Summary
Sleeping pills may mask insomnia, but they rarely solve it—and often create new problems. CBT-I offers a proven, long-term alternative that retrains the brain for restorative sleep while reducing medication dependence. This article explains why CBT-I is transforming insomnia treatment in Canada.
The topic of sleep is certainly not a new one at The Health Insider. We’ve covered it from different angles since our inception. The idea that a good night’s sleep is important is not only supported by what we read, but also reinforced daily by how we feel when we get up in the morning and we consider the number of hours we slept, the quality of our sleep, etc.
We want to know, and now we have biometrics doing the tracking for us in the form of Apple watches, biometric rings and a multitude of phone apps, all of which capture a plethora of sleep metrics for further analysis.
Chronic Insomnia in Canada – What’s the real problem?
One of the lesser talked-about issues is the dependence that a large percentage of the population has on sleeping pills to combat chronic insomnia. This is not one, but rather two serious issues.
A recent national survey of more than 4,000 Canadian adults found that about 16.3% meet the criteria for insomnia disorder, with many more experiencing significant sleep difficulties without a formal diagnosis. The same study reported that 14.7% of Canadians used prescribed sleep medications in the previous 12 months, and even more turned to over-the-counter products, “natural” sleep aids or alcohol to try to sleep better.
In older adults, the picture becomes even more concerning. A Canadian review of sedative use shows that roughly 10–12% of adults overall and about 13% of people 65+ report past-year use of prescription sedatives, which include many sleeping pills and anti-anxiety medications.
There’s a Real Problem in New Brunswick
In Atlantic Canada, these statistics skew even higher. In New Brunswick, the Canadian average for regular sleeping pill use in people 65 and older (about 8%) jumps to a concerning 22% according to Dalhousie University. And background work for the “Your Answers When Needing Sleep in New Brunswick” (YAWNS NB) study suggests about one in four older adults in NB is a long-term user of benzodiazepine receptor agonists (BZRAs), the class that includes many commonly prescribed sleeping pills.
So yes, insomnia is common, and so is long-term reliance on medications that were never meant to be a lifelong solution.
Sleeping Pills – So What’s the Problem?
Drugs like Xanax, Valium, Halcion and Ativan have been around for decades. They all fall under a class of pharmaceuticals called benzodiazepines. Their cousins include the so-called “Z-drugs” such as zopiclone and zolpidem, which are also widely used as sleeping pills. The street equivalents are zombie pills, downers, “roofies” (“the date rape drug”), tranquilizers, sedatives and hypnotics.
This class of drugs was originally approved for short-term use for things like acute anxiety and episodic insomnia. As their nicknames suggest, they put you in a state of hypnotic-like relaxation and ultimately knock you out. And… they are addictive. Over the long term, you require higher doses as you build up tolerance. They’re also associated with confusion, memory problems, increased risk of falls and fractures, and car crashes, especially in older adults.
Furthermore, when combined with other sedating medications (for example, opioids, certain antidepressants or alcohol), they can depress breathing and, in the worst-case scenario, contribute to overdose and death.
At the end of the day, we can’t lose sight of the fact that sleeping pills alter symptoms while doing nothing to address the underlying behavioural or cognitive causes that are often at the root of what’s really happening.
Sleeping Pills Are Not Supposed to Be the First Line of Therapy
When psychiatrist and pharmacist Dr. David Gardner and colleagues uncovered the disturbing New Brunswick statistics relating to sleeping pill dependence, they saw it as the perfect place to test a new model that would nudge people toward safer, more effective care – cognitive behavioural therapy for insomnia (CBT-I), and away from long-term sedative use.
It’s important to note that CBT-I has, for some time, been the first-line treatment for chronic insomnia in major clinical guidelines here in Canada, the US and throughout Europe. These guidelines recommend that medications, if used at all, should generally be short-term and only considered after CBT-I has been tried.
The difference with what Gardner’s group did in New Brunswick was to prove in a real-world setting that there’s a good reason CBT-I is first-line – it works, and it can help people safely reduce or stop sleeping pills while actually improving their sleep.
At the same time, large Canadian epidemiological work led by Dr. Charles Morin and the Canadian Sleep Research Consortium has documented just how common insomnia disorder and sleep-aid use have become across the country, providing the broader context for why changing treatment patterns matters.
