W08 – Managing Insomnia in Clinical Practice

W08 – Managing Insomnia in Clinical Practice

Thursday, Oct. 19
15:45 – 16:45 (1 hr)
Meeting Room: Port Alberni (4th floor – North Tower)
Nick Kates*, MBBS, FRCPC

CanMEDS Roles:

  1. Medical Expert
  2. Communicator
  3. Health Advocate

At the end of this session, participants will be able to: 1) Understand the common causes of insomnia and how it may present in primary care; 2) Be able to use a simple framework to assessment a sleep problem; and 3) Become familiar with the major approaches to managing sleep disorders.

It has been estimated that up to 60% of Canadian adults do not get sufficient sleep, and insomnia is one of the commonest problems encountered in clinical practice, although rarely the primary presenting problem. Many factors can contribute to poor sleep, including lifestyle, mental health problems, other general medical problems, medications, or primary sleep disorders. This workshop discusses the importance of sleep and the consequences of insufficient sleep and presents a framework for understanding, assessing, and treating commonly encountered sleep problems. It summarizes the five-stage sleep cycle, circadian cycle, and sleep-wake cycle and outlines the different ways these changes can contribute to sleep problems. It differentiates between a primary sleep disorder (e.g., sleep apnoea, narcolepsy, restless leg syndrome, delayed sleep onset disorder) and primary or secondary insomnia and the potential consequences of each of these. It reviews the major causes of insomnia and presents simple questions that can be introduced into any health assessment. It outlines a comprehensive but relatively concise evaluation of a sleep problem and offers simple screening tools, including a sleep log, to assist with this. It then reviews the four major approaches to managing a sleep problem: sleep hygiene strategies, cognitive-behavioural therapy for insomnia, medications, and over-the-counter drugs. Finally, it outlines an approach to managing the four primary sleep disorders listed above and the criteria for referral to a sleep clinic.


  1. Wilson SJ, Nutt DJ, Alford C, et al. British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders. J Psychopharmacol 2010;24(11):1577–601.
  2. Schutte-Rodin S, Broch L, Buysse D, et al. Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med 2008;4(5):487–504.