Sleep health education

Insomnia: Symptoms, Causes and Treatment in Canada

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Quick answer

Insomnia means regular trouble falling asleep, staying asleep or waking too early, with daytime effects such as fatigue, poor focus or low mood. It becomes chronic insomnia when it happens at least three nights a week for three months or more. About one in three Canadian adults report insomnia symptoms. Cognitive behavioural therapy for insomnia (CBT-I) is the recommended first treatment, and because insomnia and sleep apnea often occur together, snoring, gasping or heavy daytime sleepiness are worth checking.

At a glance

Key takeaways

Takeaway 1

Chronic insomnia means sleep trouble at least three nights a week for at least three months, with daytime effects.

Takeaway 2

CBT-I is the first-line treatment for chronic insomnia in adults, ahead of sleeping pills.

Takeaway 3

Sleeping pills, alcohol and cannabis can make sleep worse over time; older adults face added risks such as falls.

Takeaway 4

About 30% to 40% of people with insomnia also have obstructive sleep apnea, so snoring, gasping or daytime sleepiness should be assessed.

What is insomnia?

Insomnia is difficulty falling asleep, staying asleep or waking earlier than you want, even when you have the chance to sleep, together with daytime effects such as tiredness, irritability or trouble concentrating.

  • Short-term insomnia lasts less than three months. It often follows stress, illness, travel or a change in routine and may settle on its own.
  • Chronic insomnia occurs at least three nights a week for at least three months and causes distress or problems with daily life (American College of Physicians).

How common is insomnia in Canada?

Insomnia is common and has become more common. Statistics Canada data show that the share of adults reporting night-time insomnia symptoms most or all of the time rose from 16.8% in 2007 to 2009 to 23.8% in 2014 to 2015 (Health Reports, 2018).

A 2023 national survey of more than 4,000 Canadian adults found that 34.6% had insomnia symptoms and 16.3% met the criteria for insomnia disorder, with higher rates in women. Almost half (46%) had used something to help them sleep in the past year, including natural or over-the-counter products, cannabis, prescription drugs or alcohol (Morin and colleagues, Sleep Medicine, 2024).

Symptoms of insomnia

  • Taking a long time to fall asleep
  • Waking often during the night and struggling to get back to sleep
  • Waking too early and being unable to fall back asleep
  • Feeling unrefreshed after sleep
  • Daytime tiredness, irritability, low mood or trouble concentrating
  • Worrying about sleep, which can make it harder to sleep

Common causes and triggers

Insomnia usually has more than one contributor. Common ones include stress, anxiety and depression, pain and other medical conditions, some medications, caffeine late in the day, alcohol, irregular schedules and shift work, and other sleep disorders such as sleep apnea or restless legs. Because sleep problems can be linked to other health conditions, Choosing Wisely Canada recommends a thorough check with a health professional.

Related reading: alcohol and sleep, caffeine and sleep, shift work and sleep and your circadian rhythm.

Insomnia or sleep apnea?

Insomnia and obstructive sleep apnea often occur together. Researchers estimate that about 30% to 40% of people with insomnia also have obstructive sleep apnea, and 30% to 50% of people with sleep apnea report insomnia symptoms. When both are present, people tend to use CPAP for fewer hours and report worse sleep and quality of life, so both conditions need attention (Sweetman and colleagues, 2022).

Ask about sleep apnea testing if your sleep trouble comes with any of these signs listed by the Public Health Agency of Canada:

  • Loud snoring, or pauses in breathing that someone else notices
  • Waking up gasping or choking
  • Heavy daytime sleepiness, not just tiredness
  • Morning headaches
  • Irritability or problems with memory and concentration

Our online sleep assessment can help you organize your symptoms, and a home sleep apnea test may be an option if a qualified professional thinks it is appropriate.

Treatment: CBT-I comes first

Cognitive behavioural therapy for insomnia (CBT-I) is the recommended first treatment for chronic insomnia in adults. The American College of Physicians recommends it as initial treatment, and the American Academy of Sleep Medicine gives it a strong recommendation. CBT-I usually takes four to eight sessions and can be delivered in person, in groups, by phone, online or as structured self-help.

CBT-I typically combines:

  • Stimulus control: using the bed only for sleep and getting up if you cannot sleep, to rebuild the link between bed and sleep.
  • Sleep restriction: temporarily matching time in bed to the sleep you are actually getting, then widening it as sleep improves.
  • Cognitive therapy: working on worries and beliefs about sleep that keep you awake.
  • Relaxation strategies and sleep hygiene education.

Sleep hygiene tips alone are not enough to treat chronic insomnia, according to the American Academy of Sleep Medicine. Sleep restriction can make you sleepier at first, so check with a health professional before starting it if you drive or do safety-sensitive work, or if you may have sleep apnea. See our sleep hygiene habits and bedtime routine guide for supporting habits.

Digital CBT-I and sleep apps

CBT-I can also be delivered through an app or online program.

