Online sleep treatment: meds vs CBT-I
Most insomnia is best treated by CBT-I (cognitive behavioral therapy for insomnia), not medication. The medications telehealth can prescribe are non-controlled and second-tier. The controlled sleep meds (Ambien, Lunesta, benzos) generally require in-person prescribing.
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CBT-I first
Cognitive behavioral therapy for insomnia outperforms medications at 12 months. Digital CBT-I programs (Somryst, Sleepio) deliver the protocol online over 6-8 weeks. Some health plans cover them; out-of-pocket runs $100-400 for the full program.
Non-controlled medications
Trazodone (off-label, sedating antidepressant) — 50-100mg, $5-15/month generic. Doxepin (Silenor) — 3-6mg, FDA-approved for sleep maintenance. Hydroxyzine — antihistamine, sedating, non-addictive. Ramelteon (Rozerem) — melatonin receptor agonist, weakest of the bunch. All prescribable via telehealth.
Controlled meds and the telehealth gap
Zolpidem (Ambien), eszopiclone (Lunesta), and benzodiazepines are controlled substances. Federal law tightened telehealth controlled-substance prescribing after the 2025 DEA rule. Most platforms no longer touch these — patients with existing prescriptions are typically asked to transfer to an in-person clinic.
When to skip telehealth
Sleep apnea (needs in-person sleep study), restless legs requiring controlled meds, narcolepsy, or chronic insomnia not responsive to CBT-I and one trial of trazodone — these benefit from in-person sleep medicine.