REFRESH DALLAS · INSOMNIA
Sleep is psychiatric.
The waking at 3 a.m. that returns every night. The mind that will not turn off. The sleep that arrives but does not restore. We see patients across Texas for sleep specifically, because sleep is rarely just sleep.
In-network with most major insurance · Same-week availability · Psychiatric specialists
THE CONDITION
Insomnia is rarely just insomnia.
Insomnia is the symptom. The cause is almost always something else. Anxiety that keeps you wired at midnight. Depression that wakes you at 3 a.m. and will not let you fall back. PTSD-related nightmares. Hormonal shifts, particularly perimenopause. Untreated ADHD. Substance use, including caffeine and alcohol used as sleep aids.
Patients who have been on a sleep medication for years often have not been asked what is actually keeping them awake. The medication papers over the symptom and the symptom keeps coming back, because the underlying cause has not been addressed.
OUR APPROACH
Diagnose first. Medicate carefully.
The first visit takes a full sleep history and a full psychiatric history. What time you go to bed, what time you actually fall asleep, what wakes you, when you give up. Caffeine, alcohol, screens, exercise. Concurrent psychiatric symptoms. Medical history. Sleep deserves the same diagnostic rigor as anything else psychiatric.
When the underlying cause is treatable, treating it usually treats the sleep. When medication is the right call, we choose deliberately. Certain antidepressants have sleep-positive effects. Trazodone has a long history. Mirtazapine has its place. The traditional sleep medications have a narrower role than they are sometimes given, and they are not a long-term solution for most patients.
SCOPE OF CARE
Where another provider is the right call.
Sleep studies are not something we perform. When your symptoms point toward sleep apnea, restless legs syndrome, narcolepsy, or another primary sleep disorder, we refer to sleep medicine specialists and stay involved on the psychiatric side.
We don't continue long-term benzodiazepine sleep prescriptions started elsewhere without a clear clinical reason and a treatment plan. If a previous prescriber put you on one of these and never had the tapering conversation, we are willing to have it now.
FAQ
Questions.
Often yes, with care. Abrupt discontinuation of most sleep medications can cause rebound insomnia and, in the case of benzodiazepines, can be genuinely dangerous. We taper deliberately and at your pace.
Melatonin helps some people, particularly with circadian shifts and shift work. The over-the-counter antihistamine-based aids are widely used but have real cognitive downsides and are not a good long-term answer.
Anxiety-driven insomnia is real insomnia. 'Just anxiety' is not a treatment plan, it is a label that gets in the way of one. We treat the anxiety and the sleep in parallel.
Yes. Cognitive Behavioral Therapy for Insomnia, called CBT-I, outperforms most sleep medications for chronic insomnia. We can refer to providers who do this work.
If this is an emergency, or if you are worried about your safety right now, please reach out for support that can meet the moment. You can call or text 988 anytime to reach the Suicide and Crisis Lifeline, or go to your nearest emergency department.
Sleep responds to treatment when the underlying cause is treated. We help find the cause.