What Is CBT-I?
The premise of Cognitive Behavioural Therapy (CBT) in general is that our thoughts and interpretations of events shape our feelings and actions. By learning more adaptive ways to process information, people can reduce psychological distress and modify their emotions and behaviours.
CBT-I (for insomnia) utilizes the principles of CBT and gears them specifically to sleep. It’s designed to re-train your brain and body with respect to sleep and, when called for, also leaves no doubt in your mind as to the harmful effects of long-term exposure to sleeping pills.
The 5 core pieces of CBT-I typically include:
- Sleep education – Understanding the mechanics of sleep and what “normal” variation looks like.
- Stimulus control – Breaking the association of your bed with Netflix, “doom-scrolling” and worry, while reassociating your bed with… SLEEP.
- Sleep scheduling (aka “sleep restriction”) – Getting into bed when you actually feel tired, not beforehand, and then expanding that window over time as your sleep consolidates.
- Cognitive work – Identifying and challenging unhelpful and anxiety-provoking thoughts such as “If I don’t get my 8 hours, I’m going to be a mess,” or “I’ll never sleep without a pill.”
- Relaxation and wind-down – Preventing “arousal” just prior to bedtime, as well as during those middle-of-the-night wake-ups, through techniques like breathing exercises, muscle relaxation and structured worry time.
Decades of studies and meta-analyses show that CBT-I typically improves sleep onset, wake-after-sleep-onset and sleep efficiency, with benefits that are comparable to hypnotic medications in the short term and superior in the long term because they persist after treatment ends.
What Gardner’s New Brunswick Study Actually Showed
The YAWNS NB randomized clinical trial (“Your Answers When Needing Sleep in New Brunswick”) was designed to see whether simple, mailed information packages could help older adults taper long-term sleeping pills and adopt healthier sleep strategies, including CBT-I. It’s worth reading the full study, which can be found online. It describes the key features of the study, the randomization of the participants, the impact after 6 months and the conclusions surrounding the use of CBT-I vs. the “usual” care.
In other words, a low-cost, mailed intervention that educated people about the risks of long-term sleeping pill use and introduced CBT-I skills led to meaningful reductions in sedative use and better sleep, without substituting one sedative for another.
As the authors summarize, you would need to mail the information (“Sleepwell”) package to just over five people for one person to stop long-term sedative use – a remarkably efficient public-health intervention.
Why This Matters if You’re Struggling With Insomnia or Sleeping Pills
Taken together, the Canadian prevalence data and the New Brunswick trial tell a clear story:
- Chronic insomnia affects millions of Canadians.
- Sleeping pills are widely prescribed, especially among older adults, but carry real risks and don’t fix the root cause of insomnia.
- CBT-I is a safe, effective first-line treatment that can be delivered in many formats, including individual therapy, groups, online programs, even self-guided workbooks.
- Behaviour-change interventions like Sleepwell can help people not only reduce or stop sleeping pills but also sleep better and feel better during the day.
For many people, CBT-I becomes a kind of “sleep toolkit for life”. Once you’ve learned how to manage your thoughts around sleep, set a realistic schedule, and respond differently to those 3 a.m. wake-ups, you own those skills.
Long-term follow-up studies show that CBT-I’s benefits can last for years, with sustained improvements in sleep and lower relapse rates compared with those who rely solely on medication.
If you’re in Canada and living with chronic insomnia or long-term sleeping pill use, the emerging evidence offers a hopeful message:
- Your sleep problem is real and common, not a personal failure.
- There are safer, more sustainable options than staying on sedatives indefinitely.
- CBT-I can help you rebuild your sleep from the ground up, address the habits and thoughts that keep insomnia going, and, as Gardner’s New Brunswick study shows, can support you in reducing or even stopping sleeping pills while actually improving your nights.
For many Health Insider readers, the next best step is to talk with your family doctor or nurse practitioner about a CBT-I referral or reputable online program, and if you’re on sleeping pills, about a slow, supervised taper plan that incorporates CBT-I tools.
You’re not just trading one “treatment” for another. You’re investing in lasting behavioural change that lets you rely less on pills and more on your own, re-trained sleep system, night after night, year after year.
