Struggling With Insomnia? An Evidence-based Approach to Beat Insomnia

By Lorrie Smith-Esterle, DNP, PMHNP-BC

Why Can’t I Sleep?

If you find yourself lying awake for hours, waking up through the night, or feeling exhausted no matter how long you stay in bed, you’re not alone. Insomnia affects millions of people — and for many, it’s not just about sleep. It’s deeply connected to how our minds handle stress, anxiety, and emotions.

Personalized Help for Insomnia

If sleepless nights are taking a toll on you, help is available at Kentucky Psychiatric Care. Jan Brashear, MSN, PMHNP-BC, offers Cognitive Behavioral Therapy for Insomnia (CBT-I) — a structured, evidence-based approach that helps you retrain your mind and body to sleep better naturally, without relying solely on medication.

For those who may benefit from additional support, Lorrie Smith-Esterle, DNP, PMHNP-BC, provides personalized medication management to address the biological factors that can interfere with rest.

Our team is here to help you find lasting, restorative sleep — so you can wake up feeling refreshed and ready to take on your day. Together, we can develop an individualized treatment plan designed to restore healthy sleep and improve your overall well-being.

📞 Call 502-830-9330 to schedule an appointment.

🧠 The Mind–Body Connection

As a psychiatric nurse practitioner, I often see insomnia paired with anxiety, depression, trauma, or chronic stress. The mind and body work as one — when mental health is off balance, sleep often follows.

Why Sleep Matters

Sleep is more than rest — it’s when the brain and body reset. During sleep, your brain processes emotions, repairs cells, and regulates hormones that control mood, appetite, and energy.

Without enough sleep, people often experience:

• Mood swings or irritability

• Trouble focusing or remembering things

• Increased anxiety or depression

• Fatigue and low motivation

  
  

Over time, chronic insomnia can worsen both physical and mental health.

Understanding Insomnia

Insomnia means difficulty falling asleep, staying asleep, or waking too early — even when you have time to rest.

Common causes include:

• Stress or racing thoughts at night

• Irregular sleep schedules

• Depression, anxiety, or PTSD

• Pain or chronic illness

• Caffeine, nicotine, or alcohol

• Certain medications or stimulants

  
  

A full psychiatric and medical assessment can help uncover the root cause — and guide the right treatment plan.

CBT-I: The Gold Standard for Sleep

The most effective long-term treatment for insomnia is Cognitive Behavioral Therapy for Insomnia (CBT-I) — a structured, evidence-based approach that retrains your brain and body to sleep naturally, without relying on medication long-term.

CBT-I includes:

• 🧠 Changing sleep thoughts: Replacing “I’ll never sleep again” with realistic, calming beliefs.

• 🛏️ Stimulus control: Making your bed a cue for sleep — not frustration or scrolling.

• ⏰ Sleep scheduling: Creating consistent sleep and wake times to reset your rhythm.

• 🌿 Relaxation techniques: Calming the body and mind before bedtime.

  
  

Research shows CBT-I works better than medications in the long run — with lasting effects and no side effects.

Building Healthy Sleep Habits

Healthy routines support better sleep and mental health. Try these sleep hygiene strategies:

• Keep a steady sleep schedule — even on weekends.

• Create a relaxing bedtime routine — dim lights, stretch, or read (no screens).

• Use your bed only for sleep or intimacy — if awake more than 20 minutes, get up and do something quiet.

• Avoid caffeine and alcohol in the evening.

• Keep naps short and early (20 minutes or less).

• Get morning sunlight to reset your internal clock.

• Keep your room cool, dark, and quiet — white noise or blackout curtains can help.

  
  

Small steps, practiced consistently, can make a big difference.

💊 When Medications May Help

Sometimes, short-term medication support can help break a cycle of sleeplessness — especially if insomnia is linked with anxiety or depression.

Your provider might discuss:

• Orexin blockers (e.g., Belsomra®, Dayvigo®) to reduce wakefulness

• Melatonin agonists to support natural sleep cycles

• Sedating antidepressants (e.g., trazodone, doxepin, mirtazapine) for mood-related insomnia

• Short-term hypnotics (e.g., zolpidem, eszopiclone) — used briefly and carefully

  
  

The goal is always to support natural sleep restoration, not long-term dependence.

When to Seek Professional Help

It’s time to reach out to a healthcare provider if:

• You’ve had sleep trouble for more than 3 months

• Sleep issues affect your mood, focus, or relationships

• You snore loudly, gasp, or stop breathing in your sleep

• You experience extreme fatigue or fall asleep unintentionally

• You notice worsening anxiety, depression, or new mood changes

  
  

A psychiatric or sleep medicine evaluation can identify whether CBT-I, medication, or a sleep study may help.

A Psychiatric Perspective

Insomnia is not a weakness — it’s a signal that your brain and body need rest and recalibration. When we treat both mental health and sleep health together, patients often find lasting improvement in both.

You deserve restorative sleep — the kind that heals, refreshes, and helps you feel balanced again.

✅ Simple Next Steps

• Set a consistent wake-up time and stick to it.

• Begin a nightly 30-minute wind-down routine — lights low, screens off.

• Keep your bedroom a calm, sleep-only space.

• If your sleep hasn’t improved in a few weeks, ask your provider about CBT-I or a referral to a sleep specialist.

  
  

With patience and guidance, your body can relearn how to rest deeply.

📞 Call 502-830-9330 to schedule an appointment.

Lorrie Smith-Esterle, DNP, PMHNP-BC

Kentucky Psychiatric Care, PLLC

References

American Academy of Sleep Medicine. (2021). Behavioral and psychological treatments for chronic insomnia disorder in adults: An American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine, 17(2), 255–262. https://doi.org/10.5664/jcsm.8986

Qaseem, A., Kansagara, D., Forciea, M. A., Cooke, M., & Denberg, T. D. (2016). Management of chronic insomnia disorder in adults: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 165(2), 125–133. https://doi.org/10.7326/M15-2175

Sateia, M. J., Buysse, D. J., Krystal, A. D., Neubauer, D. N., & Heald, J. L. (2017). Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: An American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine, 13(2), 307–349. https://doi.org/10.5664/jcsm.6470

Ritterband, L. M., Thorndike, F. P., Gonder-Frederick, L. A., et al. (2017). Efficacy of an Internet-based behavioral intervention for adults with insomnia. Archives of General Psychiatry, 66(7), 692–698.

Trauer, J. M., Qian, M. Y., Doyle, J. S., Rajaratnam, S. M. W., & Cunnington, D. (2015). Cognitive behavioral therapy for chronic insomnia: A systematic review and meta-analysis. Annals of Internal Medicine, 163(3), 191–204. https://doi.org/10.7326/M14-2841