Chronic insomnia is trouble falling or staying asleep at least three nights a week for three months with daytime impairment. First-line treatment is cognitive behavioral therapy for insomnia (CBT-I), which outperforms medication long term. Short-term medication options include doxepin, trazodone, ramelteon and newer orexin antagonists, with sedative-hypnotics used sparingly. Treating coexisting depression or anxiety is essential. Stedfast Psychiatry treats insomnia at 11641 Kew Gardens Ave in Palm Beach Gardens and by video across Florida; new patients call (561) 437-2199.
Insomnia at our Palm Beach Gardens office
If you live near The Gardens Mall or in Mirasol, Frenchman's Creek, Frenchman's Reserve and Evergrene, this is your closest Stedfast Psychiatry office for insomnia treatment. We also see residents of Juno Beach, Jupiter, Lake Park and Riviera Beach who prefer not to drive farther.
New-patient scheduling for Palm Beach Gardens runs through (561) 437-2199. Existing patients reach the office directly at (561) 402-3971. Free surface parking is available at the building, including accessible spaces near the main entrance. If a same-week in-person slot is not open, a video visit with the same provider usually is.
Both Deep TMS and Spravato are delivered on site at this office, so a patient who does not respond to medication can move to an interventional option without changing clinics.
Who you will see in Palm Beach Gardens
The Palm Beach Gardens team includes psychiatrists Dr. Louis Velazquez and Dr. Tanya Peguero Estevez, psychiatric nurse practitioner Sophia Schulman and physician assistant Ellington Curtis. Visits in Spanish are available with Tanya Peguero Estevez. Children and teens are seen by Louis Velazquez, Sophia Schulman, Ellington Curtis and Stephanie Mills.
Dr. Louis Velazquez, MD
Psychiatrist · Ages 4 to 80
Sophia Schulman, PMHNP-BC
Psychiatric Nurse Practitioner · Children 7+, adolescents and adults
Ellington Curtis, PA-C
Physician Assistant · Adults and teens 14+
Dr. Tanya Peguero Estevez, MD
Psychiatrist · Adults 18+ · English, Spanish
Stephanie Mills
Clinician · Adults and teens 13+
Signs of insomnia
- Taking more than 30 minutes to fall asleep most nights
- Waking during the night and struggling to get back to sleep
- Waking an hour or more before you need to and not returning to sleep
- Unrefreshing sleep despite enough time in bed
- Daytime fatigue, sleepiness or low energy
- Irritability, low mood or anxiety about sleep
- Difficulty concentrating or remembering
- Dreading bedtime or watching the clock
How we diagnose it
A sleep evaluation at Stedfast Psychiatry starts with a detailed sleep history: your schedule, time to fall asleep, number and length of awakenings, naps, caffeine and alcohol, screen use, and what you do when you cannot sleep. We use the Insomnia Severity Index and a two-week sleep diary, and we screen for depression, anxiety, PTSD, ADHD and bipolar disorder because insomnia is often the first visible sign of one of them. We screen for sleep apnea (snoring, witnessed pauses, morning headaches, daytime sleepiness) with the STOP-Bang questionnaire and refer for a sleep study when it is likely, because sedating medications can worsen untreated apnea. We review all medications and order thyroid tests, iron studies for restless legs, or other labs when indicated.
About one third of US adults report insomnia symptoms, and roughly 10 percent meet criteria for chronic insomnia disorder.
Source: American Academy of Sleep Medicine
More than one third of US adults report sleeping less than the recommended seven hours per night.
Source: CDC, Behavioral Risk Factor Surveillance System
CBT-I is recommended as the first-line treatment for chronic insomnia in adults, ahead of medication.
Source: American College of Physicians Clinical Practice Guideline (2016); American Academy of Sleep Medicine (2021)
People with insomnia have about twice the risk of developing depression compared with those who sleep well.
Source: Meta-analysis, Journal of Affective Disorders (Baglioni et al., 2011)
Treatment for insomnia in Palm Beach Gardens
Medication management
When medication is appropriate we choose based on the pattern. Low-dose doxepin (3 to 6 mg) is FDA-approved for sleep maintenance and is not habit-forming. Trazodone 25 to 100 mg is widely used off-label, especially when depression is present. Ramelteon acts on melatonin receptors and helps with sleep onset. The orexin receptor antagonists suvorexant, lemborexant and daridorexant are newer options that reduce wakefulness without the next-day grogginess of older drugs. Mirtazapine helps when depression, poor appetite and insomnia occur together. Sedative-hypnotics such as zolpidem and eszopiclone work quickly but carry risks of tolerance, dependence, complex sleep behaviors and falls, so we use them short term and rarely in older adults. We avoid benzodiazepines for chronic insomnia. Medication is reviewed every four to eight weeks with the goal of tapering as CBT-I takes effect.
