Improving Sleep May Benefit Psychiatric Disorders

Improving sleep boosts mood, according to results from the recently concluded Treatment of Insomnia and Depression (TRIAD) clinical trial. Findings were reported at the joint meeting of the American Academy of Sleep Medicine and Sleep Research Society in Minneapolis in June.

Nearly 150 enrollees at medical centers at Stanford University, Duke University, and the University of Pittsburgh received either cognitive-behavioral therapy for insomnia (CBTI) or a control insomnia psychotherapy, as well as antidepressant medication.

Over the 16-week study, subjects participated in seven hour-long insomnia-focused individual psychotherapy sessions and took escitalopram, sertraline, or venlafaxine-XR. The selection of medication was based on each subject’s previous antidepressant use, treatment response, and tolerance. Changes in medication, if clinically indicated, were made during the trial.

Subjects initially had an average Insomnia Severity Index score of 22 and an average Hamilton Rating Scale for Depression score of 22.

Patients receiving CBTI evidenced greater improvement in insomnia than did those receiving the control therapy, Rachel Manber, Ph.D., TRIAD’s principal investigator and a professor of psychiatry and behavioral sciences at Stanford University School of Medicine, told Psychiatric News.

Depression eased across all participants, Manber said. Those who slept better after six weeks were less depressed at the end of the study than those whose poor sleep persisted.

Although the education and certification of behavioral sleep medicine specialists have expanded in recent years, demand for CBTI practitioners still exceeds supply, she pointed out. Aiming to expand availability of this first-line insomnia therapy, Manber and others are exploring its use in group settings.

At the sleep meetings, Erin Koffel, Ph.D., a staff psychologist and clinician investigator in the Minneapolis Veterans Affairs (VA) Health Care System, described a study of 21 veterans with insomnia receiving group CBTI at the Minneapolis VA Medical Center. All of the veterans had reported difficulty falling asleep, staying asleep, or not feeling rested for at least one month.

All had been diagnosed with a psychiatric disorder in addition to insomnia. Their diagnoses included posttraumatic stress disorder, anxiety, major depressive disorder, panic disorder, schizophrenia, and dysthymia.

The veterans participated in one of four consecutive CBTI groups. They attended six 90-minute weekly sessions facilitated by Koffel and kept daily sleep diaries. Koffel used a group-based CBTI protocol created and manualized by her colleague Leah Farrell-Carnahan, Ph.D., a clinical research psychologist at the McGuire VA Medical Center in Richmond, Va., and pilot-tested there. Manber served as a consultant to the VA researchers.

Nearly all of the Minneapolis veterans completed the study treatment, reporting that they fell asleep faster and awakened less often after participating in the CBTI sessions. At one-month follow-up, nearly 90 percent of the veterans fell below the threshold for clinical insomnia, as indicated by Insomnia Severity Index scores. Symptoms of comorbid psychiatric disorders also declined.

“Group-based CBTI represents a promising modality that can deliver durable improvements in sleep and overall mental health symptoms, even among veterans with complex clinical histories,” Koffel and Farrell-Carnahan said in their report in the May issue of Military Medicine. ■