Boosting access to evidence-based insomnia care: our experience with a stepped care approach in Canada
Dr. Judith Davidson
Judith Davidson's research and clinical work focus on insomnia and its treatment. She is an adjunct Professor in Psychology at Queen's University (Kingston, Ontario, Canada) where she trains graduate students and health professionals in the treatment of sleep disorders. She received Somnologist certification in behavioural sleep medicine from the ESRS in 2012. Through her writing, research, teaching and speaking, Judith is working to enhance people's access to information about sleep and to effective treatments for insomnia.
Boosting access to evidence-based insomnia care
Today is World Mental Health Day, a moment that sets us a reminder about the importance of mental wellbeing, and how sleep represents one of its most fundamental pillars. When sleep falters, so does our capacity to manage stress, regulate emotions, and maintain perspective. Supporting healthy sleep should therefore be regarded as an integral part of mental health care, essential to both prevention and recovery.
As part of this week’s Sleep Science Friday, we highlight an initiative from Canada that illustrates how a structured and inclusive approach to insomnia care can support mental wellbeing and improve quality of life.
This paper describes the experience with a stepped care model that aims to change how Canadians access insomnia care. Developed by sleep experts, primary care providers, and pharmacists, the model optimises the use of Cognitive Behavioural Therapy for Insomnia (CBT-I) and reduces reliance on sedative-hypnotic medications — addressing a public health challenge that affects 45% of Canadians who struggle to sleep and 16% who meet criteria for insomnia disorders.
The model provides a flexible, tiered pathway to care:
• Step 1: Self-Guided Resources
• Step 2: Primary Care & Community Pharmacy
• Step 3: Trained CBT-I Providers
• Step 4: Behavioural Sleep Experts
This open system adapts to urban, rural, remote, and Indigenous communities, reduces chronic sedative use, and serves as a blueprint for training diverse healthcare providers.
“The goal is to make the best treatments for insomnia available to all Canadians who seek help for chronic sleep difficulty,” says Dr. Judith Davidson. “This model allows healthcare providers at all levels to contribute, from self-managed strategies to specialist interventions.”
On this World Mental Health Day, this work reminds us that better sleep means better mental health, and both deserve equal attention within public health priorities.
Links to Paper:
Recent publications from ESRS members
- Sforza M, Morin CM, Dang-Vu TT, Pomares FB, Perrault AA, Gouin JP, Bušková J, Janků K, Vgontzas A, Fernandez-Mendoza J, Bastien CH, Riemann D, Baglioni C, Carollo G, Casoni F, Zucconi M, Castronovo V, Galbiati A, Ferini-Strambi L.(2025) Cognitive-behavioural therapy for insomnia mechanism of action: Exploring the homeostatic K-complex involvement. J Sleep Res.
- La Rovere MT, Fanfulla F. (2025). In the line of fire: Sleep well as the first step of care. Eur J Intern Med.
- Schede C, Popkirov S, Hartmann A, Klein E, Frase L, Jöbges M, Herrmann C, Lahmann C, Spiegelhalder K, Spieler D, Schredl M, Joos A. (2025) Nightmares and insomnia are frequent in patients with functional neurological disorders. J Psychosom Res.
- Ritterband LM, Shaffer KM, Thorndike FP, Chow PI, Gonder-Frederick L, Ingersoll KS, Cohn WF, Frederick C, MacDonnell K, Glazer JV, Mattos MK, Hilgart MM, Quigg MS, Bashir M, Morin CM (2025). A randomized controlled trial of a digital cognitive behavioral therapy for insomnia for older adults. NPJ Digit Med.
- Haritos R, Küppers V, Samea F, Riemann D, Jessen F, Eickhoff SB, Dafsari FS, Tahmasian M. (2025). The effect of psychotherapy on the multivariate association between insomnia and depressive symptoms in late-life depression. Eur Psychiatry.