Free consult
A 15-minute phone call to decide whether psychiatric medication management fits what your nights look like. No card required.
§ 01 Anxiety & sleep
Tired all day. Wired all night.
I see Washington adults whose anxiety clocks in when the house goes quiet: the racing mind at lights-out, the 3 a.m. wake-up with a pounding chest, the dread of tomorrow on four hours of sleep. This page explains how I treat that loop, and exactly what I will and will not prescribe for it.
No card required for the consultation request. We use the call to decide whether medication management is the right next step.
At a glance
Anxiety and insomnia care here is a 60-minute telehealth evaluation ($250) for adults physically in Washington State, followed by 30-minute medication visits ($150) when we agree they make sense. I prescribe non-controlled medications only: no benzodiazepines, no zolpidem (Ambien), no controlled sleep medications of any kind. The first step is a free 15-minute phone call.
§ 02 What this care is
Treating the loop, not just the hours.
Anxiety and insomnia rarely arrive separately. Each makes the other worse: the anxious mind will not release the day, the short night lowers tomorrow's threshold, and within weeks the bed itself has become a cue for dread. So the evaluation looks at the whole circuit: when the activation starts, what your nights actually look like hour by hour, caffeine and alcohol, your medication history, and what your body does when it is supposed to be winding down.
The goal is not to sedate you into unconsciousness. Sedation is not sleep. The goal is to turn the physiological alarm down far enough that sleep can do what it already knows how to do.
This is a private cash-pay practice for adults physically located in Washington State. I do not accept or bill insurance. Superbills are available for possible out-of-network reimbursement when applicable.
$250 intake
A 60-minute psychiatric evaluation: full history, medication review, a map of your specific loop, and an initial plan.
$150 follow-up
Thirty-minute visits to review sleep quality, panic frequency, side effects, and what to adjust next.
§ 03 The 3 a.m. loop
One bad night, hour by hour.
If this sequence reads like a transcript of your week, the loop is running you. Every stop on it is a place where treatment can intervene.
10:52 pm
Lights out, mind on.
You went to bed on time because you promised yourself you would. The moment the room goes dark, the agenda begins: the email you should have sent, the appointment, the conversation from years ago that still replays. The body reads rehearsal as threat and helpfully supplies adrenaline.
12:40 am
The arithmetic.
Still awake. You check the clock and run the math: asleep by one, I can still get five and a half. The math is part of the problem. It converts rest into a deadline, and sleep does not respond to deadlines.
2:15 am
Thin sleep.
You finally drift off, but the sleep is shallow. A nervous system that still considers itself on watch keeps you near the surface, where waking is easy and rest is partial.
3:04 am
The surge.
You are suddenly, completely awake: heart loud, chest tight, mind instantly at full speed. This is not random. It is a stress-hormone surge hitting a system that never fully powered down, and it is one of the most treatable parts of the entire loop.
4:30 am
Negotiations.
You try the tricks: the podcast, the breathing, the other room. Some nights they work. But the trying has become one more task to fail at, and failing at it wakes you up further.
6:45 am
The alarm wins.
You get up with a fraction of the rest you needed. Today's anxiety now has a head start, and tonight's bed has one more bad association attached to it. The loop hands itself to tomorrow.
None of this is a character problem. It is a feedback loop, and feedback loops have intervention points: the evening activation, the surge chemistry, the conditioned dread of the bed itself. Treatment works by finding the right point and pressing on it. I wrote more about this pattern in Breaking the Midnight Echo Chamber.
§ 04 Medication, plainly
What I prescribe, and what I won't.
You deserve the actual names before the first appointment, not a vague promise of options. These are the workhorses for anxiety-driven sleep loss.
TrazodoneFalling and staying asleep
An older antidepressant used at low doses as a sleep medication. Not habit-forming, not a controlled substance, and one of the most common starting points when anxiety fragments the night.
MirtazapineSleep with mood and appetite
Useful when poor sleep travels with depression, low appetite, or weight loss. It is more sedating at lower doses, which makes it a deliberate nighttime choice rather than a side effect to tolerate.
HydroxyzineAs-needed anxiety
An antihistamine with real anti-anxiety effects, taken as needed for spikes of daytime anxiety or at bedtime. It is not a benzodiazepine and not controlled.
PrazosinNightmares and the 3 a.m. surge
When trauma-related nightmares or adrenaline-soaked waking are part of the picture, prazosin can blunt the surge itself. It is a blood-pressure medication, not a sedative.
