Your pathway to a better night’s sleep: Treatment options for insomnia in Canada
By Dr. Amy Zwicker, Registered Psychologist See Bio
Dr. Amy Zwicker is a registered psychologist who completed her doctoral degree in clinical psychology at the University of British Columbia and her clinical residency in neuropsychology at Vancouver Coastal Health. Although she is skilled in assessment and treatment of a broad range of psychological conditions, her primary interests lie in providing assessment and interventions for adults and older adults with cognitive changes. Further to her clinical experience, Dr. Zwicker has published multiple journal articles and book chapters pertaining to cognitive and clinical psychology.Hide
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.
The amount of sleep you need varies widely based on multiple factors including your age, health, lifestyle (including physical and mental exertion), and genetic makeup. For most adults, the right amount falls between 4 to 10 hours/night. Meeting your personal sleep requirements is important for many aspects of health including learning and memory, mood, immunity, cardiovascular health, metabolism and weight, and safety.
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. 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 behavioural 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 is the best treatment for you?
If you are experiencing chronic sleep difficulties, the first step is to talk to your doctor or psychologist. A careful assessment can help
to identify whether your sleep difficulty is a primary or secondary insomnia—this will determine the most effective treatment approach
for your circumstances. It is also important to consider the pros and cons of pharmacological versus non-pharmacological 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 your lifestyle is important—this helps to build motivation to follow through with treatment and achieve optimal results.
Dr. Amy Zwicker is a registered psychologist who completed her doctoral degree in clinical psychology at the University of British Columbia and her clinical residency in neuropsychology at Vancouver Coastal Health. Although she is skilled in assessment and treatment of a broad range of psychological conditions, her primary interests lie in providing assessment and interventions for adults and older adults with cognitive changes. Further to her clinical experience, Dr. Zwicker has published multiple journal articles and book chapters pertaining to cognitive and clinical psychology.