The Current - How to beat insomnia with cognitive behavioural therapy

Episode Date: February 17, 2025

Faye Dickieson from Alberton, P.E.I., spent 35 years trying to conquer her insomnia with sleeping pills, but they never worked. What ended up helping was something she had never heard of  — cognitive behavioural therapy. We hear from sleep experts about why it’s considered the best treatment for sleepless nights and how you can access it.

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This is a CBC Podcast. Hello, it's Matt here. Thanks for listening to The Current wherever you're getting this podcast. Before we get to today's show, wonder if I might ask a favor of you if you could hit the follow button on whatever app you're using. There is a lot of news that's out there these days. We're trying to help you make sense of it all and give you a bit of a break from some

of that news too. So if you already follow the program, thank you. And if you have done that, maybe you could leave us a rating or review as well. The whole point of this is to let more listeners find our show and perhaps find some of that information that's so important in these really tricky times. So thanks for all of that. Appreciate it. And on to today's show. How'd you sleep last night?

Did you get a good sleep? If you are like a growing number of Canadians, the answer to that question is no. Like I would just be laying there saying, hey, you got to get to sleep. Got to get some sleep. And I would just toss and turn, toss and turn. Okay. I got to watch TV. Sometimes I might doze off, but it would only be for 10 minutes, 15 minutes tops.

We are only now just getting a grip on how many Canadians are up through the night. Nearly one in five adults, but most of us still have a lot to learn about how to treat insomnia. I'd take another sleeping pill at two, but I wouldn't go back to sleep. It would kind of 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. That's Faye Dickerson in Albert and PEI. She started taking sleeping pills while going through a divorce in her 30s.

And then it was a half, started with a half and there were the little blue ones. I can't remember what they were called. That might have worked for maybe a month and then I went back and I said they're not working anymore she said well take a whole one. So then she put me on another kind and they worked for a month or two months and then they didn't work so then she put me on another one and then finally the last one she said these are very addicting and I said well maybe I shouldn't take them and she says well what do you want to do? Be addicted to sleeping pills or not sleep?

So I started out with one of those and then that didn't work after maybe three months. So then she increased it to two. They weren't working out either. So she increased them to three. Like I was foggy all the time. And sometimes I would stagger. Like I'd be walking and I'd be staggering. Faye was on those pills and staggering, as you heard, for 35 years.

What ended up helping her was something that she had never actually heard of before. And it began in a chance encounter with a Dalhousie University researcher named David Gardner. He was giving a talk in a town nearby. So this one friend was putting on this senior thing in Somerside. She said, and it's about sleep. You should come, Fay. So I said, okay. And so he did his thing and he went to the hospital. He was giving a talk in a town nearby. So this one friend was putting on this senior's thing in Somerside.

She said, and it's about sleep. You should come, Fay. So I said, okay. And so he did his seminar and he was talking about sleeping and all this. And then at the end he had question period. So I raised my hand and I said to him, I said, I've been on three sleeping pills for years now and they don't work. I get maybe two hours sleep a night and that's it.

He said, so why are you taking them? And I said, well, I want I get maybe two hours sleep a night and that's it. He said, so why are you taking them? And I said, well, I want to get that two hours sleep. I'm scared that if I don't take them, I won't get any. And then he said, first thing you have to do is go to your pharmacist and get her to wean you off these pills. David Gardner then told Fay about a sleep treatment that has a big name, cognitive behavioral therapy

for insomnia. And within a few months of learning about that name, cognitive behavioral therapy for insomnia. And within a few months of learning about that, life got way better for Faye. Dr. Gardner FaceTimed me a couple of times afterwards to see how I was doing. Couldn't believe it. I was getting four and five hours sleep with no pills. And he said, how do you feel? And I said, I feel great. Like I feel full of energy and so much more happier and like not in a fog anymore. Cognitive behavioral therapy for insomnia is recognized around the world as the best treatment

for sleepless nights, not sleeping pills. David Gardner is part of a national group trying to wean Canadians off of prescription sedatives, but that has not been easy. He's in our Halifax studio this morning. David, good morning. Good morning, Matt. We're going to go through this therapy in just a moment,

but from your perspective, knowing what you know, how serious is the sleeping pill problem or addiction in this country? Yeah, I think the numbers might be a little bit alarming. When we think about people over 65 who are taking sleeping pills long term, numbers are going up and up as the age goes up. So in Eastern Canada, that's where the numbers are highest.

