GUEST COLUMN: 'ONTARIO ASLEEP' — INSOMNIA DESERVES MODERN MEDICINE

By: Dr. Pierre Blier and Dr. Serge Lessard

“I can live with my depression, but I can’t live without my sleep.”

For hundreds of thousands of people in Ontario, chronic insomnia is a daily struggle. In medical terms, chronic insomnia disorder is a serious condition that affects our work, social lives, and both mental and physical health, increasing the risks of heart disease, obesity, depression, and early death, including suicide.

Our economy and communities rely on a healthy, productive workforce, but chronic insomnia silently undermines it. Up to 15 per cent of Canadian adults suffer from chronic insomnia. Studies associate it with a 40 to 75 per cent increase in long-term work disability. The impact is hard to ignore: reduced productivity, increased safety risks, and higher costs across key sectors such as energy, construction, health care, and education.

Physicians and support workers who treat patients’ mental and physical health are concerned about limited access to effective and safe treatment options for those covered under our public drug benefit plans.

Today, these patients rely on medications with limited long-term scientific evidence that carry risks such as falls, sedation, weight gain — contributing to metabolic disorders — and dependence, including to benzodiazepines, Z-drugs, antipsychotics, and antidepressants. Or they self-medicate with alcohol, cannabis, or over-the-counter sleep aids.

Yet there is a newer class of sleep medications, studied explicitly for treating insomnia, known as dual orexin receptor antagonists (DORAs), which are safe and effective for managing chronic insomnia with minimal risks.

As clinicians, we have observed this first-hand in Ontario’s correctional settings, where chronic insomnia is common and often worsened by stress, mental health issues, and substance use. Also connected to insomnia are increased impulsivity, agitation, and the risk of aggression.

These newer medications are linked to better daytime functioning and fewer side effects compared to traditional sedating sleep aids, making them a valuable option for inmates having difficulty falling asleep or staying asleep.

Countries like Japan, France, Germany, and Italy publicly fund these medications, but Canada’s public drug plans — including Ontario’s — do not. Their absence limits safe and effective treatment options for thousands of Ontarians who could benefit.

Canada’s Drug Agency recently recommended excluding these medications from public benefits plans, neglecting the outcomes that matter most to patients and clinicians: quality of life, daytime functioning, and recovery.

That decision leaves Ontario’s public system behind global standards for timely access to medications for mental health and other physical disorders. But this is not an isolated case. A Mood Disorders Society of Canada’s 2023 report found that most provinces publicly cover only 25 per cent of approved psychiatric drugs. For the small percentage that are provincially funded, patients wait an average of 2.5 years after approval to access them.

Currently, Ontario has a two-tier system for insomnia treatment: individuals with private insurance can access newer options, while those relying on public drug plans often receive less effective and sometimes risky, non-evidence-based treatments because the province does not cover newer medications.

Including these medications in the Ontario Drug Benefit program would align us with global best practices, reduce disability, boost workforce productivity, and lower healthcare costs. More importantly, it would show our provincial leaders’ genuine commitment to mental health.

Sleep is essential and fundamental to our health; we spend nearly a third of our lives trying to restore it. Many of us struggle and fail to do so.

The science is clear, and the evidence is compelling. The time to ensure that all Ontarians can sleep and wake safely and healthily — not just those with private drug coverage — is now.

Dr. Pierre Blier is a professor in the departments of psychiatry and cellular & molecular medicine. Dr. Serge Lessard is an assistant professor of psychiatry. Both are at the University of Ottawa.

2025-12-12T12:36:54Z