Insomnia and sleep problems treatment in Miami Florida
Santana Mental Health Services provides comprehensive insomnia evaluations and individualized treatment plans for adolescents and adults. Sleep is essential to mental and physical health — and when it stops working the way it should, the effects can reach into every part of daily life. Our providers use evidence-based psychotherapy and medication management to help patients restore healthy sleep, improve daytime energy and focus, and feel like themselves again. Care is available both in-office and through secure telehealth services.
Understanding Insomnia and Sleep Problems
Insomnia is the most common sleep disorder, yet it often goes unrecognized and untreated for years. Approximately 1 in 10 adults has insomnia disorder, and another 15–20% experience occasional insomnia symptoms. Insomnia is more common in women, in people with mental health or medical conditions, and tends to increase during midlife, perimenopause, and menopause. Although a stressful event, illness, or schedule change can trigger sleep problems, insomnia becomes persistent in more than half of those affected. The good news is that insomnia is one of the most treatable conditions in mental health, and most people see meaningful improvement with the right support.
Trouble falling asleep (sleep-onset insomnia)
Lying awake for 30 minutes or more at bedtime despite feeling tired is one of the most frustrating forms of insomnia. It is often driven by racing thoughts, worry, or an inability to "turn off" the mind. This pattern is common in people who also experience anxiety and in those who spend time on screens or mentally stimulating activities close to bedtime.
Waking up during the night (sleep maintenance insomnia)
Waking up repeatedly during the night — or waking once and being unable to fall back asleep — is the most common type of insomnia, affecting roughly 6 in 10 people with the disorder. It is especially common in older adults and in people dealing with chronic pain, depression, or other medical conditions. Over time, these disruptions can leave you feeling exhausted even after spending a full night in bed.
Insomnia and physical health
Insomnia does not just affect how you feel during the day — over time, chronic sleep loss is linked to real physical health consequences, including higher risks of high blood pressure, heart disease, type 2 diabetes, and cognitive decline. These risks are especially elevated when insomnia is accompanied by consistently short sleep (less than 6 hours per night). Identifying and treating sleep problems early is an important part of protecting long-term health.
Waking up too early (early-morning awakening insomnia)
Waking up well before your alarm with no ability to return to sleep can be especially draining. This pattern is closely linked to depression and often contributes to low energy, difficulty concentrating, and a sense of dread about the day ahead. It may occur on its own or alongside nighttime awakenings.
Short-term and situational sleep problems
Not all sleep problems become chronic. Many people experience temporary insomnia during stressful life events, illness, travel, or changes in work schedule — and sleep returns to normal once the situation resolves. However, for some people, habits that develop during a difficult period — such as spending too much time in bed, napping during the day, or worrying about sleep — can keep the problem going long after the original trigger is gone. Seeking help early can prevent short-term sleep problems from becoming a long-term pattern.
Insomnia and mental health
Sleep and mental health are deeply connected. Approximately 40–50% of people with insomnia also have a co-occurring mental health condition such as depression, anxiety, PTSD, or substance use. About 80% of people with depression report insomnia, and persistent insomnia doubles the risk of developing depression in the future. An important point many people do not realize: insomnia is not just a symptom of another condition — it is a disorder in its own right that often needs its own treatment, even when other conditions are being addressed.
When to Seek an Evaluation
If sleep problems are affecting your energy, mood, concentration, or ability to get through the day, it may be time to talk to a provider. Many people live with poor sleep for months or years before seeking help, often assuming it is just something they have to deal with. It is not. Consider scheduling an evaluation if you notice:
• Difficulty falling asleep, staying asleep, or waking up too early on a regular basis
• Spending 30 minutes or more lying awake trying to fall asleep or get back to sleep
• Sleep problems occurring three or more nights per week for three months or longer
• Feeling tired, foggy, or low on energy during the day despite spending enough time in bed
• Difficulty concentrating, memory lapses, or increased irritability
• Dreading bedtime or feeling anxious about whether you will be able to sleep
• Relying on alcohol, over-the-counter sleep aids, or other substances to fall asleep
• Sleep problems that continue even after improving your sleep habits
A thorough evaluation can also help rule out other conditions that may be contributing to poor sleep, such as sleep apnea, restless legs syndrome, or circadian rhythm issues — ensuring you get the right diagnosis and the most effective treatment.