SSRIs, SNRIs, buspironeThe long game
These treat the anxiety that drives the loop rather than the sleeplessness it produces. They take weeks and careful dosing, and they are usually what makes the improvement last.
What I do not prescribe, full stop.
No zolpidem (Ambien) or other controlled sleep medications. No benzodiazepines (Xanax, Ativan, Klonopin, Valium). No stimulants. This practice does not prescribe controlled substances; that is a fixed boundary, not a case-by-case decision. If a controlled medication is central to your care, I will tell you on the free call and help you find a prescriber whose setup fits.
§ 05 Common presentations
Eight ways the loop shows up.
These patterns are physiology, not weakness. Naming yours precisely is the first half of interrupting it.
01
A mind that treats lights-out as a starting gun.
02
Exhausted by nine, wide awake the moment you lie down.
03
The 2-to-3 a.m. wake-up with a pounding heart and a racing inventory.
04
Sleep so light that a furnace click ends it.
05
Counting hours backward from the alarm, every single night.
06
Dread of the bed itself; the bedroom has started to feel like a workplace.
07
Caffeine to survive the morning, alcohol to attempt the evening.
08
Daytime panic and irritability that worsen with every short night.
§ 06 What this is not
Clear boundaries keep the care honest.
Not crisis care
If you are in acute danger or thinking of harming yourself or someone else, call 988, 911, or go to the nearest emergency department.
Not controlled substances
I do not prescribe controlled substances: no benzodiazepines, no stimulants, no zolpidem (Ambien) or other controlled sleep medications. This boundary holds for every patient and every appointment.
Not therapy replacement
Medication can support therapy, CBT-I style sleep work, and behavioral change, but it does not replace them.
Not one-size-fits-all
We track your sleep, panic frequency, side effects, and response at every visit, rather than prescribing from a template.
§ 07 Related reading
Breaking the Midnight Echo Chamber
A longer essay on the anxiety-insomnia loop: why it forms, why it persists, and where it gives way.
Read the articleTrauma and sleep
When the night-waking comes with nightmares, scanning, or a body that will not stand down, the loop may be trauma physiology.
Explore trauma careDepression overlap
Short nights deepen low mood, flatten motivation, and slow thinking. Sometimes the insomnia is the front edge of depression.
Explore depression careBurnout and work stress
When the rumination is about work, and the dread starts on Sunday afternoon, the loop has an occupational engine.
Explore burnout careAdjustment and sleep
Transitions after service, illness, or loss often get louder at night, right when there is nothing left to distract you.
Explore adjustment careVeterans services
For veterans whose vigilance, transition stress, and disrupted sleep travel together.
Explore veterans care§ 08 Questions
Do I need to know whether this is anxiety or insomnia first?
No. The two almost always travel together and feed each other. We start with the pattern itself: when the activation begins, what your nights actually look like hour by hour, what you have tried, and what your body does when it is supposed to be winding down.
Will medication just knock me out?
That is not the goal. Sedation is not the same as restorative sleep. The work targets the anxiety and the physiological arousal that fragment the night, so sleep can do what it already knows how to do.
Are benzodiazepines or controlled sleep medications part of this care?
No. I do not prescribe benzodiazepines, stimulants, or controlled sleep medications such as zolpidem (Ambien). I prescribe across the rest of outpatient psychiatry, including trazodone, mirtazapine, hydroxyzine, prazosin, SSRIs, SNRIs, and buspirone. If your care requires a controlled prescription, I will say so directly and help you find the right prescriber.
Why don't you prescribe Ambien or Xanax for sleep?
Because for chronic anxiety-driven insomnia they tend to borrow sleep rather than build it. Tolerance develops, rebound insomnia is common when they stop, and neither treats the anxiety that drives the loop. This practice does not prescribe controlled substances, and works instead with medications that can be used steadily and safely.
How quickly can sleep improve?
It varies, and no honest prescriber promises a timeline. Sleep-targeted medications such as trazodone sometimes help within the first week. Treating the underlying anxiety usually takes longer, often several weeks of careful adjustment. We measure progress at each visit, so you are never left guessing whether something is working.
What is the first step?
Request a free 15-minute phone consultation. No card is required for that call, and we use it to decide whether a full psychiatric evaluation makes sense.
The loop has a weak point. Let's find it.
A free 15-minute phone call is enough to tell whether this practice fits your nights. No card, no obligation.
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