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opinion: insomnia deserves modern medicine
decision-makers must ensure all canadians can access effective, safe insomnia treatments
3 minute read
access to viable treatment for chronic insomnia is lacking, but new medications may be on the horizon that could help more people catch better z's.
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for the more than four million canadians who have chronic insomnia, daily life can be a struggle. medically recognized as a serious brain disorder, insomnia syndrome damages mental and physical health and increases the risk of depression, heart disease, diabetes and suicide.
canada’s communities and our economy rely on a healthy, productive workforce, but insomnia is quietly undermining it. chronic insomnia is sleeplessness that occurs at least three days a week over three months and impairs daytime functioning.
research links it to a 40 to 75 per cent increase in long-term work disability. the resulting costs are hard to ignore: reduced productivity, safety issues, and higher expenses in sectors such as energy, healthcare, and education.
despite the widespread prevalence of chronic insomnia, concerns persist within the mental health community about limited access to effective treatment options for individuals covered by our public drug benefit plans.
cognitive behavioural therapy for insomnia (cbt-i) is a first-line treatment, but it is not accessible or effective for everyone. without access to cbt-i or modern pharmacotherapy, millions of canadians face preventable health issues.
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patients and their physicians rely on insomnia treatments, including benzodiazepines and z-drugs, that carry risks such as falls, excessive daytime sedation, and dependence. these treatments require careful monitoring due to these risks, taking time and resources from an already-strained healthcare system. patients are also self-medicating with alcohol, cannabis or over-the-counter sleep aids to get some respite from their insomnia.
we can–and should–do better for our patients, particularly those covered under our public drug benefit plans.
a newer class of sleep medications, called dual orexin receptor antagonists (doras), is safe and effective for treating chronic insomnia with minimal risks. countries such as japan, france, germany and italy publicly fund these medications, but canada’s provincial drug plans do not.
as clinicians and researchers, we have observed the transformative benefits of these therapies when they are accessible. we have seen patients trapped in cycles of ineffective medications or risky self-medication regain restorative sleep and return to work after switching to modern treatments.
one such example is a first nations woman who endured years of trauma and struggled with alcohol addiction. throughout her recovery, chronic insomnia repeatedly caused her to relapse. many of the medications covered under her public drug plan–the non-insured health benefits (nihb) program–were unsuitable because of their potential for addiction. desperate, she often used over-the-counter sleep aids, which only worsened her condition.
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determined to break the cycle, she saved enough money to try a dora medication. after starting this treatment, she has remained sober for over a year and was able to return to work. improved sleep gave her the strength to face and heal from her trauma. after multiple appeals, the nihb program granted her an exemption to cover the medication.
canada’s drug agency recently recommended excluding these medications from public benefits plans, overlooking the outcomes that matter most to patients and clinicians: quality of life, daytime functioning, reduced disability and recovery. this decision sharply contrasts with those of our international peers and highlights a systemic issue regarding access to mental health therapies in canada.
a 2023 mood disorders society of canada report found that canada’s access to mental health and brain disorder medications remains worse than that of other g7 countries. it concluded that most provinces publicly cover only 25 per cent of approved psychiatric drugs. for the small percentage that are publicly funded, patients wait an average of 2.5 years after approval to access them.
sleep is essential; we spend a quarter to a third of our lives sleeping or trying to sleep. chronic insomnia disrupts work, family life, and leads to healthcare and productivity costs exceeding treatment expenses. the evidence and clinical insights are clear: decision-makers must ensure all canadians can access effective, safe insomnia treatments.
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dr. atul khullar is a psychiatrist and sleep specialist, a clinical associate professor in the department of psychiatry at the university of alberta, and the medical director of the northern alberta sleep clinic.
dr. roger mcintyre is a professor of psychiatry and a professor of pharmacology and toxicology at the university of toronto.
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