Quick answer: Sleep medication can help in the short term, but it usually stops working once you stop taking it. Cognitive Behavioral Therapy for Insomnia (CBT-I) takes a few weeks longer to kick in, but its results tend to last. That’s why the American College of Physicians and the American Academy of Sleep Medicine both recommend CBT-I as the first treatment for chronic insomnia. It doesn’t have to be one or the other: CBT-I can be done alongside medication, with any medication decisions made by you and your prescriber. At Blooming Minds Counseling in Fairfax, VA, Kelly Mulder offers CBT-I in person and virtually across Virginia.
At some point, almost everyone with insomnia ends up in the same spot. It’s been weeks (or months, or years). You’ve tried the tea, the app, the no-screens rule. And you’re thinking: should I just ask my doctor for something?
That’s a completely reasonable question. Lack of sleep is miserable, and wanting relief fast makes total sense.
We’re not here to tell you medication is bad. For some people, in some seasons, it’s genuinely helpful. What we want to do is give you the full picture, so whatever you choose, you’re choosing it with your eyes open.
The simplest way to think about it
Here’s the analogy we use with clients.
If you break your ankle, crutches help right away. You’d be silly to refuse them. But crutches don’t heal the ankle. Physical therapy does the slower work of rebuilding strength, so eventually you can walk without them.
Sleep medication is the crutch. It can get you through a rough stretch. CBT-I is the physical therapy. It works on the pattern that’s keeping you awake, so you can sleep without needing the support.
Plenty of people use both for a while. The question is whether you only have crutches, or whether you’re also doing the work that lets you put them down.
What sleep medication does well (and where it falls short)
Where it helps:
- It works quickly, often the first night.
- It can give real relief during an acute crisis, a hospitalization, a death in the family, or a stretch where you simply can’t afford to be wrecked.
- For some people, a prescriber decides it’s the right call, and that’s a valid medical decision.
Where it falls short:
- It doesn’t change what’s keeping the insomnia going. The clock-watching, the bracing, the 3am spiral are all still there underneath. When the medication stops, the insomnia often comes right back.
- Some common sleep medications carry real risks. In 2019, the FDA added its strongest warning, a boxed warning, to zolpidem (Ambien), eszopiclone (Lunesta), and zaleplon (Sonata) after reports of sleepwalking, sleep driving, and other complex sleep behaviors that led to serious injuries and some deaths (FDA, 2019).
- Morning grogginess is common, even when you feel fully awake.
- Over time, some people start to feel like they can’t sleep without it. That fear can become its own source of nighttime anxiety.
What about melatonin and over-the-counter sleep aids?
This surprises a lot of people. The American Academy of Sleep Medicine’s guideline on insomnia medications suggests that clinicians not use melatonin or diphenhydramine (the active ingredient in Benadryl and most “PM” sleep aids) to treat chronic insomnia in adults (Sateia et al., 2017).
That doesn’t mean melatonin is dangerous or useless for everything. It has a role in things like jet lag and some circadian rhythm problems. It just isn’t a strong fix for the kind of insomnia that’s been going on for months.
If you’ve been taking more and more melatonin with less and less result, this is probably why.
What CBT-I does differently
CBT-I is a short, structured treatment, usually around 4 to 8 sessions. Instead of putting you to sleep, it changes the conditions that have been keeping you awake.
In plain language, CBT-I helps you:
- Retrain your brain to link bed with sleep, not with lying awake.
- Build up natural sleep pressure, so your body arrives at bedtime actually ready.
- Quiet the thoughts that act like an alarm at night (“If I don’t sleep, tomorrow is ruined”).
- Have a specific plan for 3am, so one wake-up doesn’t turn into two hours.
The trade-off is honest: CBT-I asks more of you up front, and sleep can feel a little worse for a week or two before it gets better. But the skills are yours. They don’t wear off when the prescription runs out.
Both the American College of Physicians (Qaseem et al., 2016) and the American Academy of Sleep Medicine (Edinger et al., 2021) recommend CBT-I as the first treatment for chronic insomnia in adults. The ACP recommends that medication be considered through shared decision-making when CBT-I alone hasn’t been enough.
For a full breakdown of how CBT-I works at our practice, see CBT-I and Sleep Therapy in Fairfax, VA.
What happens when you combine them?
This is where the research gets really interesting.
In a randomized trial published in JAMA, researchers compared CBT-I alone with CBT-I plus zolpidem (Ambien) for people with persistent insomnia (Morin et al., 2009). Here’s what they found:
In the first six weeks, both groups improved about the same amount. The medication added a bit more sleep time early on.
For the long run, the best results came from people who used both at first, then stopped the medication and continued with CBT-I alone. At the six-month follow-up, 68% of that group was in remission from insomnia, compared to 42% of people who kept taking the medication alongside CBT-I.
