“I saw my partner sleeping and said to myself, ‘Damn, he’s so lucky. How come I don’t sleep?” »
Insomnia entered Danielle Gélinas’ life at the same time as motherhood, 44 years ago. Sitting in a conference room at Montreal’s Sacré-Cœur hospital, north of the city, the retired teacher recounts the thoughts that came to her in the middle of the night as she watched the hours tick by on the clock face.
I’ve been shooting for two hours already… I’ll be tired tomorrow… 4 hours already…
Danielle Gélinas talks about it in the past tense, but these memories are recent. After waiting three years, she was given a place in group therapy this spring to learn to sleep better again. The Center for Advanced Studies in Sleep Medicine’s sleep clinic is one of the only centers in Canada (if not THE only one) that offers free cognitive behavioral therapy for insomnia to its patients.
However, it is the first-line treatment for insomnia, well ahead of medications such as benzodiazepines and Z-hypnotics, whose overuse is increasingly criticized. “People who come to us tell us: ‘I’ve lost the prescription for sleeping,’” summarizes neurologist Alex Desautels, director of the clinic. We give them some kind of procedure that they have to follow in order to sleep well. »
60% to 80%
Percentage of people for whom therapy has a therapeutic effect. Approximately 70% of patients maintain their clinical gains after two years, and 50% after 10 years. Of the patients who respond, half are in complete remission.
Source: “Insomnia”, The Lancet2022
Danielle Gélinas takes out the sleep diary she kept during the therapy, which ends today. “Every week I got an average of 20 to 30 minutes of sleep per night,” she calculates. She now sleeps almost seven hours a night. And she is “super excited”.
Milie Alary, who suffers from fibromyalgia, initially had little hope for therapy. Her problem wasn’t falling asleep (she fell like a baby at 10 p.m.), but rather staying asleep. She woke up around 1 a.m. and thanks to medicinal cannabis, she was able to daydream a little at the end of the night. Today she goes to bed at 11 p.m. “For me it’s huge,” she said.
PHOTO FRANÇOIS ROY, THE PRESS
Cloé Blanchette-Carrière
The participants all had realistic expectations, underlines Cloé Blanchette-Carrière, PhD candidate in clinical psychology, and that is a good thing. Trying to be a perfect sleeper puts too much pressure… and that’s an illusion. “Everyone has bad nights,” she remembers.
Conditioning
Over six weeks, the six participants learned to improve their sleep hygiene, deflate the anxiety-inducing (or even obsessive) thoughts that often accompany insomnia, and deconstruct the negative conditioning that has built up over the years.
Insomnia is common: a third of people experience a transient episode during their lifetime, often during special circumstances (a marriage, a divorce, a promotion, etc.). When stress decreases, sleep improves. But some people will develop bad habits that will contribute to the condition becoming chronic. Marie-Hélène Pennestri, a sleep researcher and professor at McGill University, has plenty of examples: developing a drug dependency; taking long naps; stimulate yourself to screens at night; refuel with coffee or relax with alcohol; go to bed earlier, even if you don’t fall asleep; forcing yourself to sleep…
10%
Percentage of the population suffering from chronic insomnia
PHOTO FRANÇOIS ROY, THE PRESS
The dR Alex Desautels
“People ultimately associate the bed with the frustration of not sleeping,” summarizes neurologist Alex Desautels. The stress system is activated in the evening and peaks around bedtime. The pressure increases, as does the heart rate. Not ideal for falling asleep.
Paradoxically, sleep deprivation is at the heart of the therapy. Participants first determine a six-hour period in which they are allowed to sleep at night. The sleep debt thus created helps to overcome the state of hyperactivity that prevails around bedtime, explains Alex Desautels. The sleep window gradually increases during therapy.
Other essential instructions: remove time entry to the bedroom (too scary) and avoid tossing and turning in bed for too long. After 20 to 30 minutes (subjectively calculated) we leave the room and do a boring activity until drowsiness returns. The bed should be associated with sleep and cuddling, period.
Insomnia sufferers also need to become aware of the cognitive distortions that inhabit them. It definitely costs me eight hours of sleep. I’m not going to sleep well all week. Milie Alary, for her part, believed that an adult should go to bed at 10 p.m., and no later.
Tame thoughts
And what do we do when thoughts arise? Are we trying to control them? Charles Morin, holder of the Canada Research Chair in Behavioral Sleep Medicine at Laval University, recommends taming them instead and replacing them with more realistic, more constructive thoughts. “It’s about taking a step back and telling yourself that there’s no point in panicking at 2 a.m. or trying to solve a problem,” he summarizes.
To free the mind, the participants also have a writing exercise in the evening, to put the issues that need to be resolved on paper. Before going to sleep, they also do a relaxation exercise related to sleep.
The idea is also to learn to downplay the drama. “Sleep is important, but you shouldn’t panic either,” summarizes Marie-Hélène Pennestri. Psychologist Charles Morin proposes an experiment. After a bad night’s sleep, spend the day lying down and record your mood and energy level from hour to hour. And we repeat the experience after another bad night, but this time by planning pleasant or energetic activities. “People certainly agree that they functioned better when they stayed active,” notes Charles Morin.
Studies have shown that a night of insomnia has little impact on cognitive functions the next day, points out Alex Desautels, who adds that the brain adapts and changes the sleep architecture the next day to make it deeper. Another reassuring fact: almost all insomniacs underestimate the number of hours they sleep.
Participant Philippe St-Germain, who suffers from restless leg syndrome, had more difficulty following the instructions and the therapy worked less well for him. But he learns an important lesson. “If things go badly, don’t get discouraged: it will get better later,” he concludes.
A special recipe
Initiatives are taking place in the medical world to reduce the number of prescriptions for sleeping pills. In January, the College of Physicians launched an exercise monitoring program for opioids and benzodiazepines (Rivotril, Ativan, etc.). In recent months, the Choosing Wisely campaign has provided resources for doctors and patients: video clips and a ‘non-pharmacological prescription’, both inspired by cognitive behavioral therapy. Several experts believe that sleeping pills can occasionally be useful during times of acute stress, but the majority of patients use them for longer periods, which carries risks of dependency and side effects. Cognitive behavioral therapy for insomnia remains poorly accessible, both publicly and privately.
Check out Choose Wisely Quebec’s sleep video clips
Consult the Choose Wisely Quebec method for a drug-free night of sleep
Visit the Dormez surça website
Seek help from a psychologist (private)