About Insomnia

WHAT IS INSOMNIA?

Insomnia is more than just trouble sleeping, it involves disrupted rest that affects how a person feels or functions during the day. This can mean difficulty falling asleep, staying asleep, or waking up too early without being able to fall back asleep. An estimated 16.3% of the population experiences insomnia as a clinical disorder, with significantly higher rates among women, indigenous communities, and individuals facing mental or physical health challenges. (Chaput et al., 2024)

INSOMNIA AND COMORBIDITIES

Insomnia is rarely an isolated condition; it frequently coexists with other medical and psychiatric disorders, a phenomenon known as comorbidity. Indeed, these are the comorbidity rates between insomnia and other health conditions:

(Statistics Canada (Bédard, Connolly, & Gravel, 2004) – Salari et al., 2023 – Molano & Vaughn, 2014 )

The relationship between insomnia and these other conditions is often complex, characterized by bidirectionality, meaning that they can influence and exacerbate each other, creating a feedback loop. For example, a medical condition might cause insomnia, and the resulting sleep deprivation can, in turn, worsen the symptoms or progression of that medical condition.

More generally, about half of individuals with chronic insomnia also have at least one mental health condition.

Depression

Sleep problems are closely tied to depression so much so that insomnia is one of its core symptoms. Around 75% of depressed people show symptoms of insomnia. Just as sleep issues can raise the risk of developing depression, depressive episodes can also make it harder to get quality rest.

People with depression may experience a range of symptoms, including:

• Persistent sadness or hopelessness
• Irritability or a short temper
• Changes in appetite or weight
• Ongoing fatigue
• Feelings of guilt, worthlessness, or failure
• Difficulty making decisions
• Trouble focusing or remembering things (Sleep Foundation, n.d.)

Anxiety

Sleep issues are common in people with anxiety disorders. Unlike occasional stress, anxiety involves ongoing worry or fear that can make it hard to fall or stay asleep, impacting daily life, work, and relationships.

• Generalized Anxiety Disorder (GAD): Affects 5–10% of the population. Sleep disturbances are a core symptom, though it’s often unclear whether poor sleep or anxiety came first.
• Post-Traumatic Stress Disorder (PTSD): Up to 90% of people with PTSD report insomnia. Nightmares are frequent and can make falling back asleep difficult. (Sleep Foundation, n.d.)

Bipolar Disorder

Bipolar disorder is a mental illness characterized by shifts in mood, energy, and focus. People with bipolar disorder experience alternating episodes of depression, elevated or irritable mood, and in some cases, mania, which is a period of abnormally elevated, extreme changes in mood or emotions, energy or activity level. In addition, sleep patterns tend to vary significantly depending on the phase.

Research shows that nearly everyone living with bipolar disorder experiences sleep disturbances.

• During depressive episodes, individuals may struggle with insomnia or, in contrast, hypersomnia, the need to sleep excessively.
• In manic episodes, sleep drastically decreases. People may go several days with little to no sleep yet still feel energized or believe they are well rested. This reduced need for sleep is a hallmark of mania and differs from the inability to sleep seen during depression. (Sleep Foundation, n.d.)

Substance use disorders

Insomnia and substance use disorders (SUD) often go hand in hand. People who struggle with sleep are at greater risk of developing substance use issues, and for those in recovery, persistent insomnia can be a serious barrier to long-term sobriety.

SUD involves the misuse of alcohol, prescription medications, or illicit drugs, often linked to brain changes or behavioral health issues. Addiction is considered the most severe form of SUD.

Experts believe that regular substance use, especially alcohol and certain drugs, can disrupt the brain’s natural systems that regulate sleep and wake cycles. For example:

• Alcohol, a common sedative, can make people feel sleepy initially. This leads some to use it as a sleep aid.
• Studies show that over 10% of people use alcohol to help them fall asleep, this number is even higher among those with insomnia.
• However, alcohol-related sleep may be shallow, fragmented, and lead to worsening symptoms over time.

Insomnia often appears years before the onset of alcohol abuse. It is a strong predictor for the development of substance use disorders, particularly alcoholism. Once substance use begins, poor sleep often worsens, affecting mood, cognition, and day-to-day functioning.

Sleep difficulties can also persist throughout withdrawal and recovery. In fact, insomnia is one of the most common complaints among people in recovery, and for some, these disturbances may last for months or even years after quitting substances.

According to research, ongoing insomnia significantly increases the risk of relapse during recovery. (Sleep Foundation, n.d.)

Schizophrenia

Schizophrenia is a mental illness that affects a person’s thoughts, emotions, and behavior. Individuals with schizophrenia might perceive things that aren’t real or strongly believe in ideas that aren’t based in reality. It’s common for them to experience reduced motivation, lose interest in daily activities, withdraw from loved ones, and struggle to find enjoyment in life.

