Sleep Difficulties and Insomnia: A Practical Guide

Published on September 16, 2007 in Diseases & Conditions


On average, we need about seven to eight hours of sleep a night to function optimally. In today’s fast paced and high stress society, a third of the population reports difficulties with sleep, and about 10% of people report chronic insomnia, a condition that involves trouble falling or staying asleep, waking up in the middle of the night or too early in the morning, persistently poor sleep quality, and trouble functioning the next day.

There are many reasons why people have trouble sleeping. High levels of stress, anxiety, and/or depression are often the culprit. Other possible causes include medical problems or conditions, chronic pain, use of certain medications, excessive use of alcohol, nicotine, or caffeine, or the presence of a more complicated sleep disorder (such as sleep apnea or restless leg syndrome).

In order to address sleep difficulties, it is important to identify the specific cause. It is wise to consult with your family physician to rule out medical problems that could be causing poor sleep.

If sleep problems are caused by depression, anxiety, or high levels of stress, consulting with a psychologist is a good idea, as psychological treatments such as cognitive-behavioural therapy have been shown to very effective at decreasing anxiety and depression and helping people to improve how they cope with stress. Certain medications that target anxiety and depression can also be prescribed by your physician. If an underlying depression or anxiety disorder is properly treated, sleep problems often improve.

Sometimes people have sleep problems or insomnia in the absence of any other psychological difficulties such as depression or anxiety. In these cases, seeing a psychologist can still be very helpful, as certain psychological interventions have been shown to be effective at addressing poor sleep directly. Psychologists can teach you to learn to relax, cope with stress, and improve your “sleep hygiene” (or habits). Psychologists can also use other behavioural strategies to help target sleeping problems. About 75% of people with insomnia report significantly improved sleep after undergoing such psychological treatment.

Family physicians often prescribe hypnotic medications that help people to sleep. These medications are often helpful for individuals who are going through a stressful period. It is advised to only use these medications in the short-term as they can become addictive and less effective if you use them nightly over longer periods of time. Moreover, some of these medications can result in drowsiness and concentration difficulties the following day. Over the counter sleep supplements have generally been found to be ineffective.

As a general rule, sleeping medication can be helpful in the short-term but becomes less effective over time, whereas psychological treatments are effective in the long-term.

Dr. Jeremy Frank is a Toronto psychologist in private practice in North York.