In New Brunswick where we did some of our research, there's about one in four to one in five people 65 years of age and older taking sleeping pills chronically. The recommendations are not to take them at all. In the West Coast, it's a lot lower. It's probably something like one in 15. So we have some differences across the country. But overall, we're seeing too much sleeping pill use. We're going to head to New Brunswick

and talk about what's going on there in a moment. But broadly, we take a look at this country. What's going on? I mean, why is it that we are taking so many sleeping pills? Dr. Sinclair K. I think there's many different reasons, but the most important one is that people don't know that there's a better alternative out there. For decades, sleeping pills have been the standard treatment for insomnia. So, when somebody goes to see a pharmacist or a family doctor, the expectations on their side is

that I'm going to be leaving here with a remedy for my problem and it's going to fix my problem. And when you're thinking about being a physician or a pharmacist, you say, well, I have to meet the needs and I don't really have a better alternative. And so we've been doing this for years and years and years and just thinking about, well, maybe we can give them a few tips on how to improve their sleep, but ultimately we're relying on medication and substances to help people think they're going to get a better sleep. Well, if you listen to Fay, I mean, people think they're going to get a better sleep. Fay was on these pills for 35 years.

She said she was staggering around. The pills didn't even work. She started with one, then ended up on two, then ended up on three pills. Dr. Mark S. Baxter Yeah, imagine you take a sleeping pill for the first time, and you get to sleep so much faster than you have been over days, weeks, months, or years. You're going to quickly build a relationship with that medication, a very positive relationship. And it might be one of those relationships, you go, well, you're not treating me like you used to, but I'm still dedicated to this relationship. So no matter how off the rails it goes, and Fay really showed what that vicious cycle

of sleeping pills can be like for individuals, you just don't wanna give up on it with the hope that it's going to come back and treat you the way it did the first time around. Are they always bad for us? I mean, people take them because they are going to presumably help you fall asleep Are there times when a sleeping pill can be of some assistance?

Yeah, they're not always bad for us The way to use sleeping pills is for short-term use only and when I say short-term use I mean just for a few nights like less than a week If you are running into having the need for sleeping pills that's longer than that, then it's not the ideal therapy because sleeping pills can't undo the causes of chronic insomnia or long-lasting or recurrent insomnia. Alternatively, is this cognitive behavioral therapy for insomnia that actually directly treats the causes of long-term insomnia where sleeping pills can't do that.

But that short-term use doesn't seem to be the case. People are prescribed these drugs for years. Well, it always starts with a hope. A hope that in a few days everything will go back to normal and you don't need the sleeping pills anymore. But what happens if you... A few days turn into like weeks and months? Yeah, and one of the reasons we have such high use is physiological withdrawal. What's the first thing that happens when you stop your sleeping pills abruptly is you get rebound insomnia, which means the insomnia comes back with a vengeance.

But they're especially dangerous for seniors, right? Yeah, we know that the risks are higher and higher in seniors. Some risks are across the ages. It doesn't really matter how old you are. We think about driving impairment, next morning driving impairment. Canada's most popular sleeping pill actually impairs your level of driving, the same amount of drinking alcohol and going driving a half an hour later and getting a blood alcohol content level of 0.08, which is the illegal level. And so we're quite concerned across the ages, but as you get older,

the risks increase and increase. So we think of cognitive impairment, so memory problems, forgetfulness, and as Fay really clearly pointed out, that next day grogginess, you can't remember even how you got to work, you start to feel like your brain isn't working the way it used to, and it's medication related. And in addition to that, slowed reaction time and loss of balance and so forth really contributes to the risk of falls and fractures. So as you get older, you're more likely to fall anyway, and this medication only makes that worse.

What about over-the-counter drugs? I mean, we're talking about prescription pills, but I mean, you know that somebody is having difficulty sleeping, they might pop a gravel, take some Benadryl, what have you. The issue is broad. So when I say sleeping pills, I kind of define it very broadly, substances or medications that make you drowsy. Anything that's going to knock you out. Yeah.

So cannabis is part of what I'm talking about. A lot of people are saying and relying on cannabis, but they fall into the same trap as Fay described, where people talk to me but they fall into the same trap as Fay described where people talk to me and ask me for the same advice. I'm now realizing I'm dependent on my cannabis. I can't stop my cannabis. My sleep is not great, but stopping the cannabis actually seems to just make a not great sleep even worse.

