Insomnia and Sleep Disorder Treatment in York, PA

Per the 2021 American Academy of Sleep Medicine Clinical Practice Guideline, multicomponent Cognitive Behavioral Therapy for Insomnia (CBT-I) is the most effective first-line treatment for chronic insomnia disorder — and the only intervention to receive a "strong" recommendation in the guideline. CBT-I combines stimulus control, sleep restriction therapy, cognitive therapy, relaxation, and sleep hygiene education. Typically delivered in 4–8 sessions.

CBT-I is recommended over medication because it produces durable improvements that persist after treatment ends, while medication benefits typically stop when the medication does. For patients who can't access CBT-I or have urgent symptoms, evidence-based medication options exist (suvorexant, lemborexant, doxepin, ramelteon, eszopiclone, zolpidem).

No — we don't perform sleep studies (polysomnography) or CPAP titration in-house. Sleep apnea diagnosis and CPAP management require a sleep medicine specialist with access to a sleep lab. What we do at Optimal Health York:

Screen for sleep apnea using validated tools (STOP-BANG, Epworth Sleepiness Scale), refer for sleep studies when sleep apnea is suspected, treat the comorbid psychiatric conditions (depression, anxiety, PTSD) that often accompany sleep apnea, and address insomnia that may persist alongside or after CPAP treatment. Sleep apnea and insomnia frequently co-occur ("comorbid insomnia and sleep apnea" or COMISA), and CBT-I helps both.

CBT-I typically produces meaningful improvement within 4–6 sessions, with most patients completing a full course in 4–8 sessions. Some patients see initial improvement after just 1–2 sessions; others need the full 8 sessions to consolidate gains.

The early phase often involves temporarily worse sleep (because sleep restriction therapy compresses time in bed) before sleep consolidates and improves. This is expected, and we guide patients through it. Effects of CBT-I tend to persist for years after treatment ends — unlike sleep medications, which usually stop working once discontinued.

Yes. Psychiatric Mental Health Nurse Practitioners (PMHNP-BC) are licensed in Pennsylvania to evaluate sleep disorders and prescribe sleep medications — including non-controlled options (suvorexant, lemborexant, doxepin, ramelteon, mirtazapine, trazodone) and controlled options (zolpidem, eszopiclone, temazepam) — working under Pennsylvania's collaborative-practice requirements for nurse practitioners. Abu Koroma prescribes in PA, MD, and VA; Zainab Koroma in PA and MD.

Per AASM guidelines, however, medication is generally a second-line option after CBT-I for chronic insomnia. PMHNPs at Optimal Health York follow these guidelines: we recommend CBT-I first when appropriate, prescribe medication as adjunct or when CBT-I isn't accessible, and avoid long-term reliance on benzodiazepines and OTC sleep aids.

Melatonin has limited evidence for chronic insomnia disorder — per AASM 2017 pharmacologic guidelines, the recommendation is weak against melatonin for chronic insomnia. It works much better for circadian rhythm sleep-wake disorders (delayed sleep phase, jet lag, shift work disorder), where it's used as a "phase-shifter" rather than a sleep aid.

If you've tried melatonin without success, that doesn't mean nothing will work — it's the wrong tool for chronic insomnia. CBT-I and prescription sleep medications have stronger evidence. Quality control with melatonin supplements is also a real concern: a 2017 study found actual melatonin content varied from 17% to 478% of label claims across products.

It depends on which medication. Z-drugs (zolpidem, eszopiclone) and benzodiazepines can cause tolerance, dependence, complex sleep behaviors (sleep-driving, sleep-eating), cognitive effects, and falls — especially in older adults. They're generally not recommended for long-term use. Newer orexin antagonists (suvorexant, lemborexant) and doxepin have a more favorable long-term profile with lower dependence risk.

OTC "PM" products with diphenhydramine or doxylamine are not recommended for chronic use — they cause anticholinergic side effects (dry mouth, constipation, cognitive fog) and have been linked to increased dementia risk in older adults with long-term use. The safer long-term answer is almost always CBT-I, treating underlying conditions, and using medications strategically rather than as a permanent crutch.

Yes — sleep disorders are covered by major insurance plans, particularly when an underlying psychiatric or medical condition is contributing. We accept all major insurances. Call today to confirm your insurance. (717) 202-2285.

Most patients pay only their plan's specialist copay (typically $20–60). Self-pay rates are $249 for an initial evaluation and $99 for medication management follow-ups; CBT-I techniques begun within your visit are not billed separately. Note: a full CBT-I course with an outside therapist is billed by that therapist; sleep studies (when needed) are billed by the sleep lab/specialist.

Yes — sleep disorders are well-suited to telehealth. Evaluation, medication management, follow-ups, sleep apnea screening, and CBT-I work all function well via secure HIPAA-compliant video. We provide telehealth across Pennsylvania, Maryland, and Virginia.

You must be physically located in a state where your provider is licensed at the time of the visit. Abu Koroma sees patients in PA, MD, and VA (ages 12+); Zainab Koroma sees patients in PA and MD (ages 8+) including in-person at York. Sleep studies require an in-person sleep lab; we coordinate referral when indicated.

Yes — Zainab Koroma sees patients ages 8 and up at our York office and via telehealth in PA and MD. Abu Koroma sees ages 12 and up via telehealth in PA, MD, and VA. Pediatric sleep problems often have distinct causes: behavioral sleep difficulties, anxiety, ADHD, irregular schedules, screen exposure, and sometimes sleep apnea (often related to enlarged tonsils/adenoids).

Pediatric medication options are limited and used cautiously — we often work with parents on behavioral interventions and refer for pediatric sleep medicine evaluation when sleep apnea or other organic disorders are suspected. Children & adolescent care details.

New patient appointments at Optimal Health York are typically available within one week. Sleep evaluations are 60-minute initial visits, allowing time for sleep history, screening for sleep apnea and other disorders, evaluation of co-occurring psychiatric conditions, and treatment planning; follow-ups are 30 minutes. Same-day and next-day telehealth appointments are often available depending on provider schedule. Call (717) 202-2285 to check current availability, or book online 24/7 through our HIPAA-compliant patient portal.