Insomnia: medical help by video to sleep better

Insomnia is a common sleep disorder: you struggle to fall asleep, wake up at night and cannot get back to sleep, or wake too early without feeling rested. It is more common in women and in older adults.

It can be short-term, lasting days or weeks, often from stress or a change in routine; or chronic, when it happens 3 or more nights a week for more than 3 months. Adults need 7 to 9 hours of sleep a night.

Request a visit online 24/7 — we confirm your time by email or text.

A doctor visit costs US$79, the same price for every age, with no membership. You pay by card when you request the visit, and you get a full refund if the visit can’t take place. We do not bill insurance; the lab and the pharmacy charge separately. See all prices. The service is run by The Health Initiative, a nonprofit.

The most common signs are:

• Trouble falling asleep
• Waking up at night and not getting back to sleep
• Waking up too early
• Waking up tired, as if you had not slept
• Daytime sleepiness, trouble concentrating or irritability

Often there is more than one cause:

• Stress and worry: work, school, family, money or a loss. Worrying about not sleeping makes it worse too.
• Habits: irregular schedules, long naps, screens in bed, too little exercise, and caffeine, nicotine or alcohol.
• Your surroundings: noise, light or a hot room; in Puerto Rico, a hot night with no power and no fan is enough to keep you up.
• Shift work or travel across time zones.
• Health conditions: sleep apnea, thyroid problems, reflux, allergies, pain such as arthritis, an enlarged prostate, menopause, depression or anxiety.
• Medicines taken for other conditions.

In the long run, lifestyle and sleep-habit changes work best. Try this:

• Go to bed and get up at the same time every day, weekends included.
• Use your bed only for sleep: if you cannot fall asleep, get up, do something calm in dim light and go back when you feel sleepy.
• Keep the room cool, dark and quiet.
• Avoid caffeine, nicotine and alcohol near bedtime, and heavy late dinners.
• Exercise during the day and limit afternoon naps.
• Keep your phone and screens out of bed.
• Keep a sleep diary: when you went to bed, how long it took to fall asleep and how you felt the next day.

Cognitive behavioral therapy for insomnia (CBT-I). It is a 6- to 8-week program that helps you ease anxiety about sleep, learn to relax and reset your schedule so your bed means sleep again. If it suits you, we refer you.

Be careful with over-the-counter sleep aids. Many contain antihistamines, which are not safe for everyone, and supplements have not been proven to work. Ask before using them, especially if you are an older adult or take other medicines.

The doctor sees children of all ages by video; patients under 21 need a parent or legal guardian on camera for the whole visit, with ID. For children and teens, a set schedule and keeping screens out of the bedroom are the foundation. If your child snores loudly or stops breathing for moments during sleep, tell the doctor.

Insomnia is rarely an emergency, but some signs need help now. If you have thoughts of harming yourself, call or text 988 or call Línea PAS at 1-800-981-0023. In an emergency, call 911. See when to go to the ER.

• Thoughts of harming yourself or ending your life
• Chest pain or shortness of breath at night
• Falling asleep while driving or at dangerous moments
• Someone notices you stop breathing in your sleep and you are very sleepy during the day
• Confusion or major changes in behavior