In other words, medication may help you get started. CBT-I is what keeps you sleeping well after.
Important: in that study, any medication changes happened under medical supervision. Some sleep medications shouldn’t be stopped suddenly. If you’re currently taking something and want to reduce it, that’s a conversation for your prescriber, and CBT-I can support you while you have it.
So how do you decide?
You might lean toward talking with your doctor about medication first if:
- You’re in an acute crisis and need relief right now.
- You have a medical condition where your physician wants to manage sleep directly.
- You’ve already done a full course of CBT-I and it wasn’t enough.
CBT-I is probably worth trying first (or adding) if:
- Your insomnia has gone on for three months or more.
- You’d rather not rely on a pill long term.
- You’ve tried melatonin, OTC sleep aids, or prescriptions and the relief didn’t last.
- You’re already on sleep medication and want a plan that doesn’t depend on it forever.
- Lying in bed has started to feel like a place you brace, not rest.
And a quick safety note: if you snore loudly, wake up gasping, or feel unrefreshed even after a full night in bed, talk to a doctor about sleep apnea first. Neither sleeping pills nor CBT-I fix apnea, and some sleep medications can make it worse. Kelly screens for this at your first consult.
How Kelly works with clients on medication
Kelly Mulder doesn’t prescribe or change medications, and she’ll never ask you to stop something your doctor gave you. Plenty of her clients start CBT-I while already taking a sleep aid. With your permission, she’s happy to coordinate with your prescriber so everyone’s on the same page.
Kelly also brings a somatic, mind-body lens and a personal understanding of chronic illness. If your sleep problems are tangled up with anxiety, pain, or a health condition, she’ll look at the whole picture, not just the hours you’re logging.
If trauma is part of what’s keeping you up, you may also find our post Can Trauma Cause Insomnia? helpful. And if you’re still trying to figure out why you’re so tired but so wired, start with Why Am I Exhausted All Day but Wide Awake at Night?.
How to get started
Kelly sees clients in person at our Fairfax office and virtually anywhere in Virginia, including Arlington, Alexandria, Vienna, McLean, Centreville, and Sterling.
Sessions are $175, self-pay. HSA and FSA are accepted, and we provide superbills for out-of-network reimbursement.
Book a free 15-minute consultation: Schedule a free consultation
Or call 703-655-9880.
You don’t have to pick between “suffer through it” and “take something forever.” There’s a third option, and it’s the one the research keeps pointing to.
Frequently asked questions
Is Sleep Therapy (CBT-I) better than sleeping pills?
For chronic insomnia, CBT-I is recommended as the first treatment by the American College of Physicians and the American Academy of Sleep Medicine because its benefits tend to last after treatment ends. Medication can work faster, but insomnia often returns when it’s stopped. Many people use both under the guidance of their prescriber.
Can I do Sleep Therapy (CBT-I) while taking sleep medication?
Yes. CBT-I can be done alongside medication. Decisions about starting, continuing, or reducing medication stay between you and your prescriber.
Does Sleep Therapy (CBT-I) help you get off sleeping pills?
Research suggests it can. In a 2009 JAMA trial, people who used medication with CBT-I at first, then continued CBT-I alone, had the best long-term results: 68% were in remission at six months. Any medication changes should be supervised by your prescriber, since some sleep medications shouldn’t be stopped suddenly.
Does melatonin work for insomnia?
For chronic insomnia, the evidence is weak. The American Academy of Sleep Medicine suggests clinicians not use melatonin or diphenhydramine to treat chronic insomnia in adults. Melatonin may still be useful for things like jet lag.
How long does CBT-I take to work?
Most people complete CBT-I in about 4 to 8 sessions. Sleep can feel slightly worse in the first week or two before improving.
Is there a Sleep Therapy (CBT-I) therapist near me in Northern Virginia?
Yes. Kelly Mulder offers CBT-I at Blooming Minds Counseling, 3900 University Drive, Suite 130, Fairfax, VA, and virtually anywhere in Virginia.
Will my therapist tell me to stop my medication?
No. Kelly Mulder doesn’t prescribe or adjust medication. She can coordinate with your prescriber, with your permission.
How much does Sleep Therapy (CBT-I) cost at Blooming Minds?
Sessions with Kelly Mulder are $175. HSA and FSA are accepted, and superbills are provided for out-of-network reimbursement.
References
Supervision disclosure
Kelly Mulder, Resident in Counseling, provides services at Blooming Minds Counseling under the clinical supervision of Farah Alnajar, LPC, CCTP, License #0701011115. This article is for educational purposes and is not medical advice. Talk with your prescriber before making any changes to medication.
