The amount of sleep needed varies widely based on multiple factors including age, health, lifestyle (including physical and mental exertion), and genetic makeup. For most adults, the right amount falls between 6 to 10 hours/night. Meeting personal sleep requirements is important for many aspects of health including learning and memory, mood, immunity, cardiovascular health, metabolism and weight, and safety.

Most adults will experience an episode of poor sleep at some point in life, which is often triggered by a stressor. For many adults, sleep difficulties naturally subside as the triggering circumstances resolve – but for others, this is the onset of insomnia.

What is Insomnia?

Insomnia is a diagnosable disorder that exists when an individual has a significant sleep difficulty (non-restorative sleep or difficulty falling/staying asleep) that persists for at least one month and causes significant daytime symptoms such as fatigue, poor concentration, mood disruption, or difficulty meeting social or occupational demands. It is more common among women, older adults, shift workers, and people with medical or psychological problems. According to the Canadian Sleep Society, about 10% of the adult population in Canada experience persistent insomnia and an additional 20% to 25% reports occasional insomnia symptoms.

Insomnia can be classified as either “primary” or “secondary.” Primary insomnia is diagnosed when sleeplessness cannot be attributed to any other cause, whereas secondary insomnia is diagnosed when it is a symptom of another condition. Sleeplessness in secondary insomnia is often the result of an underlying difficulty with physical health (e.g., obstructive sleep apnea, arthritis or other pain conditions), psychological health (e.g., depression, anxiety), or substances (e.g., prescription medications, alcohol, or recreational drug use).

What treatment options are available?

Key treatments for primary insomnia range from natural supplements such as melatonin and medications such as hypnotics and antidepressants, to psychological interventions such as Cognitive Behavioural Therapy for Insomnia (CBT-I). CBT-I is a structured therapy that involves monitoring and changing cognitive and behavioral factors that cause or maintain sleep difficulties. Significant improvements in sleep are often achieved after six to eight treatment sessions. Research has shown that CBT-I is as effective in treating insomnia as prescription medications, but the effects are longer lasting.

Secondary insomnia is often best treated by treating the underlying cause. If sleeplessness persists after the contributing condition has been treated, additional sleep treatments may be appropriate.

Which treatment is best?

For those experiencing chronic sleep difficulties, the first step is to talk to a doctor or psychologist. A careful assessment can help identify whether sleep difficulty is a primary or secondary insomnia – this will determine the most effective treatment approach for the given circumstances. It is also important to consider the pros and cons of pharmacological versus nonpharmacological approaches. While medications can have side effects and many are not intended for long-term use, sleep improvements are often achieved quickly. In contrast, CBT-I requires more effort and time to produce improvements; however, sleep improvements are more durable and the side effects of medications can be avoided. Selecting treatment options that fit a person’s lifestyle is important – this helps to build motivation to follow through with treatment and achieve optimal results.

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