I Cannot Sleep and Nothing Has Worked: When Insomnia Needs a Psychiatrist

Chronic insomnia is one of the most common reasons people reach for help and one of the most commonly undertreated. By the time someone has tried melatonin, sleep hygiene advice, and over-the-counter options without lasting results, the problem is usually more than a sleep problem. Persistent insomnia is frequently tied to anxiety, depression, or another condition that keeps the nervous system from settling, and treating the sleep without addressing what is driving it rarely holds. A psychiatric evaluation looks at the whole picture: the sleep, what is underneath it, and how to treat both.

At Empathy Therapy, Dr. Mark Chofla evaluates insomnia as part of the full clinical picture, not in isolation. One board-certified psychiatrist handles the medication and the therapy, for patients across seven states via telehealth.

Empathy Therapy is a telehealth psychiatry and psychotherapy practice built around empathic therapy, where genuine connection, careful listening, and integrated care are the foundation of every patient relationship. Dr. Mark Chofla, DO, is a board-certified psychiatrist who completed his undergraduate education at the University of California, Davis, his medical training at Midwestern University College of Osteopathic Medicine in Arizona, and his psychiatry residency and internship at the University of Southern California (USC). He has also served as a Professor of Psychiatry at the University of California, Davis Medical Center and School of Medicine. Dr. Chofla provides psychiatric medication management and formal psychotherapy for adults, adolescents, and children, and executive life coaching for adults, across California, Oregon, Washington, Arizona, Alaska, New York, and Florida via telehealth. New patient intakes are 75 minutes. Follow-up appointments are 45 minutes. New patients are typically seen within days, not weeks. Evening appointments are available for patients in New York and Florida.

Why Sleep Advice Stops Working

Sleep hygiene advice helps people whose insomnia is driven mainly by habits. Consistent bedtimes, less screen time, a cooler room. For many people that is enough. For the person who has already done all of it and still lies awake, the advice stops helping because the problem was never only behavioral.

Persistent insomnia often has a clinical driver. Anxiety keeps the mind active past the point where sleep is possible. Depression disrupts the sleep cycle directly, causing early waking or unrefreshing sleep no matter how many hours are spent in bed. Untreated ADHD can leave the mind unable to shut off. Trauma produces hypervigilance that the body reads as a reason to stay alert. In each case, the insomnia is a symptom, and treating it in isolation leaves the driver untouched.

This is why the person who has tried everything and still cannot sleep benefits from an evaluation that looks past the sleep itself. The 75-minute intake at Empathy Therapy is built to do that, assessing mood, anxiety, and the full picture before any recommendation is made.

One patient described that depth of evaluation on Healthgrades:

"My first appointment made me feel treated with dignity and respect. It was obvious that Dr. Chofla was making a sincere effort to understand me as a person." — Patient on Healthgrades

Why Sleeping Pills Alone Are Rarely the Answer

The common response to persistent insomnia is a prescription for a sleep medication. For short-term use in specific situations, that can help. As a standalone long-term solution, it often falls short, because it addresses the symptom while the underlying driver continues.

A psychiatrist evaluates whether the insomnia is primary or secondary to another condition, and treats accordingly. If anxiety is keeping someone awake, treating the anxiety often resolves the sleep. If depression is disrupting the sleep cycle, treating the depression addresses the sleep as part of the recovery. Where a sleep-specific approach is warranted, it is chosen with the full picture in view rather than as a default.

Because Dr. Chofla provides both medication management and therapy, the treatment can combine the two where that fits. Cognitive and behavioral approaches to insomnia are among the most effective long-term treatments, and having them available from the same provider managing any medication keeps the care coordinated.

One patient described that integrated understanding on Healthgrades:

"I have had a hard time finding a psychiatrist. Dr. Chofla challenges me when it is needed, but it always feels respectful and grounded in a real understanding of what I am going through." — Patient on Healthgrades

Who Dr. Chofla Works With

Empathy Therapy serves adults, adolescents, and children across seven states via telehealth: California, Oregon, Washington, Arizona, Alaska, New York, and Florida. Insomnia is well suited to telehealth care, and appointments happen from home without the travel that can make regular follow-up harder to keep.

Alongside insomnia, Dr. Chofla treats the full range of psychiatric conditions, including anxiety, depression, ADHD, bipolar disorder, PTSD and trauma, grief, and burnout. Because insomnia so often accompanies these, the integrated model lets one provider address the sleep and whatever is driving it together.

One patient described the experience on Vitals:

"Dr. Chofla listens carefully and truly cares. His approach makes healing feel possible again." — Patient on Vitals

Private Pay, Superbills, and How Costs Work

Empathy Therapy is a private-pay, fee-for-service practice. Insurance is not accepted. Appointments are as long as the clinical situation requires, the same provider delivers both medication management and therapy, and the provider relationship stays consistent from the first appointment forward.

Patients receive a detailed superbill after each appointment, which can be submitted to insurance for potential out-of-network reimbursement. Many patients with PPO plans recover a portion of their costs this way. Dr. Chofla's office can provide guidance on that process.

One patient described the value of that model on Vitals:

"This is a place you go to get better. Dr. Chofla was so very helpful. He got me stable. He seems expensive and you get what you pay for here." — Patient on Vitals

Dr. Chofla provides telehealth psychiatry and psychotherapy for patients across California, Oregon, Washington, Arizona, Alaska, New York, and Florida.

The information in this article is intended for educational purposes only and does not constitute medical advice, diagnosis, or treatment. If you are experiencing a mental health emergency, call or text 988 to reach the Suicide and Crisis Lifeline, or call 911.

Frequently Asked Questions

Can a psychiatrist help with insomnia?

Yes. A psychiatrist evaluates whether insomnia is primary or driven by another condition such as anxiety or depression, and treats accordingly. The 75-minute intake at Empathy Therapy assesses the full picture before any recommendation.

Why has nothing I have tried for sleep worked?

Persistent insomnia often has an underlying clinical driver that sleep hygiene and over-the-counter options do not address. Treating the driver, rather than the sleep alone, is frequently what produces lasting improvement.

Does Dr. Chofla provide therapy as well as medication for sleep problems?

Yes. Dr. Chofla provides both, which allows cognitive and behavioral approaches to insomnia to be combined with medication where appropriate, all through one provider.

How long are appointments?

New patient intakes are 75 minutes. Follow-up appointments are 45 minutes.

How quickly can I be seen?

New patients are typically seen within days, not weeks.

Does Empathy Therapy accept insurance?

No. Empathy Therapy is a private-pay, fee-for-service practice. Patients receive a superbill after each appointment for potential out-of-network reimbursement.

Which states does Empathy Therapy serve?

Empathy Therapy serves adults, adolescents, and children across California, Oregon, Washington, Arizona, Alaska, New York, and Florida via telehealth.

Are evening appointments available?

Evening appointments are available for patients in New York and Florida. The fully telehealth model means patients across all seven states can schedule without commuting.

How do I get started?

New patient appointments can be booked directly at www.empathytherapy.com. You can also review frequently asked questions at www.empathytherapy.com/faqs or call 888-832-9635 with any questions before booking.