Psychotherapy
Cognitive behavioral therapy for insomnia (CBT-I) is the first-line treatment recommended by the American Academy of Sleep Medicine and the American College of Physicians. Over four to eight sessions it uses sleep restriction (temporarily limiting time in bed to consolidate sleep), stimulus control (bed is for sleep only; get up if awake more than 20 minutes), fixed wake times, cognitive work on anxiety about sleep, and relaxation training. CBT-I improves sleep in 70 to 80 percent of patients and the gains last after treatment ends, which medication cannot claim. It can be delivered by telehealth and combined with medication during the first weeks when sleep restriction is hardest.
What to expect
Your first visit is a 45 to 60 minute evaluation, in person or by video, and we may ask you to keep a sleep diary beforehand. You leave with a working diagnosis of what is driving the insomnia and a plan that may include CBT-I, medication, treatment of an underlying condition, or a referral for a sleep study. Follow-ups are every two to four weeks at first. Telehealth works especially well for CBT-I and medication follow-up, and we see patients across Florida and South Carolina.
The complete guide, including causes, subtypes and research, is on our Insomnia page.
Emergency and crisis resources near Palm Beach Gardens
In an emergency, call 911 or go to Palm Beach Gardens Medical Center Emergency Room (3360 Burns Rd, Palm Beach Gardens). The 988 Suicide and Crisis Lifeline is available by call or text 24 hours a day. Jupiter Medical Center Emergency Department and 988 Suicide and Crisis Lifeline are also listed on the Palm Beach Gardens office page.
Frequently asked questions
Who provides insomnia treatment at the Palm Beach Gardens office?
The Palm Beach Gardens team includes psychiatrists Dr. Louis Velazquez and Dr. Tanya Peguero Estevez, psychiatric nurse practitioner Sophia Schulman and physician assistant Ellington Curtis. Visits in Spanish are available with Tanya Peguero Estevez. Every provider works under psychiatrist oversight and the same evaluation standard: about an hour for a first visit, validated screening scales, and a written plan.
Can I be seen by video instead of coming to Palm Beach Gardens?
Yes. Stedfast Psychiatry providers are licensed in Florida and offer video visits for evaluations and follow-ups. Some situations, including certain controlled-substance prescriptions and first visits for young children, require an in-person appointment at 11641 Kew Gardens Ave.
Does the Palm Beach Gardens office take my insurance?
We accept most major commercial plans and Medicare. Call (561) 437-2199 with your member ID and we will verify benefits before the visit. Self-pay new-patient evaluations are $185.
How soon can a new patient be seen in Palm Beach Gardens?
Most new patients are scheduled within one to two weeks. If you need to be seen sooner, ask about a video visit; those often open up within days. If you are in crisis, call or text 988 or go to the nearest emergency room rather than waiting.
Can I get Deep TMS or Spravato as a Palm Beach Gardens patient?
Yes. Deep TMS is delivered on site in Palm Beach Gardens. Spravato is available at Palm Beach Gardens, Palm Beach Gardens and Royal Palm Beach.
Is medication or CBT-I better for insomnia?
CBT-I is better for chronic insomnia. It works for 70 to 80 percent of people, the gains hold after treatment ends, and it carries no risk of dependence. Medication works faster and has a role in short-term insomnia, during the first weeks of CBT-I, and when an underlying condition such as depression needs treatment. Our usual plan is CBT-I as the foundation with medication as a bridge if needed.
What is the safest sleep medication for long-term use?
Low-dose doxepin, ramelteon and the orexin antagonists (suvorexant, lemborexant, daridorexant) have the best safety profiles for ongoing use and do not cause dependence. Trazodone is widely used and generally safe. Zolpidem and similar drugs are best kept to short courses. Over-the-counter diphenhydramine (Benadryl, ZzzQuil) is a poor choice for regular use, especially in older adults, because of next-day impairment and anticholinergic effects.
Nearby Stedfast offices
If you are in crisis, call or text 988 or go to the nearest emergency room. Educational content; individual results vary. Reviewed by Dr. David Husted, board-certified psychiatrist.