So what am I supposed to do? So tell me about this cognitive behavioral therapy for insomnia. People might know of cognitive behavioral therapy, CBT, for depression, for other things that they might be experiencing, mental health disorders, what have you. What about for insomnia? What is that? Yeah, it's actually quite distinct from the cognitive behavioral therapy that is used for anxiety disorders and depression and so forth. It's really structured. It's something

like four to eight weeks long. You layer on the different sleep enhancing techniques that you learn as you go through the program and it directly addresses the underlying causes that perpetuate long-term insomnia. So one of the first things people learn about is a sleep diary or a sleep blog. So each day during this program that you go through, you're recording last night's sleep and that takes one to two minutes and you're really tracking how your sleep is changing over time. And while you're doing that, you're learning different sleep enhancing techniques. So you start off with, for example, setting a specific bedtime and setting a specific

rise time so your sleep schedule is very regular and when you're going to bed, the rule is only go to bed at your bedtime or after, not before. So, Faye was talking about I would fall asleep in front of the TV and so forth. So you really have to stay up and be active until at your bedtime. And if you just happen to be wide awake at your bedtime you can't go to bed. You can only go to bed when you're feeling really tired and ready to sleep. A lot of people who have insomnia say when I turn out the light my head hits the pillow my mind races and that can be extremely frustrating and when you're frustrated you're not ready to sleep and Fay talked

about that as well and so this approach makes it so that we're going to break that habit of being in bed and feeling frustrated, take you away from the bed until you actually feel very tired. So some components of CBTI have you stay up very late so that you're so exhausted by the time you get to bed you can't do anything but fall asleep. And that breaks that cycle or that association of being in bed and feeling frustrated and stressed and therefore unable to sleep. So you layer on all of these different techniques and so we see a four to eight week program resolving twenty or thirty years of sleep problems and they don't come back. And this is so different than sleeping pills.

The expectation for a lot of people is I need eight hours of sleep. And so I'm going to go to bed at X time and wake up at this certain time, and that's gonna give me eight hours, even though I might be tossing and turning and I'm not getting those full eight hours. How do you convince somebody to go to bed

two o'clock in the morning if they have to get up at five or six? Yeah, I totally understand. And this is where the eight hours of sleep idea can get in the way. A natural response that is not actually helpful is, I'm going to go to bed at a reasonable time tonight, even earlier than I normally go to bed, to give myself the best chance that I can for getting a good night's sleep. And it actually gives you the best chance for having more frustration and worsening

the problem. Because you're frustrated, you're lying in bed, you're tossing and turning, and you're becoming annoyed because you're not falling asleep. And that's no way to sleep. The research is so deep. You know, I'm a pharmacist. I know research about drugs. The research about CBTI is deeper and more extensive than it is for medications, all sorts of medications.

It works extremely well. So, it's as effective as sleeping pills in the short term and it's much more effective than sleeping pills in the long term. And that's the big advantage, a short term therapy, CBTI, for long term benefits. So why aren't we using it then? Well, I do coin the phrase every now and again, it's the best therapy for insomnia that you haven't heard of. And one of the reasons you haven't heard of it is because it's been around a long time, but it's been hard for people to access.

So family doctors will say, well, I may have heard of CBTI, but I don't know who in my neighborhood is actually offering CBTI. And the Canadian Sleep Research Consortium is just coming out with a list in the next few days of who offers CBTI across the country. This is really a breakthrough and it's going to be really helpful. We're going to put it on our website to make sure people can access the list of therapists. But what's more for me exciting is CBTI is now available in a self-help approach. Now you can have digital, online or apps that are CBTI based and very effective or you can do it through books. If you like a workbook and you like to learn things through workbooks, we also recommend a variety

of them. So they're on mysleepwell.ca because we want people to be able to say, I heard this story on the current, I want to get a good night's sleep tonight and they could actually get started with one of the books or one of the digital resources that are recommended. So you can do self-help or you can get referred to a trained therapist in CBTI. I'm Dena Temple-Raston, the host of the Click Here podcast from Record of Future News. Twice a week, we tell true stories about the people making and breaking our digital world. And these days, our digital world is being overrun by hackers. I was just targeted by a nation state. And they range from reflective.

It's a crime, bro. And I live with that every day. To ruthless. Do you feel guilty about it? No, not really. Click here from Recorded Future News. You can find us wherever you get your podcasts. I want to bring in another voice into our conversation.

He's been listening in. Mike Simon is a family doctor in New Brunswick, where, as you said, sleeping pill use is among the highest in the country. He's in our studio in St. John. Dr. Simon, good morning to you. Good morning. How do you understand that?

Why so many people in your province are using sleeping pills? Well, I think we can back up and say that basically, insomnia is one common issue that we see in family practice, basically on a daily basis. I think that's triggered by the stress we have in our lifestyles. I mean, everyone has work.

