Insomnia

Insomnia means trouble falling asleep, staying asleep, or waking too early and not being able to get back to sleep, even when you have the chance to sleep. It becomes a disorder when it keeps happening over weeks or months and affects how you feel and function during the day. It is not simply about hours in bed, and it is not a matter of willpower.

What insomnia is, and what it is not

Insomnia is not the same thing as short sleep, and the two need separating. Adult sleep needs vary, and what counts is whether your sleep leaves you able to get through the day. Statistics Canada found that between 52% and 59% of Canadians with insomnia symptoms slept less than the recommended amount, compared with about one third of the population overall, so the two overlap without being the same. Plenty of people lie in bed for eight hours and still wake unrefreshed.

It is also not usually a passing phase to be waited out. Most Canadians reporting insomnia symptoms said they had gone on for a year or more. Insomnia commonly travels with something else as well, including chronic pain, arthritis, restless legs, sleep apnea, menopause symptoms, an enlarged prostate, low mood or anxiety. Identifying what else is going on is part of the assessment rather than a detour from it, and related conditions are covered on our pages for chronic pain and depression.

Signs and symptoms

• Lying awake for a long time before falling asleep
• Waking several times in the night and struggling to get back to sleep
• Waking much earlier than you meant to
• Feeling tired, foggy or irritable during the day
• Trouble concentrating, remembering things or making decisions
• Worrying about sleep, or dreading bedtime
• Sleep that does not leave you feeling refreshed, even after a full night in bed

Most people have a mix of these rather than one, and the pattern often shifts over time: months of trouble falling asleep can turn into months of waking at 4 in the morning.

What raises the risk

Some risk factors cannot be changed:

• Getting older, since sleep becomes lighter and more broken with age
• Being female, which is linked to higher reported rates in Canadian survey data
• Family history of insomnia
• Health conditions that disturb sleep, such as chronic pain, arthritis, restless legs, sleep apnea, menopause symptoms and an enlarged prostate

Others can often be worked on, usually with support from a health care team:

• Irregular sleep and wake times, including shift work and long naps
• Caffeine, alcohol, nicotine and screen use close to bedtime
• Stress, worry, low mood, and untreated anxiety or depression

How insomnia is diagnosed in Canada

Insomnia is diagnosed mainly through conversation rather than testing. A family doctor or nurse practitioner asks about your sleep pattern, how long it has been going on, how it affects your days, and about caffeine, alcohol, medicines, mood, pain and shift work. You may be asked to keep a sleep diary for one to two weeks. A sleep study is generally used only when another sleep disorder such as sleep apnea or a movement disorder is suspected, and some people are referred to a sleep clinic or to a psychologist trained in sleep.

Treatment and day-to-day management

Clinical research for Insomnia is enrolling. See the current studies ↓

There is a gap in Canada between what guidance recommends and what most people actually receive, and it is worth knowing about. Depending on your situation, a health care team may discuss:

• Cognitive behavioural therapy for insomnia, known as CBT-I, delivered one to one, in groups, or through digital and telephone-supported programs. Ontario Health’s 2025 quality standard describes this as the first-line approach for adults with insomnia disorder
• Prescription sleep medicines, which Ontario Health notes remain the most commonly used treatment in Canada. The quality standard describes them as being offered after an adequate trial of CBT-I, at the lowest dose for the shortest duration
• Assessment and management of conditions that disrupt sleep, including chronic pain, sleep apnea, restless legs, menopause symptoms, depression and anxiety, along with a review of medicines that affect sleep
• Behavioural components used within structured programs, such as consistent sleep and wake times, stimulus control, sleep restriction and relaxation training
• Over-the-counter products and supplements, which people often try on their own and which are worth raising with a pharmacist or clinician because of interactions with other medicines

Access to trained CBT-I providers is uneven across the country, so what is realistically available where you live is part of the conversation. These are decisions for you and your own clinician, and if you already take a prescribed sleep medicine, changes to it are a discussion with your prescriber rather than something to do on your own.

When to talk to a doctor

• Seek medical care if you fall asleep without meaning to during the day, especially while driving, and pull over safely if you feel drowsy at the wheel. Ongoing daytime sleepiness can point to a sleep disorder such as sleep apnea that needs assessment.
• Call 911 or go to an emergency department if you have thoughts of harming yourself. In Canada you can also reach the 988 Suicide Crisis Helpline by calling or texting 988 at any time. Ongoing insomnia and low mood often occur together.
• Book an appointment if poor sleep has lasted more than a few weeks, if your bed partner notices you stop breathing, gasp or choke in your sleep, or if you are relying on alcohol or over-the-counter sleep products to get to sleep.

Why clinical research matters for insomnia

Access is the central unresolved problem in Canada. Cognitive behavioural therapy for insomnia is described as the first-line approach in Ontario Health’s quality standard, yet prescribed medicines remain the most commonly used treatment, and trained providers are unevenly spread across the country. Researchers also cannot predict who will respond to behavioural therapy rather than medication, and long-term outcomes after treatment stops are not well understood. Trials under way are testing digital and app-delivered CBT-I, stepped care and group models that widen access, newer classes of sleep medicine including orexin receptor antagonists, approaches for people whose insomnia coexists with chronic pain, menopause or mental health conditions, and strategies for tapering long-term sleep medicine use.

Clinical studies are how those questions get answered. Taking part is voluntary, you give informed consent before anything begins, and you can stop at any time without affecting the care you get from your own doctor. No one can say in advance whether a study will help you personally.

Learn more from Canadian sources

• Canadian Sleep Society: sleep information, sleep centre map and the Sleep On It campaign
• Ontario Health: Insomnia Disorder quality standard for adults
• Statistics Canada: prevalence of insomnia for Canadians aged 6 to 79
• Pain BC: support for people whose sleep is disrupted by ongoing pain