How Insomnia Is Treated
Effective insomnia treatment is built on two pillars: specialized psychotherapy and medication management. Clinical practice guidelines recommend cognitive behavioral therapy for insomnia (CBT-I) as the first-line treatment for chronic insomnia in adults. Unlike sleep medications, CBT-I addresses the root causes of insomnia and produces improvements that last well beyond the end of treatment. Medication may be added when therapy alone is not enough. Treatment is always personalized based on the type and severity of insomnia, patient preferences, co-occurring conditions, and what has or has not worked in the past.
Medication for Insomnia
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Medication may be helpful when therapy alone has not been enough, when symptoms are severe and need more immediate relief, or based on personal preference. Medication works best when combined with behavioral strategies like those in CBT-I, and treatment decisions are always made collaboratively between patient and provider.
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DORAs are a newer class of sleep medication that work by blocking the brain's wake-promoting signals, helping the brain transition more naturally into sleep. Three DORAs are FDA-approved for insomnia:
• Suvorexant (Belsomra)
• Lemborexant (Dayvigo)
• Daridorexant (Quviviq)
DORAs can help with both falling asleep and staying asleep. They carry a lower risk of next-day grogginess and cognitive impairment compared with older sleep medications, and they have a low potential for dependence. Common side effects include daytime drowsiness, dizziness, and vivid dreams.
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Z-drugs — including zolpidem (Ambien), zaleplon (Sonata), and eszopiclone (Lunesta) — are effective for helping with sleep onset and maintenance. However, they carry risks including next-day sedation, sleepwalking or other complex sleep behaviors, rebound insomnia when stopped, and potential for dependence. These medications are generally not recommended for older adults due to increased fall risk and cognitive effects.
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Doxepin at very low doses (3–6 mg) is FDA-approved for insomnia, particularly for people who wake up during the night. It works differently from antidepressant doses and has a low potential for dependence. It is one of the safer medication options for older adults.
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Ramelteon (Rozerem) is FDA-approved for difficulty falling asleep and works through the brain's melatonin system. It has few side effects and very low abuse potential, though it does not help with staying asleep. Over-the-counter melatonin supplements have limited evidence for treating insomnia disorder in adults, though they may be helpful for jet lag or circadian rhythm issues.
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Sleep medications can provide meaningful relief, especially when combined with behavioral strategies. A few things to keep in mind:
• Most sleep medications begin working within the first few nights
• Side effects vary by medication and are often manageable with dose adjustments
• Medications are generally used at the lowest effective dose for the shortest time needed
• Some sleep medications can cause rebound insomnia or withdrawal symptoms if stopped suddenly — any changes should be made gradually with provider guidance
Therapy for Insomnia
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CBT-I is the most effective treatment for chronic insomnia and is recommended as the first choice by every major medical guideline. What makes CBT-I different from sleep medications is that it targets the thoughts, habits, and patterns that keep insomnia going — so the benefits last long after treatment ends. A typical course involves 4 to 8 sessions.
CBT-I includes several core components:
• Sleep restriction — This may sound counterintuitive, but temporarily limiting the time spent in bed to match actual sleep time is one of the most powerful tools for improving sleep. It strengthens the body's natural sleep drive and helps consolidate fragmented sleep into deeper, more restorative rest. Time in bed is gradually increased as sleep improves.
• Stimulus control — Over time, people with insomnia often begin to associate the bed with frustration and wakefulness rather than sleep. Stimulus control rebuilds that connection through simple but specific guidelines: go to bed only when sleepy, get out of bed if you cannot sleep, use the bed only for sleep and intimacy, and wake at the same time every morning.
• Cognitive restructuring — Many people with insomnia develop unhelpful beliefs about sleep — for example, "If I don't sleep tonight, I won't be able to function tomorrow." These thoughts increase anxiety and make it even harder to fall asleep. CBT-I helps identify and challenge these patterns so they have less power over the sleep experience.
• Sleep hygiene education — Practical guidance on lifestyle and environmental factors that affect sleep, including caffeine and alcohol use, exercise timing, light exposure, and bedroom setup. Sleep hygiene alone is not enough to treat chronic insomnia, but it is a helpful part of a comprehensive plan.
Research consistently shows that CBT-I works — and works well. A large analysis of 241 clinical trials found that the most effective CBT-I approach was associated with a number needed to treat of just 3, meaning that for every three people treated, one additional person achieves remission. CBT-I is also effective when insomnia occurs alongside other conditions such as depression, chronic pain, PTSD, or cancer.
