A 7-week treatment program for chronic insomnia for ages 13+ in Ontario
A consultation is required to ensure this program is a good fit.
WHAT IS THE DECODE INSOMNIA PROGRAM?
The DECODE Insomnia Program offers a comprehensive, non-medication solution for insomnia, rooted in Cognitive Behavioural Therapy for Insomnia (CBT-I). The program blends personalized support with an online curriculum for self-paced, convenient learning.
HOW DOES THIS PROGRAM WORK?
While knowledge is essential, it’s not enough. Achieving sustainable healthy sleep comes from taking action, consistently and in the right order. This requires energy, attention, and motivation–all of which are severely compromised when not sleeping well. This program was designed to provide you with a streamlined step-by-step roadmap with the right support, recognizing that relying on willpower alone is seldom effective. In this program, we blend strategies taught in a traditional course of CBT-I with *Habit-breaking and building strategies *Strategies from acceptance and commitment therapy (ACT) to more effectively respond to thoughts and emotions that drive unhelpful behaviours *A focus on other ‘tricky-to-navigate’ moments that derail healthy sleep (bedtime procrastination, waking up, being active, managing fatigue) *An emphasis on aligning your sleep goals with your big picture life goals & what matters most to you, providing genuine motivation to get the most out of the program *Techniques to effectively manage the influx of thoughts that arise at bedtime The program design is also unique with the following features to support implementation and effective progress through the program: *An online platform (available on a desktop and via the program app) for convenient, on-the-go learning and the ability to revisit content at anytime *Live sessions that complement the online curriculum, ensuring a personalized approach *A workbook with lesson summaries, cheat sheets, checklists, and templates *Audio to guide action in-the-moment *A guide with resources, ideas, and recommended products
Phase One lasts 3 weeks and jumpstarts progress with powerful behavioural strategies. During this phase, participants use a two-week protocol (RESET) to address powerful factors driving chronic insomnia (an out of sync body clock, an unhelpful association with the bed). There is a strong focus on getting set up properly for the RESET as there are many common traps that can derail progress. Simple routines and a plan for when unable to sleep are created. Sleep is monitored with logs during the RESET. Phase 1 is supported by 2-3 virtual OHIP-covered clinic visits with a physician.
Phase Two lasts 4 weeks and focuses on building a toolkit of skills to maintain good sleep. In this phase, participants learn how to break habits, build helpful habits, build relaxation & cognitive skills, and create realistic plans to guide difficult in-the-moment action. There is also a focus on learning skills to manage the volume of thoughts that arise at bedtime. Participants learn to better navigate other ‘tricky moments’ that derail sleep (waking up, powering down/bedtime procrastination, managing fatigue, staying active). At the end of Phase 2, a relapse prevention plan is created. Phase 2 is delivered in 4 weekly sessions with a psychotherapist.
IS THE PROGRAM RIGHT FOR ME?
A consultation at the DECODE Insomnia Clinic will help you determine if the program is a good fit. Please speak to your physician about a referral to the clinic.
I have been a night owl my whole life. I thought it was genetic, as almost everyone in my family stays up late and sleeps in as long as logistically possible. Mornings were always painful. I was also always tired - which I just accepted as just a part of life. After completing this program, I was shocked (and am still somewhat in disbelief) about 2 aspects. One, that I could do it. And two, that I loved it. I felt in control of my time, in touch with the version of who I want to be, and a fogginess that I didn't know had been there seemed to clear. I felt generally more calm and focused on the things I've always tried but only semi-succeeded in prioritizing. I was surprised to find myself feeling sad when the program was over. But I also feel genuinely motivated to work my learnings into my everyday life.
It's now almost 3 months since completing the program and I can confidently say I am no longer a night owl unless I choose to be, mornings are not painful, and I feel generally more in control of my time in the evening and also the daytime. It's crazy to think about how such a short program had such lasting effects for me. I'm so thankful it did because, with my schedule, there is no way I would have been able or willing to commit to something that wasn't time limited. It was doable, I did it, and when I think about it now I realize I'm actually still mainly doing it, but the beautiful thing is - it doesn't feel like a thing to do anymore.
~Dr. R.B., Program Participant
WHAT IS THE COST OF THE PROGRAM?
The cost of the program is $500CAD* for 6 months access to the online platform plus the psychotherapy session fees ($175CAD*+HST/session x 4 sessions). A letter can be provided for insurance purposes. *Pricing is subject to change.
IS IT COVERED BY INSURANCE?
There's a possibility that the program may be covered by your insurance. A letter can be provided for your insurance company confirming your diagnosis and treatment with the first-line recommended treatment for insomnia (cognitive-behavioural therapy for insomnia, CBT-I) with a registered psychotherapist.
WHAT IS THE TIME COMMITMENT?
During Phase 1, participants have 2 or 3 virtual clinic visits with the physician every 1-2 weeks and devote ~1-2 hours per week between appointments to program-related activities. During Phase 2, participants meet with the psychotherapist weekly for 50 minutes (virtual or in person in midtown Toronto). In between sessions, ~1 hour per week is required to watch the video lessons and complete the worksheets.
