Cognitive behavioural therapy can help with insomnia, and lessen the chance of depression, according to a new study.
The research, published in JAMA Psychiatry, looked at 291 adults above the age of 60 with insomnia, and who hadn’t experienced depression in the last year. The sleep disorder, which makes it hard to fall asleep or stay asleep, affects nearly half of adults in that age group. Many people with insomnia also have depression: one study found that people with insomnia are twice as likely to become depressed as people without a sleep disorder.
“Depression prevention is urgently needed, and such efforts have been neglected for older adults,” the study read. A 2018 study found that depression among people in that age group is more common than previously believed: more than 10 per cent of adults over the age of 60 have major depressive disorders. In addition to the mental health toll that takes, depression in older people is also linked to cognitive decline, disability, and a number of diseases.
“Given that older adults account for nearly 20 per cent of the U.S. population and are the most vulnerable for health risks associated with depression, effective depression prevention is urgently needed,” said Dr. Michael Irwin, lead author of the study and the director of the Cousins Center for Psychoneuroimmunology at the Semel Institute for Neuroscience, and a Professor of Psychiatry and Biobehavioral Sciences at the David Geffen School of Medicine at UCLA.
For two months, one group of participants was given cognitive behavioural therapy, a kind of therapy that involves identifying and working to change unhelpful thought patterns as a way to change behaviour. In this case, the focus was on thoughts and behaviours around stimulus control, sleep restriction, sleep hygiene, and relaxation. The other group was given sleep education therapy (SET), described in the study as “target[ing] day-to-day behavioural and environmental factors that contribute to poor sleep.” SET is comparable to CBT, the study said, but it’s “less robust and durable.” The people undergoing SET were taught about sleep hygiene, sleep biology, characteristics of healthy sleep, stress biology, and the impact these things had on sleep. Both kinds of therapies were performed by trained psychologists.
The study found that 12 per cent of people in the CBT group did go on to develop depression. But that’s significantly lower than the 26 per cent of people in the SET group who developed depression. It also found that 51 per cent of people who did CBT no longer had insomnia, compared with 38 per cent of people who did SET.
That means that many adults who have access to a cognitive behavioural therapist can essentially “sleep train” themselves, and learn to get back to adequate, restful sleep — and that that same therapy will lower their risk of developing depression.
“What is exciting about these findings is that they are among the first to demonstrate that treating insomnia with a behavioural strategy, not a pill, can prevent the development of depression in older adults,” sleep specialist Wendy Troxel told CNN. (Troxel was not involved in the study.)
If remission from insomnia could be sustained for three years, Irwin said, there’s “an 83 per cent reduction in the likelihood of developing depression” — a significant number.