Many people with schizophrenia also face various sleep issues. Studies show that a significant number of individuals with this condition report insomnia symptoms. Additionally, they often experience disturbances in their sleep patterns, including irregular circadian rhythms and altered progression through different sleep stages during the night.

Like in substance use disorder, these sleep problems can increase the likelihood of relapse among those undergoing treatment for schizophrenia. (Sleep Foundation, n.d.)

HOW DO I KNOW IF I HAVE INSOMNIA?

A simple and reliable way to assess whether you have insomnia, whether acute (less than 3 months) or chronic (3 months or more), is by using the Insomnia Severity Index (ISI). Developed by Dr. Charles M. Morin and colleagues, this tool is widely used in both clinical and research settings to evaluate the severity and impact of sleep difficulties.

The ISI is a self-assessment tool made up of several questions. It asks you to think about your sleep over the past two weeks and rate the following:

STEPS FOR YOUR TREATMENT

Chronic insomnia is treatable, even when it exists alongside other conditions like anxiety, depression, or neurological disorders. It’s important not to ignore insomnia just because it co-occurs with other issues. Addressing it directly can lead to better overall health outcomes (Health Quality Ontario, 2025).

MEDICATION

While behavioral strategies are usually the first step, medications can also play a role, especially in the short term or when symptoms are severe.

Be mindful when taking certain medications. Some side effects may include:

• Daytime sedation
• Memory and motor deficits
• Tolerance, dependence
• Rebound insomnia

New treatments are available and more are being researched that may support longer-term sleep health with fewer side effects or lower dependency risks.

There is no one-size-fits-all solution. If you’re struggling with insomnia, consulting a healthcare provider is key. They can help tailor a treatment plan based on your individual health needs, lifestyle, and preferences, whether that includes CBT-I, medication, or a combination of both. (Morin et al., 2024)

If you want to learn more about insomnia treatment process and guidelines, you can find the Delphi Consensus on Chronic Insomnia Management in Canada here : https://www.sciencedirect.com/science/article/pii/S1389945724004593

HOW & WHEN TO TALK TO A HEALTHCARE PROVIDER

It’s normal to feel unsure about bringing up sleep concerns, but your sleep is important — and your healthcare provider can help. Preparing ahead of time can help you get the most out of your appointment. Before your appointment, keep a sleep journal for 1–2 weeks and track:

• When you go to bed and wake up
• How long it takes to fall asleep
• How often you wake during the night
• How you feel during the day (alert, foggy, anxious, etc.)
• Write down any symptoms or concerns, including how your sleep is affecting your mood, focus, energy, or relationships
• List any treatments you’ve tried, such as over-the-counter sleep aids, herbal supplements, sleep hygiene routines, or relaxation techniques
• Bring a list of medications and supplements you’re currently taking (You can find a sleep diary template here: https://mysleepwell.ca/cbti/sleep-diary/)

AWARENESS, PERCEPTION AND LIVED EXPERIENCE OF INSOMNIA

MDSC’s Insomnia Public Perception Study:

To better understand public perceptions and experience of insomnia, Mood Disorders Society of Canada (MDSC) conducted the Insomnia Public Perception Study in 2025. The study included over 800 participants diagnosed with a mental illness/es and revealed the following insights.

Insomnia is a medical condition that is often unrecognized and undertreated:

•  Nearly 80 per cent (79%) of Canadians with mental health conditions reported having insomnia, yet only 25 per cent recognize it as a serious health condition requiring medical attention.
• Only one-third (32%) of Canadians with mental health conditions consider insomnia serious enough to seek treatment.
•  77 per cent of Canadians with mental health conditions and insomnia report a reduced quality of life because of it.
• Thirty per cent of Canadians with mental health conditions have chronic insomnia that remains undiagnosed or untreated, and even fewer – 20 per cent – receive a medical diagnosis

The impact of insomnia on a patient’s life can be major. The following being the most prevalent issues experienced by respondents:

• 75% of people feel low in energy and fatigued
• 65% experience irritability/mood swings/feeling depressed/ anxious
• 62% have trouble sleeping
• 53% saw a decrease in their productivity
• 50% experienced overall emotional distress

When it comes to the treatment of insomnia:

• Thirty-two per cent of Canadians with mental health conditions have never heard of CBT-I, and the same number don’t know it’s for insomnia
• Over 46 per cent of Canadians with mental health conditions try over-the-counter remedies without healthcare guidance
• Over one-third (32%) of Canadians with mental health conditions use substances such as cannabis or alcohol to treat insomnia, which evidence shows can make the issue worse
• Only about 19 per cent of healthcare providers regularly recommend CBT-I.
• Among those that have tried CBTi, 70% (53 + 17) have found it to be effective to some degree

You can find the full report here: NR-MDS001-1005 MDS 2025 Insomnia Study Report-June 25-25