Insomnia: What Causes It and What Actually Works

Insomnia: What Causes It and What Actually Works

You're exhausted all day. Then you get into bed and your brain switches on. Or you fall asleep fine and wake at 3am, wide awake, doing the math on how many hours you have left.

You're far from the only one. In a 2024 survey of more than 4,000 Canadian adults, about 1 in 3 had insomnia symptoms and 1 in 6 met the criteria for insomnia disorder. Women were about 24% more likely to have it than men.[1]

So what is actually going on, and what can help.

Is it insomnia, or just a rough stretch?

Everyone has bad nights. A stressful week, a sick kid, travel. Short-term sleep trouble is normal and usually settles on its own.

It becomes insomnia disorder when:

• You have trouble falling asleep, staying asleep, or waking too early

• It happens at least 3 nights a week

• It's been going on for at least 3 months

• It affects your days: fatigue, poor focus, low mood, irritability

That last point matters. Some people sleep 6 hours and feel fine. Insomnia is about the struggle and its impact, not only the number of hours.

What makes us sleep

Three systems work together:

1. Your body clock (circadian rhythm). Light, especially morning light, sets your internal clock. In the evening, darkness lets melatonin rise, signalling it's time to wind down. Light suppresses melatonin release.

2. Your sleep drive. The longer you're awake, the more a chemical called adenosine builds up and the sleepier you get. Caffeine works by blocking adenosine. Naps and sleeping in let off some of that pressure, which is why they can make the next night harder.

3. Your alertness system. Stress, worry and a racing mind activate your "fight or flight" system. That raises heart rate, body temperature and brain activity, all of which work against sleep.

What keeps insomnia going

Insomnia is often described as a problem of hyperarousal: your body and brain stay too "on" at night.[2] It usually builds in three layers:[3]

• What makes you prone to it. A tendency to worry, a sensitive sleep system, family history.

• What sets it off. Stress, illness, a life change, pain, hormonal shifts.

• What keeps it going. This is the big one. After a few bad nights, most of us do things that make sense in the moment: going to bed earlier, sleeping in, napping, lying in bed trying harder. Over time your bed becomes a place where you're awake and frustrated, and your brain learns that.

The good news is that the habits keeping insomnia going are the part we can change.

How much sleep do you actually need?

Canada's adult guidelines recommend 7 to 9 hours a night, with consistent bed and wake times.[4] Needs vary. Chasing a perfect 8 hours can make you more anxious about sleep, which makes sleep harder.

Sleep hygiene: a good baseline, not a treatment

Sleep hygiene means the habits and environment around sleep. The useful basics:

• Keep a consistent wake-up time, even on weekends. This anchors your body clock.

• Get daylight in the morning to help set your rhythm.

• Cut caffeine by early afternoon. In one study, caffeine taken 6 hours before bed still cut total sleep by more than an hour.[5]

• Go easy on alcohol. It can help you fall asleep, then fragments the second half of the night.[6]

• Make your room dark, cool and quiet. Blackout blinds, a fan or white noise, and covering lights from electronics.

• Wind down. A calmer last hour before bed: reading, stretching, low light.

These are worth doing. But if you already have insomnia, they're rarely enough on their own.

The American Academy of Sleep Medicine reviewed the research and recommends against using sleep hygiene as a stand-alone treatment for chronic insomnia. People understand the advice well; it just doesn't fix insomnia by itself.[7]

So if you've tried every sleep tip and you're still awake, it's not a willpower problem. You've been given the wrong tool.

What actually works: CBT for insomnia

CBT-I is the recommended first-line treatment for chronic insomnia in adults.[7,8] It has much stronger evidence than any sleep aid, and its benefits last after treatment ends. A review of 30 trials found improvements held for up to a year.[9]

CBT-I targets the habits and thought patterns that keep insomnia going. It usually includes:

• A sleep diary, so the plan is based on your real sleep, not your worst night

• A consistent wake-up time

• Matching your time in bed to the sleep you're actually getting (sleep restriction), which rebuilds your sleep drive

• Stimulus control: only going to bed when sleepy, and getting up if you can't sleep after about 20 minutes, so your brain relearns that bed means sleep

• Tools for the racing mind and the worry about sleep itself

There's also a shorter version called brief behavioural treatment for insomnia (BBTI), which focuses on the behavioural pieces over about four sessions. Brief therapies like this are also recommended in guidelines.[7]

The first week or two can feel harder before it gets easier. That's why it works best with guidance and check-ins.

