New research being presented this week at a meeting of the Association for Behavioral and Cognitive Therapies will show results that indicate treating insomnia among people with depression may dramatically boost rates of recovery. This is important news and could dramatically change and broaden treatment for millions of people who suffer the debilitating effects of depression.
The study being presented is one of four major research endeavors sponsored by the National Institute of Mental Health and dedicated to furthering our understanding of the impact of disrupted sleep on the course of depression. In particular, this group of studies — all of which are expected to be published in 2014 — explores the use of cognitive behavioral therapy for insomnia, often referred to as CBT-I. CBT-I is a form of talk therapy designed specifically to address the sleep disorder. Working regularly with a therapist, patients identify issues, emotions, and behaviors that may impede their sleep. They also learn skills and routines designed to improve sleep. These sleep-improving strategies include:
- Implementing regular bedtimes and wake times.
- Developing strong sleep hygiene habits.
- Use of relaxation and visualization exercises.
- Avoiding naps.
- Using sleep restriction to avoid prolonged periods of time spent in bed and awake.
- Keeping sleep diaries.
Also critical to the goal of CBT-I is the easing of anxiety and stress about one’s ability to fall asleep and to sleep well.
CBT-I has some terrific inherent advantages. It is a relatively low-cost treatment option. The course of treatment often can be a short-term one: once patients receive the help they need to change their approach to sleep, they can stop the therapy and continue to sleep well. CBT-I does not involve the use of prescription sleep aids, a welcome change of direction from the increasing reliance on chemical aids for sleep. A substantial body of research shows that CBT-I can be a highly effective treatment for insomnia, even when the sleep disorder occurs in the presence of another illness or health condition. Studies also suggest that this form of sleep therapy works as well or even better than prescription sleep medications.
The results being unveiled this week involve a study of 66 patients with both insomnia and depression. The use of CBT-I to alleviate insomnia appeared to nearly double the rate of recovery from depression, according to the study results being reported. Among the study patients who received four weeks of CBT-I therapy to alleviate their insomnia, 87 percent also had their depression symptoms disappear after eight weeks of treatment. This was nearly twice the number of patients who saw their depression symptoms alleviated without also alleviating their insomnia. If the results of the new research hold up in upcoming studies, sleep therapy may in fact be able to significantly raise the recovery rates for people with depression.
The catalyst for this latest series of investigations into depression and sleep was an earlier study conducted by researchers at Stanford University. This research, published in 2008, included 30 patients with major depressive disorder and insomnia. Patients were all treated with anti-depressant medication, and some were also given seven individual CBT-I sessions, while others were not. Similar to the latest findings, the combination of treatment for depression with CBT-I treatment for insomnia resulted in nearly double the recovery rate from depression symptoms.
The relationship between sleep and depression is complicated. In many ways, science is just beginning to grasp how the two conditions interact and affect one another. In recent years there’s been an important change in the fundamental way this relationship is viewed by clinicians and scientists. Where once insomnia and other sleep difficulties were regarded only as a consequence of depression, the sleep disorder is now increasingly recognized as also contributing to depression itself. It is true that depression can and often does interfere with sleep. But the relationship between sleep and depression is now commonly regarded as bi-directional, with each condition capable of influencing the other. A significant body of research indicates that insomnia and other forms of disrupted sleep elevate sharply the risks of depression and other mood disorders. Disordered sleep appears to raise the risk of suicide among depressed patients. And studies indicate that the presence of sleep problems undermines the effectiveness of treatment for depression once diagnosed.
The results of this new sleep-depression research — the first in a series of studies we’ll be seeing results from — are already being hailed as potentially transformative to the treatment of depression. I am among those eagerly awaiting the full results of this study and the others expected in the coming months. Roughly 19 million U.S. adults are estimated to suffer from depression. Worldwide, that number rises to a staggering 350 million. A significant portion of these people are also likely to be coping with insomnia. Integrating sleep therapy into standard treatment — a low-cost, non-invasive treatment that may dramatically increase the likelihood of recovery — could have a profound impact on millions of lives.
Michael J. Breus, PhD
The Sleep Doctor®
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