“I saw my partner sleeping, and I said to myself: “Damn how lucky he is. How come I’m not sleeping?” »
Insomnia arrived in Danielle Gélinas’ life at the same time as motherhood, 44 years ago. Sitting in a meeting room at Montreal’s Sacré-Cœur hospital in the north of the city, the retired teacher recounts the thoughts that arose in the middle of the night, when she saw the hours ticking by on the dial.
I’ve been shooting for two hours… I’m going to be tired tomorrow… 4 a.m. already…
Danielle Gélinas talks about it in the past tense, but these memories are recent. After three years of waiting, she obtained a place this spring in group therapy to relearn how to sleep better. The sleep clinic at the Center for Advanced Studies in Sleep Medicine is among the only centers in Canada (if not THE only one) to offer free cognitive-behavioral therapy for insomnia to its patients.
However, it is the first-line treatment for insomnia, well before medications such as benzodiazepines and Z-hypnotics, the overuse of which is increasingly criticized. “People who come to see us tell us: ‘I have lost the recipe for sleeping,’” summarizes neurologist Alex Desautels, director of the clinic. We give them a kind of procedure to follow to sleep well. »
60% to 80%
Percentage of people for whom therapy has a therapeutic effect. Approximately 70% of patients maintain their clinical gain 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 that she kept throughout the therapy, which ends today. “Each week, I gained an average of 20 to 30 minutes of sleep per night,” she calculates. She sleeps almost seven hours a night now. And she is “super excited”.
Milie Alary, who suffers from fibromyalgia, initially had little hope for therapy. Her problem wasn’t falling asleep (she was falling like a log at 10 p.m.), but rather staying asleep. She woke up around 1 a.m. and medical cannabis allowed her to daydream a little at the end of the night. Today, she goes to bed at 11 p.m. and wakes up around 4 or 5 a.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, doctoral student in clinical psychology, and that is a good thing. Wanting to be a perfect sleeper puts too much pressure… and it’s illusory. “Everyone has bad nights,” she recalls.
Conditioning
For six weeks, the six participants learned to improve their sleep hygiene, to deflate the anxiety-provoking (even obsessive) thoughts that often accompany insomnia and to deconstruct the negative conditioning that has built up over the years.
Insomnia is common – a third of people experience a transitional episode during their life, 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 making the disorder chronic. Marie-Hélène Pennestri, sleep researcher and professor at McGill University, has plenty of examples: developing a dependence on medication; take long naps; stimulate yourself on screens at night; fuel up 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 who suffer from chronic insomnia
PHOTO FRANÇOIS ROY, THE PRESS
The Dr Alex Desautels
“People end up associating the bed with the frustration of not sleeping,” summarizes neurologist Alex Desautels. The stress system is activated in the evening and peaks at bedtime. The pressure increases, so does the heartbeat. Not ideal for falling asleep.
Paradoxically, sleep deprivation is at the heart of therapy. Participants first establish a six-hour window during which they are allowed to sleep at night. The sleep debt thus created helps overcome the state of hyperactivity that prevails at bedtime, explains Alex Desautels. The sleeping window gradually increases during therapy.
Other essential instructions: remove time access to the bedroom (too anxiety-provoking) and avoid tossing and turning in bed for too long. After 20 to 30 minutes (calculated subjectively), we leave the room and do a boring activity until drowsiness returns. The bed should be associated with sleep and cuddles, period.
Insomniacs must also become aware of the cognitive distortions that inhabit them. It takes me absolutely 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., not later.
Tame thoughts
And what do we do when thoughts arise? Are we trying to control them? Holder of the Canada Research Chair in Behavioral Sleep Medicine at Laval University, Charles Morin advises instead to tame them and replace them with more realistic, more constructive thoughts. “It’s about taking a step back and saying to yourself that there’s no point 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 down on paper the things that need to be resolved. At bedtime, they also do a relaxation exercise associated with sleep.
The idea is also to learn to play down the drama. “Sleep is important, but you shouldn’t panic either,” summarizes Marie-Hélène Pennestri. Psychologist Charles Morin suggests an experiment. After a bad night’s sleep, you spend the day lying down and note 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 energizing activities. “Certainly, people agree that they functioned better by remaining active,” notes Charles Morin.
Studies have shown that a night of insomnia has little impact on cognitive functions the next day, emphasizes Alex Desautels, who adds that the brain adapts and changes the architecture of sleep the next day to make it deeper. Another calming fact: insomniacs almost all underestimate the number of hours they sleep.
Participant Philippe St-Germain, who suffers from restless legs syndrome, had more difficulty following the instructions, and the therapy worked less well for him. But he learns an important lesson. “When things are bad, you shouldn’t get discouraged: it will get better later,” he concludes.
A special prescription
Initiatives are taking place in the medical world to reduce 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 produced tools for doctors and patients: video clips and a “non-pharmacological prescription”, both inspired by cognitive-behavioral therapy. Several experts are of the opinion that sleeping pills can be beneficial in times of acute stress, on an occasional basis, but the majority of patients consume them for prolonged periods, which carries risks of dependence and side effects. Cognitive-behavioral therapy for insomnia remains poorly accessible, both publicly and privately.
Consult the video clips on sleep from Choosing Wisely Quebec
Consult the Choosing Wisely Quebec method for a night of sleep without medication
Visit the Dormez sur ça website
Seek help from a psychologist (private)