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William Shakespeare felt that sleep was the “chief nourisher in life's feast.” A recent study from Quebec, published in the Journal of the American Medical Association, provides fresh insight for insomnia sufferers and hopefully some hope for better enjoying life's feast.

Insomnia is an affliction that affects at least one in three people. Doctors treat the symptom poorly and there is limited research to help guide us.

Poor sleep wrecks jobs and relationships, increases weight, makes other diseases and pain much worse, and plays a serious cause-and-effect game with depression and anxiety.

Some people can't get to sleep, others wake frequently and still others wake too early. Occasionally we can treat a specific problem, such as pain or depression, and insomnia goes away.

Short-term insomnia typically lasts a few days to a few weeks. Chronic insomnia, lasting more than a month and affecting up to 15 per cent of the population, can be especially insidious. Previous research by these same authors shows that 74 per cent of troubled sleepers had their insomnia persist to the one-year mark and 46 per cent to at least three years.

The research team, led by Charles Morin of Laval University, attempted to answer three questions. First, does a treatment known as cognitive behavioural therapy, or CBT, work? Second, how does CBT compare with sleeping pills? Third, is there a combination of approaches that works best? The study population was adults from Quebec, mostly under 60 years of age.

Before we delve into the answers to these questions, let's consider the three basic approaches to insomnia.

The first is what we call sleep hygiene – for example, not drinking caffeine after lunch, keeping to a specific bed and awakening routine, exercising and making sure your bedroom is not a CNN media centre.

The second approach is sleeping pills. One of the more revealing studies on this treatment option was conducted by Jennifer Glass and colleagues from the University of Toronto in 2005. They collected data on 2,400 people over 60 years of age to see how much of a difference medications made in patients with insomnia. On average, sleeping pills increased sleep by 25 minutes, but one out of six people taking the drugs had a significant adverse event such as loss of memory, daytime fatigue or confusion, according to the results published in the British Medical Journal.

Furthermore, despite excellent ad campaigns that suggest otherwise, all sleeping pills are roughly equivalent in effectiveness, the data showed. And while the public fears addiction, this seems uncommon. However, when coming off the medications, patients certainly tend to have a few tricky nights and those prone to addiction may want to steer clear.

The third approach, CBT, started in the 1960s when a U.S. psychiatrist named Aaron Beck noticed that his clients would often have what he called an “internal dialogue” that they didn't articulate. For example, if Dr. Beck was quiet, the patient might silently observe, “Maybe he's annoyed with me.” This thinking, what he called “automatic thoughts,” often led to a negative emotion such as anxiety or annoyance. On further probing, he realized that patients often weren't even aware of these thoughts, which were usually negative and unhelpful, but that their moods and actions were clearly affected.

Dr. Beck found that when he helped the person recognize and reframe these distorted thoughts in a realistic and positive way, people did better. Examples of distortions are catastrophizing (“I didn't sleep well; my day will be a disaster”) and overgeneralization (“I haven't been able to sleep for 10 minutes; now I'll be up all night”).

He called this cognitive therapy, and it has since morphed into cognitive behavioural therapy or CBT. It's not a fancy or deep psychological theory, but rather based on the idea that how you think (cognition) and act (behaviour) affects the way you feel. CBT has now been proved to be the most effective therapy in psychology over a wide domain of illnesses that range from depression to irritable bowel syndrome.

CBT works for sleep because it focuses on changing the way you think. For example, when we have insomnia, the bedroom becomes a place associated with tossing and turning, not sleeping. As we settle into bed, we may say to ourselves consciously or unconsciously, “I can't sleep.” This is why people with insomnia are often sleepy on the couch, but wide awake when they go to bed (and why they sometimes sleep better when they go back to the couch).

This is also why we give people the counterintuitive advice to get up when they have been clock-watching for 15 minutes. Instead of just lying there, research shows that people who get up and do something relaxing for a few minutes and then return to bed for sleep have less insomnia.

With this in mind, let's take a look at the Quebec study where Dr. Morin and his colleagues examined patients with persistent insomnia. Patients attended weekly group CBT sessions for six weeks, with half the patients also receiving a sleeping pill (10 milligrams of zolpidem nightly). Techniques of relaxation, worry management and problem-solving were used as needed.

In the short term – six weeks – CBT helped four out of 10 people put their insomnia into complete remission. If we looked at people just getting better, but not complete relief, the success rate increased to six out of 10. This happened with or without a sleeping pill.

After the initial trial, the insomniacs were then randomized to either monthly CBT sessions for six months or just usual care. Half of the group that were taking the sleeping pills continued them and half stopped.

The group that did best, after all was said and done, were the individuals who started with both sleeping pills and CBT initially, and then stopped the pills and just had the CBT. Seven out of 10 of these patients had complete remission of their insomnia.

The reality is that each of us are going to find our own unique solution to how we spend the one-third of our lives meant to be in bed, but this trial tells us that there is hope for many, especially if we add CBT to our strategy.