We have to run the kids back and forth. We have appointments to make, busy, busy lifestyles. So as we get older and our sleeping pattern changes and there's a demand for us to be on our best, willing to do and able to do our jobs. There's a lot of stress on people and that's why we see them in the office coming in saying, Doc, I got to sleep. You know, I'm on shift work or something's happened. And it's up to us as family, Doc, to sit back and say, okay, we just don't throw out

these pills willy-nilly. We got to find the underlying reasons why. Okay? And in many cases, it's a medical condition. Is it osteoarthritis causing pain at night? Was there a recent death in the family? This is some of the issues that come in to complicate the insomnia. It's an issue that we see frequently and we see patients looking for a fix, oftentimes a quick fix.

That's a national story in some ways. I mean, all of what you said could be related across the country. What's going on in New Brunswick that would lead so many people to be using sleeping pills? I certainly can't speak for all the doctors in the Brunswick, but what we see is when patients come in, they're tired, they're fatigued and obviously looking for a fix. Oftentimes patients come in and say, look doc, I'm on shift work and really I just got to sleep a couple nights a week, could I just have a pill for that night or for a couple nights? So, these are discussions that we have with patients. Our job is to try to make the symptoms better. So, we have to look at all avenues to try to fix it.

We know and we're taught, sleeping pills are not for long-term use. We know that family doctors like yourself are, I mean, you talk about being busy and time crunched, I mean, you're under the gun, right? You have more patients than you could possibly see. There is a narrative that perhaps doctors are quick to prescribe because that's one way, if somebody comes in to do what you're doing,

to walk through those various steps, that can take a long time. You don't have a long time. One of the things you can do is prescribe a pill and maybe that will alleviate the symptoms. Does that sound familiar? To my point, as you mentioned, actually, I have a couple thousand plus patients in my practice and when I have a patient come in, the way it usually goes is that they'll come

in and they'll present with insomnia complaints and they'll be tired and they just want a quick fix. So that's when I take a breath and I sit back and say, okay, let's talk about it. And you have statistics that say, you know, Brunswick's using a lot of sleeping pills. Well, we're teaching our students the same across Canada. We try not to use them. So that's the way we try to handle this thing. But the patient has symptoms and oftentimes the patient's doc look at, I don't have time. Can I just have pills for a couple of weeks? You know, and then what we do in that case is that you don't just give it and go, you make an appointment, you have a telephone phone call with them in two weeks.

This takes work. What do you make of the promise of something like the cognitive behavioral therapy for insomnia? The issue is accessibility as your guest stated. It's in the same area almost like mental health, trying to get counselors and therapists. It's like pulling teeth. We end up doing a lot of it ourselves because A, there's not much around and B, those that is around has a huge waiting list and C, it's expensive.

David, from your perspective, if we aren't sleeping well, what is the cost broadly? Well, the cost is medical and mental health issues that are very expensive for the system across the country. And we really need to think about how do we help people who have been taking sleeping pills chronically come off them safely and get a better night's sleep. And that's what we've been doing with My Sleep Well to try and get the word out and have people get over the access issue because there are tools and resources available right there on the website that will help people start without delay.

And we're hoping that family doctors and others will be able to pick up on that and be able to recommend an effective intervention to get that insomnia as something in their past. How are you sleeping these days? I'm sleeping all right, but I have to use a variety of different techniques. Sleep hygiene, you know, last night I was offered a coffee at an event at my kid's school late at night, and I said, absolutely no way. And a parent beside me said, I'm going to do it, but at three in the morning I'm going to feel bad about saying yes.

Dr. what about you? Do you sleep okay? Not as good as I used to and the hard part is taking those calls from the hospital in the middle of the night that wake you up and also disturb the pattern. So that doesn't help. You both are, I think, are representative of much of the society where we wish we could get more sleep and we're struggling to figure out how we could get more sleep. Thank you both for being here.

Thank you. Thank you. Mike Simon is a family doctor in St. John, New Brunswick. David Gardner is a professor in the department of psychiatry at Dalhousie University in Halifax. That website he mentioned, mysleepwell.ca, a not-for-profit project from Dalhousie. How are you sleeping? What are you doing to get better sleep?

Are you on sleeping pills, perhaps using that CBT-I, maybe something else? Let us know because we are all looking for more sleep. How you are getting more sleep. You can email us, thecurrent at cbc.ca. For more CBC podcasts, go to cbc.ca slash podcasts.