The Current19:15How to beat insomnia with cognitive behavioural therapy
For more than 30 years, Faye Dickieson battled the exhausting effects of insomnia. She turned to sleeping pills in an attempt to get a peaceful night’s rest, but found no relief — only its lingering side effects.
“I would just toss and turn, toss and turn,” Dickieson, who lives in Alberton, P.E.I., told The Current‘s host Matt Galloway, noting she’d typically get just two hours of sleep
“I wouldn’t go back to sleep. It would just put me in a fog, and then I’d get to work, and I thought, ‘Oh God, I don’t even remember driving here.'”
One in six Canadians suffers from insomnia, according to a phone survey of 4,037 Canadian adults published last year in the journal Sleep Medicine.
The researchers found there’s an “increasing use of various medications and substances to cope with this health issue.” In particular, survey results suggested that use of medications, alcohol and cannabis for sleep is now 1.5 to two times higher than it was 16 years ago.
But the Canadian Centre on Substance Use and Addiction warns that sedatives for insomnia, like benzodiazepines, are addictive and can cause harmful side effects, including amnesia, liver damage and tolerance toward the drug — leading people to increase their dose to achieve the desired effects.
Dickieson found an alternative treatment for her insomnia at a sleep seminar led by David Gardner, a psychiatry professor at Dalhousie University, where she was introduced to cognitive behavioural therapy for insomnia (CBT-I).
It’s a non-pharmaceutical approach that can help with insomnia, but it can also be expensive and hard to access. Now, some doctors are trying to change that.
The therapy route
Dickieson says, for her, the results of CBT-I were transformative. “I was getting four and five hours [of] sleep with no pills,” she said.
“I feel full of energy, and so much more happier, and not in a fog anymore.”
CBT-I is a drug-free treatment that helps patients recognize and change old thoughts, behaviours and emotions that perpetuate insomnia into new approaches that bring on sleep naturally, says Gardner.
This is done by having patients keep sleep diaries to track sleep habits and patterns, and learn a variety of sleep-enhancing techniques. Those include relaxation exercises, good sleep hygiene practices like setting a regular bedtime and wake time, and strategies for managing anxious thoughts.
“So you layer on all of these different techniques, and … we see a four- to eight-week program resolving 20 or 30 years of sleep problems and they don’t come back,” said Gardner.
A certified psychologist helps guide this, and it can be done either one-on-one or in a group setting.
According to a 2022 study involving 62 participants, half to two-thirds of people with insomnia responded to CBT-I, showing improvement in their self-reported sleep quality over three months.
However, people who may be biologically predisposed to insomnia might be less responsive to the treatment, and in such cases, “some medications may be more useful,” said neurologist Thanh Dang-Vu, a professor in the department of health, kinesiology and applied physiology at Concordia, where he is also research chair in sleep, neuroimaging and cognitive health.
“The current hypothesis is that maybe that some people [whose] cause of insomnia is more biological in nature, would be less likely to respond,” said Dang-Vu, who is also a researcher at Centre de Recherche de l’Institut Universitaire de Gériatrie de Montréal.
“This is still an ongoing investigation.”
Many different factors can contribute to insomnia. Stressful events, such as losing a loved one, medical conditions like chronic pain and heart failure, and medications such as steroids, antidepressants and over-the-counter allergy medicines can all be potential contributors.
A Radio-Canada investigation into the use and side-effects of benzodiazepines such as Ativan and Xanax reveals the drugs are often overprescribed and there isn’t enough education for doctors or patients about the risks — including falls, fractures and addiction.
Why aren’t more people using CBT-I?
Though sleep experts recognize CBT-I as effective — and the preferred first-line treatment, ahead of medication — it’s not accessible to many people.
Each session of CBT-I typically costs between $100 and $250, with most patients requiring six to eight sessions, says Dang-Vu. Additionally, most CBT-I providers are located in private psychology clinics, and in many provinces, the treatment is not covered by the provincial healthcare system.
Qualified psychologists in CBT-I are also in short supply, because it’s not typically offered in the core curriculum of clinical psychology programs, according to Dang-Vu. Specialized training is often required, and it’s available only through a limited number of programs.
Dr. Mike Simon says the responsibility of administering the treatment then falls on the shoulders of family doctors like himself.
“Trying to get counselors and therapists [is] like pulling teeth … because A, there’s not much around, and B, those around [have] a huge waiting list,” said Simon, who works in Saint John.
Many of his patients also approach overcoming insomnia with the expectation of a quick fix.
“When patients come in, they’re tired, they’re fatigued.”
“[They’ll say], ‘Doc, look, I don’t have time, can I just have pills for a couple of weeks?'”
Increasing awareness and accessibility
Last November, Dang-Vu co-authored an open letter published in the Montreal Gazette, signed by over 50 sleep medicine researchers and clinicians from across the country. It called on policymakers to prioritize public reimbursement for CBT-I.
The letter urged the government to include the treatment in public health plans, making it accessible to all Canadians, regardless of their socioeconomic status.
In addition to policy changes, the researchers are working to make it more accessible to the public through a self-help approach.
For a geriatric research centre in Montreal, Dang-Vu developed an online version of the program aimed at older adults. The program is currently being tested in research trials before being launched to the public. The goal is to make the resource freely accessible, Dang-Vu said.
For Dalhousie University, Gardner created a website called Sleepwell that features a curated list of resources, including books and apps to help individuals begin their CBT-I treatment in their own time and place.
A good night’s sleep is essential for mental and physical well-being, says Dang-Vu.
That’s why he says it’s crucial to recognize signs of sleeplessness, and know that drug-free treatments exist.
“It’s very important now to consider sleep as not a minor problem, but it can be a catalyst for more serious health consequences,” he said.
“That’s how we can get the word out that it’s important to diagnose and treat.”
