Psychiatric Comorbidity: The Case for Treating Insomnia

The GoodNight study--online CBT for insomnia for the indicated prevention of depression: study protocol for a randomised controlled trial

BACKGROUND

Cognitive Behaviour Therapy for Insomnia (CBT-I) delivered through the Internet is effective as a treatment in reducing insomnia in individuals seeking help for insomnia. CBT-I also lowers levels of depression in this group. However, it is not known if targeting insomnia using CBT-I will lower depressive symptoms, and thus reduce the risk of major depressive episode onset, in those specifically at risk for depression. Therefore, this study aims to examine whether Internet delivery of fully automated self-help CBT-I designed to reduce insomnia will prevent depression.

METHOD/DESIGN

A sample of 1,600 community-dwelling adults (aged 18-64), who screen positive for both subclinical levels of depressive symptoms and insomnia, will be recruited via various media and randomised to either a 9-week online insomnia treatment programme, Sleep Healthy Using The internet (SHUTi), or an online attention-matched control group (HealthWatch). The primary outcome variable will be depression symptom levels at the 6-month post-intervention on the Patient Heath Questionnaire-9 (PHQ-9). A secondary outcome will be onset of major depressive episodes assessed at the 6-month post-intervention using 'current' and 'time from intervention' criteria from the Mini International Neuropsychiatric Interview.

DISCUSSION

This trial is the first randomised controlled trial of an Internet-based insomnia intervention as an indicated preventative programme for depression. If effective, online provision of a depression prevention programme will facilitate dissemination.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry (ANZCTR), Registration number: ACTRN12611000121965.

Physiological correlates of insomnia

Insomnia is a prevalent sleep disorder that is typically comorbid with medical, psychiatric, and other sleep disorders. Yet, it is a disorder with its own course and morbidity that can persist if untreated. This chapter describes the physiological correlates of insomnia expressed during sleep and during the daytime. Together, the data from nighttime and daytime electrophysiology, event-related brain potential recording, neuroimaging studies, sympathetic nervous system, and HPA axis monitoring all suggest that insomnia is a 24 h disorder of hyperarousal.

A randomized controlled trial of an internet intervention for adults with insomnia: effects on comorbid psychological and fatigue symptoms

OBJECTIVE

Insomnia is frequently comorbid with other medical and psychological disorders. This secondary data analysis investigated whether an Internet-delivered cognitive behavioral therapy for insomnia (CBT-I) intervention could also reduce comorbid psychological and fatigue symptoms.

METHOD

Data from a pilot randomized controlled trial (RCT) testing the efficacy of Internet-delivered CBT-I relative to a waitlist control was used to examine changes in symptoms of depression, anxiety, mental health quality of life (QOL), and fatigue.

RESULTS

Group by time interactions from repeated measures analyses revealed significant post intervention improvements in Internet participants (n = 22) relative to control participants (n = 22) on all psychological symptoms, mental health QOL, and fatigue. A small post hoc subsample of Internet participants with mild or moderate depression also showed large effect size changes in these constructs (depression, anxiety, mental health QOL, and fatigue).

CONCLUSION

Internet-delivered CBT-I appears to not only improve sleep but also reduce comorbid psychological and fatigue symptoms.