A note on safety: sleep restriction isn't right for everyone. People with bipolar disorder, seizure disorders, untreated sleep apnea, or significant daytime sleepiness (especially while driving) need a modified approach. This is another reason to do it with a practitioner.

Want a plan that targets what's keeping you awake? We'll walk you through a behavioural sleep plan with check-ins along the way. Book a free 15-minute meet and greet.

What about sleep aids?

Almost half of Canadian adults used some kind of sleep aid in the past year, most often natural or over-the-counter products, with cannabis and alcohol also common.[1]

Some can help a little, in the short term, for some people. But guidelines don't recommend common over-the-counter sleep aids or supplements as a treatment for chronic insomnia, because the evidence is weak.[10] If a sleep aid is doing all the work, the cause hasn't been addressed.

Curious about cannabis specifically? Read Does Cannabis Help You Sleep?

When it might be something else

Sometimes poor sleep has a specific cause that needs its own treatment. We look for:

• Sleep apnea: snoring, gasping, morning headaches, or feeling sleepy even after a full night

• Restless legs: an urge to move your legs in the evening, often linked to low iron

• Mood: anxiety and depression often travel with insomnia, in both directions

• Labs where they'd change the plan, like iron and thyroid

• Medications and substances that can affect sleep

Sleep through life stages

Sleep changes across life, and some stages bring their own challenges:

• Pregnancy: [link coming soon]

• Postpartum: Struggling With Sleep After Baby?

• Perimenopause and menopause: Can't Sleep in Perimenopause? What Actually Helps

Want help with your sleep?

If poor sleep has lasted more than a few weeks and it's affecting your days, it's worth addressing. You don't have to wait until you're running on empty.

Book a free 15-minute meet and greet →

We'll talk through what's going on and match you with the right practitioner for your stage of life. We see patients in Toronto and virtually across Ontario.

This article is for general education and isn't a substitute for personalized medical advice.

References (click to expand) ▾

1. Morin CM, Vézina-Im LA, Chen SJ, Ivers H, Carney CE, Chaput JP, et al. Prevalence of insomnia and use of sleep aids among adults in Canada. Sleep Medicine. 2024;124:338-345.
2. Riemann D, Spiegelhalder K, Feige B, et al. The hyperarousal model of insomnia: a review of the concept and its evidence. Sleep Medicine Reviews. 2010;14(1):19-31.
3. Spielman AJ, Caruso LS, Glovinsky PB. A behavioral perspective on insomnia treatment. Psychiatric Clinics of North America. 1987;10(4):541-553.
4. Ross R, Chaput JP, Giangregorio LM, et al. Canadian 24-Hour Movement Guidelines for Adults aged 18-64 years and Adults aged 65 years or older. Applied Physiology, Nutrition, and Metabolism. 2020;45(10 Suppl 2):S57-S102.
5. Drake C, Roehrs T, Shambroom J, Roth T. Caffeine effects on sleep taken 0, 3, or 6 hours before going to bed. Journal of Clinical Sleep Medicine. 2013;9(11):1195-1200.
6. Ebrahim IO, Shapiro CM, Williams AJ, Fenwick PB. Alcohol and sleep I: effects on normal sleep. Alcoholism: Clinical and Experimental Research. 2013;37(4):539-549.
7. Edinger JD, Arnedt JT, Bertisch SM, et al. Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine. 2021;17(2):255-262.
8. Qaseem A, Kansagara D, Forciea MA, et al. Management of chronic insomnia disorder in adults: a clinical practice guideline from the American College of Physicians. Annals of Internal Medicine. 2016;165(2):125-133.
9. van der Zweerde T, Bisdounis L, Kyle SD, Lancee J, van Straten A. Cognitive behavioral therapy for insomnia: a meta-analysis of long-term effects in controlled studies. Sleep Medicine Reviews. 2019;48:101208.
10. Sateia MJ, Buysse DJ, Krystal AD, Neubauer DN, Heald JL. Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: an American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine. 2017;13(2):307-349.