WHAT IS COGNITIVE-BEHAVIOURAL THERAPY FOR INSOMNIA (CBT-I)?
CBT-I is a structured and evidence-based therapeutic approach designed to treat insomnia. It focuses on addressing the underlying thoughts, behaviours, and habits that contribute to sleep difficulties. CBT-I involves various techniques such as sleep restriction, stimulus control, and relaxation training to improve sleep quality and duration. CBT-I has a strong evidence base, with research indicating that it is effective for around 70-80% of individuals with chronic insomnia. This success rate is often comparable to or even surpasses that of medication with the added benefits of avoiding medication risks (side effects, dependance, development of tolerance, etc.) and more sustained results. CBT-I leads to significant improvements in sleep latency (the time it takes to fall asleep), sleep efficiency (percentage of time in bed spent asleep), and overall sleep quality. The DECODE Insomnia Program is based on CBT-I techniques, adjusted for self-paced learning via our online portal and supported by appointments for accountability, troubleshooting and therapeutic interventions.
WHAT IS ACCEPTANCE AND COMMITMENT THERAPY (ACT)?
Acceptance and Commitment Therapy (ACT) is a type of psychotherapy that helps individuals accept their thoughts and feelings rather than trying to eliminate or suppress them. It emphasizes being present in the moment, clarifying personal values, and taking action in alignment with those values.
HOW IS CBT-I DIFFERENT FROM CBT FOR MOOD & ANXIETY? CAN MY THERAPIST PROVIDE CBT-I?
While there is some overlap, CBT for mood and anxiety does not cover critical interventions for chronic insomnia. Working with a therapist with training in CBT-I and experience working with individuals with chronic insomnia is highly recommended.
WHAT IF I HAVE DEPRESSION, ANXIETY, CHRONIC PAIN OR OTHER HEALTH CONDITIONS?
There is evidence to show that CBT-I is effective if you have concurrent conditions like depression, anxiety, and chronic pain. In addition, addressing insomnia with CBT-I can have a positive impact on these co-occurring conditions.
HOW DO I ENROL?
Consultation is first required at the DECODE Insomnia Clinic before enrolling in this program. Please speak to your physician regarding a referral to the clinic. This virtual clinic provides OHIP-covered consultation for patients 13+ in Ontario, Canada only. If you have already had a consultation at the DECODE Insomnia Clinic (or a consultation with Dr. Ooi at the Toronto Sleep Institute): If it has been more than one year since the consultation or chronic insomnia treatment was not discussed during a previous consultation, request a consultation through the portal and speak to your physician about another referral. If it has been less than one year and you had previously discussed returning at a later time for chronic insomnia treatment, please email email@example.com to arrange an appointment to discuss next steps.
WHAT ARE THE ALTERNATIVES?
There are lots of free resources on this site (see 'Tools') that provide education and general strategies. While general strategies for sleep can be helpful, these strategies alone may not be enough. Addressing insomnia in the long-term requires breaking unhelpful habits, building helpful habits, and building skills. For some, committing to a treatment program with a clear roadmap and the right support is what is required to get traction and for sustainable progress. There are also various ways of accessing CBT-I or CBT- I strategies including books, apps, and other programs. There is also an additional brief behavioural treatment option for youth (ages 13-26) at this clinic. This option can be discussed at the time of consultation.
I DON'T LIVE IN ONTARIO. WHAT ARE MY OPTIONS?
Currently, the DECODE Insomnia Program is only available for individuals living in Ontario, Canada. There is the possibility that this program may be available outside of Ontario in the future. For now, get started with the DECODE tools and consider treatment for insomnia in your area.
MY CHILD IS 12 OR YOUNGER. WHAT ARE MY OPTIONS?
Currently, the DECODE Insomnia Program is not available for children ages 12 or younger. Education and strategies from the free DECODE resources, however, may benefit a younger age group.
I CAN'T AFFORD THE PROGRAM. WHAT ARE MY OPTIONS?
An OHIP-covered consultation is worthwhile to understand your sleep concern, for general strategies, and to better understand your options. In the future, we plan to introduce group treatment options and a youth scholarship initiative. We also hope to partner with other organizations to provide more accessible options for individuals committed to improving their sleep. Other options for CBT-I can be found at https://mysleepwell.ca/cbti/sleepwell-recommends/
ARE THERE ANY OTHER TREATMENT OPTIONS FOR YOUTH?
There is an additional brief behavioural treatment option for youth ages 13-26 that can be discussed at the time of consultation.
WHY START WITH SLEEP?
Sleep concerns are very common and have a profound impact on mental and physical health. Poor sleep impact mood, motivation, focus and performance and undermines the ability to learn new skills, to change habits, and to benefit from other interventions. If delivered in a digestible way with the right support, evidence-based sleep interventions are quick and very effective. Perhaps most importantly, the strategies, frameworks, principles that are learned by getting sleep on track can be applied to other challenges such as managing anxiety and depression.