with chronic insomnia disorder — defined by the American Academy of Sleep Medicine as difficulty initiating or maintaining sleep at least three nights per week for at least three months. In New York's high-pressure environment, where work demands, noise, and the expectation of constant productivity are constant companions, chronic insomnia is both extremely common and consistently undertreated.
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At Strong Enough Mental Health, Salvatore Marchica, PMHNP-BC, provides comprehensive telehealth evaluation and treatment for insomnia in adolescents and adults, addressing both the sleep disorder itself and the mental health conditions that so frequently drive it.
What is Insomnia?
Insomnia is a sleep disorder characterized by persistent difficulty falling asleep, staying asleep, or obtaining restorative sleep — despite adequate opportunity for sleep — that results in daytime impairment or distress. Insomnia is not simply about getting fewer hours of sleep. It is the combination of sleep difficulty and the functional consequences it creates: fatigue, cognitive impairment, mood disturbances, and reduced quality of life.
Insomnia and mental health have a bidirectional relationship — anxiety, depression, PTSD, and ADHD worsen insomnia, and insomnia worsens anxiety, depression, PTSD, and ADHD. Treating sleep is frequently an essential part of treating these conditions effectively.
What Are The Signs And Symptoms of Insomnia?
Nighttime Symptoms
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Difficulty falling asleep — lying awake for 20–30 minutes or more despite wanting to sleep
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Waking frequently during the night and struggling to return to sleep
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Waking significantly earlier than intended, unable to fall back asleep
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Unrefreshing sleep — waking up as tired as when you went to bed
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Heightened anxiety or dread about bedtime and the prospect of another poor night
Daytime Consequences
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Significant fatigue and low energy throughout the day
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Difficulty concentrating, remembering, and making decisions
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Irritability, mood disturbances, and low frustration tolerance
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Reduced motivation and productivity
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Increased errors or accidents
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Relying on caffeine, alcohol, or sleep aids to function or fall asleep
What Are The Risk Factors of Insomnia?
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Anxiety and depression: Among the most common underlying drivers of chronic insomnia
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Stress: Work pressure, relationship difficulties, financial concerns, major life transitions
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PTSD and trauma: Hyperarousal and nightmares severely impair sleep quality and continuity
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Poor sleep habits: Irregular schedules, excessive screen use before bed, caffeine after noon
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Medical conditions: Chronic pain, sleep apnea, restless leg syndrome, acid reflux
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Medications: Some antidepressants, stimulants, beta-blockers, and corticosteroids affect sleep
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Age: Sleep architecture changes naturally with age, making insomnia more common in older adults
How is Insomnia Diagnosed?
Insomnia is diagnosed through a comprehensive clinical evaluation covering your sleep history and patterns, daytime functioning, mental health history, medical conditions, and current medications. At Strong Enough Mental Health, Salvatore takes a thorough approach to understanding the full picture driving your insomnia — because lasting improvement requires addressing root causes, not just symptoms.
What Are Possible Treatments For Insomnia?
Medication for Insomnia
While Cognitive Behavioral Therapy for Insomnia (CBT-I) is the gold-standard first-line treatment for chronic insomnia, medications play an important role — particularly in the short term, during acute periods of stress, or when insomnia is embedded in a broader psychiatric picture. At Strong Enough Mental Health, we prescribe sleep medications thoughtfully and aim for the lowest effective dose for the shortest necessary duration, always with an eye toward long-term wellbeing.
Non-Benzodiazepine Sleep Aids (Z-Drugs)
These medications enhance GABA activity to promote sleep and are among the most commonly prescribed sleep aids. They are intended primarily for short-term use.
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Zolpidem (Ambien, Ambien CR) — Immediate or extended-release formulations; helps with both sleep onset and sleep maintenance
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Eszopiclone (Lunesta) — FDA-approved for both sleep onset and maintenance insomnia
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Zaleplon (Sonata) — Ultra-short-acting; best suited for sleep onset difficulties
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Side effects may include next-day sedation, dizziness, and in rare cases parasomnias such as sleepwalking. Risk of dependence increases with prolonged use.
Orexin Receptor Antagonists — A Newer Approach
Rather than sedating the brain, these medications work by blocking orexin — the neurotransmitter that drives wakefulness — allowing sleep to occur more naturally. They generally have a lower risk of dependence and next-day cognitive effects.
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Suvorexant (Belsomra)
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Lemborexant (Dayvigo)
Sedating Antidepressants — Non-Habit-Forming Options
Several antidepressants have sedating properties and can improve sleep without the dependence risks of traditional sleep aids — particularly useful when insomnia co-occurs with depression or anxiety.
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Trazodone — Widely used off-label for insomnia; generally well-tolerated at low doses
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Mirtazapine (Remeron) — Particularly helpful when insomnia co-occurs with depression and appetite loss
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Doxepin (Silenor) — FDA-approved at low doses specifically for sleep maintenance insomnia
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Amitriptyline — Used off-label for insomnia, particularly when chronic pain is also a factor
Melatonin Receptor Agonist
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Ramelteon (Rozerem) — Acts on melatonin receptors; non-habit-forming and appropriate for longer-term use. Particularly useful for circadian rhythm disruption and sleep onset difficulties.