What is insomnia?

Insomnia can be linked to a stressful event (problems at work, bereavement, divorce, etc.). This is referred to as temporary or acute insomnia, although it can last for several weeks. It usually resolves itself once the triggering factor disappears. Insomnia is often caused or aggravated by poor sleep habits, such as consuming coffee or tobacco in the hours before bedtime, excessive alcohol consumption, engaging in intense activity late at night, irregular schedules, or a disruptive environment (noise, light, temperature, etc.).

It can accompany physical problems, such as heart and lung disease, musculoskeletal disorders and chronic pain, or psychological disorders, such as depression and anxiety. It can also be associated with other sleep disorders, including obstructive sleep apnea, which is very often diagnosed in people who complain of insomnia or non-restorative sleep. This medical condition is called comorbid insomnia and sleep apnea, better known by the acronym COMISA.

In addition to having difficulty falling asleep, waking up frequently or experiencing prolonged periods of wakefulness during the night, waking up early in the morning and being unable to fall back asleep, a person suffering from insomnia will not feel rested in the morning. They may also experience various symptoms during the day, such as irritability, excessive fatigue (physical and mental), episodes of drowsiness, decreased motivation, headaches, digestive problems, and difficulty concentrating or paying attention. In the long term, lack of sleep can disrupt daily activities, reduce quality of life, aggravate the symptoms of other illnesses and cause accidents. Insomnia is also associated with an increased risk of suicide, especially when it coexists with psychiatric disorders such as major depression. This link has been observed in adults as well as children and adolescents. [3]

If insomnia symptoms have only lasted a few days, adopting better sleep hygiene can be beneficial. However, if difficulty sleeping occurs at least three nights a week for more than three months, insomnia is chronic and requires consultation.

The diagnosis of insomnia is usually based on a thorough clinical assessment, including a detailed history of the person's sleep complaints. This assessment also aims to identify any psychiatric comorbidities, as well as medical or pharmacological factors that may alter sleep quality. To fully understand the problem, it may be helpful to keep a sleep diary for one to three weeks, noting when and under what conditions insomnia occurs, the severity of episodes, and their impact on daily life.

Polysomnography (PSG) is not routinely recommended for the diagnosis of chronic insomnia. Its use is limited to cases where another sleep disorder is suspected.

CBT-I remains the gold standard treatment for complex or persistent chronic insomnia. It combines behavioural and cognitive strategies to work in depth on the thoughts, beliefs and concerns that interfere with sleep.

CBT-I is generally offered in 5 to 12 sessions, depending on the programme and individual needs, and is provided by psychologists, psychotherapists or social workers.

In most cases, CBT-I is effective. However, when sleep difficulties persist or complex cognitive issues are identified during follow-up, a referral to CBT-I may be recommended.

At Biron, your journey begins with a comprehensive assessment and personalised support from our team of sleep care specialists. It consists of three stages:

1. A thorough assessment of your situation;
2. An initial intervention based on TCB-I;
3. A referral to CBT-I if necessary.

If insomnia persists, medication may be used. However, according to Charles Morin, professor at Laval University and world-renowned expert on insomnia, medication does not eliminate the cause of insomnia and should be considered an occasional lifeline. [5]

• There are seven main categories of sleeping pills (hypnotics) that can be prescribed to help patients get some rest, but only for a short period (two to four weeks), as they carry a risk of dependence, and some lose their effectiveness after a few weeks.
• Antihistamine hypnotics include most over-the-counter medications. These are not sleeping pills; they are medications commonly used to treat allergies that can cause drowsiness. However, their effectiveness in treating insomnia has not been clearly demonstrated [6], and their side effects are similar to those of sleeping pills.
• Melatonin is a hormone secreted by the brain that helps maintain the sleep-wake cycle. It also exists in synthetic form in over a hundred products approved as natural health products in Canada. However, it is important to note that in North America, the actual melatonin content of natural supplements can vary considerably—from -83% to +478% of the dose indicated on the label—which can affect their efficacy and safety. [7] Although it promotes sleep and may be beneficial for certain sleep disorders, its effectiveness in treating insomnia appears to be limited. [8]

We offer services that can assist your doctor in diagnosing sleep disorders and determining the appropriate treatment.

• Sleep care services
• Insomnia treatment
• Online boutique

Do you have a medical prescription for one of these tests? Book an appointment online or contact Biron Health Group’s customer service at 1 833 590-2712.