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Acceptance and commitment therapy (ACT) takes a different approach to sleep-related distress. Rather than trying to control or eliminate frustrating thoughts about sleep, ACT helps patients make room for those experiences while refocusing on what matters most in their lives. Research supports ACT as an effective treatment for insomnia, and it may be especially helpful for people who find the structured behavioral demands of CBT-I difficult to follow.
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Mindfulness-based approaches teach skills for noticing thoughts, emotions, and body sensations without becoming overwhelmed by them. For many people with insomnia, the mind races at bedtime with worries, to-do lists, or frustration about not sleeping. Mindfulness techniques can help quiet that mental activity and reduce the physical tension that keeps people awake. These approaches may be used on their own or as part of CBT-I or ACT.
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BBT-I is a shorter version of CBT-I that focuses on the two most effective behavioral strategies — sleep restriction and stimulus control — and is typically delivered in just 1 to 4 sessions. It may be a good fit for people who prefer a more streamlined approach or who want to start with the most impactful changes first.
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For many patients, the best results come from combining CBT-I with medication when needed.
CBT-I builds the long-term skills and habits that sustain healthy sleep over time, while medication can provide more immediate relief during the most difficult period. Research shows that CBT-I produces results equal to medication in the short term and superior results in the long term — and unlike medication, the benefits of CBT-I tend to last after treatment ends. Your provider will work with you to find the approach that fits your needs, goals, and preferences.
Telehealth for Insomnia Treatment
Insomnia evaluations and follow-up appointments are available through secure telehealth. Research shows that telehealth-delivered CBT-I is just as effective as in-person treatment, with similar improvements in sleep quality, daytime functioning, and the relationship with your provider. Telehealth can be especially convenient for insomnia treatment, since sessions focus on reviewing sleep patterns, adjusting behavioral strategies, and building skills, all of which translate well to a video format.
Take the next step toward better sleep. Book a secure telehealth appointment today and get support from the comfort of home, on a schedule that works for you.
Frequently asked questions
Didn’t find what you were looking for?
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Yes. Insomnia disorder is a well-established medical condition recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). It involves changes in the brain's sleep-wake systems and is characterized by a state of heightened mental and physical arousal that makes it difficult to fall or stay asleep. Insomnia is not a personal failing or something you should just push through — it is a treatable condition, and most people improve significantly with the right care.
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Yes. CBT-I is the recommended first-line treatment for chronic insomnia and can produce significant, lasting improvement without any medication. All major medical guidelines — including those from the American College of Physicians and the American Academy of Sleep Medicine — recommend starting with CBT-I. Medication may be added if therapy alone is not enough, if symptoms are severe, or based on personal preference. The treatment plan is always tailored to the individual.
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Good sleep habits — like keeping a consistent schedule, limiting caffeine, and creating a comfortable sleep environment — are important, but sleep hygiene alone is not enough to treat chronic insomnia. Clinical guidelines are clear on this point: sleep hygiene should not be used as a standalone treatment. Effective insomnia treatment requires structured approaches like CBT-I, which includes specific behavioral and cognitive techniques that go well beyond general sleep tips.
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For most people with chronic insomnia, the answer is no. Research shows that approximately 70% of people with insomnia still have it one year later, and about half still have it three years later. Without treatment, insomnia is associated with a significantly higher risk of developing depression, anxiety, substance use problems, cardiovascular disease, and cognitive difficulties. The earlier treatment begins, the better the outcomes tend to be.
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This varies from person to person. CBT-I typically involves 4 to 8 sessions, and many people begin noticing improvement within the first few weeks. A shorter version called BBT-I can be completed in as few as 1 to 4 sessions. If medication is prescribed, most sleep medications begin working within the first few nights. One of the most important advantages of CBT-I is that improvements tend to be long-lasting — unlike medication, where sleep problems may return after stopping.
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Almost everyone has a bad night of sleep from time to time — that is normal. Insomnia disorder is different: it is diagnosed when sleep problems occur at least three nights per week, last for three months or longer, cause real difficulty during the day (such as fatigue, trouble concentrating, or mood changes), and happen despite having enough time and opportunity to sleep. If poor sleep is affecting how you feel or function during the day, it is worth getting an evaluation.
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Yes. Both initial evaluations and ongoing follow-up appointments are available through secure video telehealth. Clinical research — including randomized trials and meta-analyses — confirms that telehealth-delivered CBT-I is just as effective as in-person treatment, with similar improvements in sleep, daytime functioning, and the therapeutic relationship.