  • A 2025 review of 29 randomized trials (9,475 people) found digital CBT-I reduced insomnia severity by a moderate to large amount, and the benefit lasted at follow-up (Kwon et al., npj Digital Medicine, 2025).
  • CBT-I with a therapist involved worked better than fully automated programs.

Not every sleep app is CBT-I. Meditation, sleep sounds and tracker dashboards may help you relax, but they don’t include the core parts of CBT-I:

  • sleep scheduling;
  • stimulus control;
  • working with unhelpful thoughts about sleep.

Look for a program that includes those elements. In Canada, Sleepwell, created by researchers at Dalhousie University, lists free and paid CBT-I programs and apps, including the free CBT-i Coach app. If you use a sleep tracker, see sleep scores and orthosomnia.

Sleeping pills and sleep aids

Sleeping pills can help in the short term, but they are not recommended as the first choice for chronic insomnia. Choosing Wisely Canada advises against benzodiazepines and other sedative-hypnotics as the first choice for insomnia in older adults. In older adults, sleeping pills more than double the risk of falls and hip fractures and can cause confusion and memory problems. Choosing Wisely Canada also suggests older adults avoid over-the-counter sleep aids that contain diphenhydramine.

The Canadian Deprescribing Network notes that the body can get used to sleeping pills after as little as a few weeks, and that CBT-I remains effective in the long term. Do not stop a prescribed sleeping pill suddenly; talk to your prescriber or pharmacist about a gradual plan.

Melatonin: in Canada, adult melatonin products are sold as natural health products. Since June 2026, melatonin for sleep in anyone under 18 requires a prescription (Health Canada). Ask a pharmacist before combining it with other medications. See melatonin in Canada.

Alcohol, cannabis and sleep

Alcohol can help you fall asleep faster, but research reviews show it disrupts sleep in the second half of the night, which cancels out the benefit (Ebrahim and colleagues, 2013). Alcohol also relaxes the throat muscles and can worsen snoring and sleep apnea. Read more in alcohol and sleep: why a nightcap can disrupt rest. In the Canadian survey above, about 1 in 10 adults had used alcohol and about 1 in 6 had used cannabis to help them sleep; talk to a health professional rather than relying on either.

Where to find insomnia help in Canada

  • Your family doctor or nurse practitioner can review medical causes and medications, and refer you to CBT-I or a sleep specialist.
  • Psychologists and other therapists trained in CBT-I offer individual or group programs. Workplace and private insurance plans often cover psychology services.
  • Sleepwell, a not-for-profit program at Dalhousie University supported by the Government of Nova Scotia, curates self-help CBT-I resources and information about sleeping pills.
  • Community mental health organizations in some regions run free or low-cost CBT-I programs; ask your local branch.

Virtual Sleep Care does not currently provide CBT-I. We can help you find out whether sleep apnea is part of the picture through a consultation and, where appropriate, home sleep testing.

When to see a health professional

  • Sleep trouble most nights for more than a few weeks, or three nights a week for three months
  • Daytime sleepiness that affects work, driving or safety
  • Snoring, gasping or breathing pauses during sleep
  • Low mood, anxiety or changes in appetite along with poor sleep
  • Sleep problems that started with a new medication

Do not drive if you feel drowsy. If you are having thoughts of suicide, call or text 9-8-8 at any time, or call 911 in an emergency.

Common questions

Frequently asked questions

What is the best treatment for chronic insomnia?

Cognitive behavioural therapy for insomnia (CBT-I) is the recommended first treatment for adults. It usually takes four to eight sessions and its benefits tend to last after treatment ends.

How do I know if I have insomnia or sleep apnea?

Insomnia is mainly trouble falling or staying asleep. Sleep apnea is repeated breathing interruptions during sleep, often with snoring, gasping and daytime sleepiness. They often occur together, and only a sleep study can confirm sleep apnea.

Can sleep apnea cause insomnia?

Sleep apnea can wake you repeatedly during the night, and many people with sleep apnea report insomnia symptoms. If you snore, gasp or feel very sleepy in the day, ask about sleep apnea testing.

Are sleeping pills safe for insomnia?

They can help for a short time, but they are not the recommended first treatment for chronic insomnia. Risks include dependence, next-day drowsiness and, in older adults, falls and memory problems. Talk to your prescriber before starting or stopping one.

Is melatonin good for insomnia?

Melatonin is sold for adults in Canada as a natural health product and may help with some timing-related sleep problems. It is not a substitute for CBT-I. Since June 2026, melatonin for sleep in people under 18 needs a prescription.

Does Virtual Sleep Care treat insomnia?

We do not currently provide CBT-I. We can help you check whether sleep apnea may be contributing to your sleep problems and guide you to appropriate next steps.

Sources

Disclaimer

This page is general health information, not medical advice, and it does not replace an assessment by a qualified health professional. Virtual Sleep Care does not currently serve Quebec, Yukon, the Northwest Territories or Nunavut.

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