A research team led by experts at Queen’s has developed an insomnia care model that they think will help people treat sleep issues and avoid dependence on prescriptions.
The team, led by sleep expert Dr. Judith Davidson, put together a stepped care model that aims to boost access to cognitive behavioural therapy (CBT) as a primary step in insomnia care, and emphasizes a self guided approach to treating sleep disorders.
The study which was published earlier this month highlights that while CBT for insomnia is an effective treatment and a recommended response, access is limited and inequitable.
Katherine Fretz, a postdoctoral fellow at Queen’s and registered psychologist, says the primary response for insomnia and sleeping problems is prescription medication, while more basic and cheaper interventions are not even tried.
She says people suffering from insomnia are often waiting for specialized care when self guided treatments may have been all that was necessary.
“Right now the way insomnia care is often happening in Canada is that people are waiting for these more specialized treatments that they might not actually need,” Fretz said.
“This model really emphasizes self-care and self-guided approaches for the treatment of insomnia, which are shown to be effective for a lot of people.”
Fretz says that many people don’t even know that CBT is a recommended first step treatment for insomnia, but with more and more people struggling with sleep -nearly half of Canadians reporting issues falling or staying asleep while 1 in 6 meet the criteria for insomnia disorder- there is more of a desire for accessible and self guided aids.
She says especially in a health care system where so many people lack access to a primary care provider, increasing accessibility to treatment that people can deliver themselves is a need.
“We have this safe and effective treatment that’s out there, CBT-I, that is the first line and it’s not known about, and even if it is known about, there’s not equitable access to care,” Fretz said.
“A lot of people don’t have access to a primary care provider, a lot of providers maybe don’t have the training or knowledge in first line insomnia treatments. We really wanted to address the reality of the Canadian health care system the way it is right now.”
Encouraging doctors to make patients aware of CBT as an effective first line treatment is a big part in the model, as there can be a misconception that people would prefer to just take a pill when often they believe it’s their only option.
Fretz says that the effects of CBT treatment can be fairly clearly seen in real time if patients buy in.
The necessary changes to truly make an impact are often more than just sleep hygiene related, and while they require attention and effort they can be implemented completely independently.
“What we know is that sleep hygiene on its own is not effective for people who have insomnia,” Fretz said.
“We know that it’s the behavioral sleep scheduling strategies that are the most effective components, and again those are ones that for most people you don’t necessarily need a sleep trained psychologist such as myself to guide you through that.”
While CBT as a first step treatment to insomnia and sleep disorders may not be common knowledge, the idea of lack of sleep becoming an epidemic and the role of sleep in a healthy lifestyle has become a popular talking point.
Biohacking and optimizing sleep have made their way more into the mainstream, with supplements and devices meant to act as sleep aids being recommended for purchase.
Fretz says however for people who suffer from sleep disorders, this type of hyper vigilance around sleep could actually have adverse consequences.
“One of the things that we often see in people who have insomnia, is that they’re focusing so much on perfecting their sleep routine, they’re focusing so much on the amount of sleep they’re getting, the potential consequences of not getting enough sleep that it actually backfires on them,” Fretz said.
“Doing really, really specific things to make our sleep routine super super precious may actually kind of create more vigilance about sleep and could contribute to some of the anxiety around sleep… I don’t know the specifics about each of the different supplements and things, but I will say that as a sleep practitioner, they’re not things that I would recommend.”
The findings were published in coordination with the Canadian Sleep Research Consortium.
