For more than 30 years, Faye Dickieson of Alberton, P.E.I., lay awake. Sleeping pills never fixed it. “I would just toss and turn, toss and turn,” she told CBC’s The Current, and she usually managed about two hours. The pills left her foggy. She remembers arriving at work and thinking, “Oh God, I don’t even remember driving here.”
What changed things was a sleep seminar led by David Gardner, a professor of psychiatry and pharmacy at Dalhousie University. There she met cognitive behavioural therapy for insomnia, known as CBT-I. After a course of it, she said, she was getting four and five hours of sleep without pills. “I feel full of energy, and so much more happier, and not in a fog anymore.”
How the therapy works
Gardner describes CBT-I as a drug-free treatment that teaches patients to spot the thoughts, behaviours and emotions that keep insomnia going and replace them with habits that bring on sleep naturally. Patients keep a sleep diary and learn relaxation exercises, regular bedtimes and wake times, and ways to handle anxious thoughts. A certified psychologist guides the process, one-on-one or in a group.
“You layer on all of these different techniques,” Gardner said, and a four- to eight-week program can settle 20 or 30 years of sleep problems “and they don’t come back.”
Evidence is more modest than that anecdote. A 2022 study of 62 participants found that half to two-thirds of people with insomnia responded, reporting better sleep quality over three months. Thanh Dang-Vu, a neurologist and professor at Concordia University, said people who are biologically predisposed to insomnia may respond less, and “some medications may be more useful” for them. He called that hypothesis “still an ongoing investigation.”
Why so few people get it
Sleep experts treat CBT-I as the preferred first-line option, ahead of medication. Getting it is another matter. Dang-Vu said each session typically costs between $100 and $250, and most patients need six to eight. Most providers work in private psychology clinics, and in many provinces public health care does not cover it. Psychologists trained in CBT-I are scarce because it is not usually part of core clinical psychology programs.
That leaves family doctors holding the problem. Dr. Mike Simon, who practises in Saint John, said finding therapists is “like pulling teeth,” since there are few and those who exist have long waiting lists. Patients arrive exhausted and often ask, “Doc, look, I don’t have time, can I just have pills for a couple of weeks?”
The pills carry their own risk. The Canadian Centre on Substance Use and Addiction warns that sedatives such as benzodiazepines are addictive and can cause amnesia, liver damage and tolerance, which pushes people to raise their dose. A phone survey of 4,037 Canadian adults, published last year in Sleep Medicine, found that one in six Canadians has insomnia, and that use of medications, alcohol and cannabis for sleep is now 1.5 to two times higher than it was 16 years ago.
Researchers are pushing for change. Last November Dang-Vu co-authored an open letter in the Montreal Gazette, signed by more than 50 sleep medicine researchers and clinicians, urging policymakers to put CBT-I into public health plans. He has also built an online version of the program for older adults at a Montreal geriatric research centre; it is in research trials, and the aim is to make it free. Gardner created MySleepwell.ca, a site listing books and apps for people who want to start CBT-I on their own.
Consult your doctor for medical advice.
