Online Therapy for Insomnia Reduces Depression

Feel like sleeping

“If only I could get a good night’s sleep my mood would be much better.”

Many people who suffer from chronic depression are aware of the relationship between the quality of their sleep and their levels of mood and anxiety.

A study published in the April 2016 addition of the British journal, Lancet Psychiatry, supports this view.

1100 internet users (aged 18–64 years) with insomnia and depression symptoms who did not meet criteria for major depression were randomly assigned to receive SHUTi, a 6 week, online cognitive behavioral therapy for insomnia program, or HealthWatch, an interactive internet-based placebo control program.

As you can see in the graph on the right, the SHUTi program was associated with a SHUTi Reduces Depression on PHQ9.jpgsignificant and rapid reduction in symptoms of depression as measured using a standard rating scale, the PHQ-9.

Scores on the PHQ-9 were reduced by 50% by week 5 of the program. And these scores remained at that same level for the full 25 weeks of follow up. Confirming our experience with the SHUTi program: it is effective at improving sleep long after the user completes the program.

The SHUTi program was associated with reductions in symptoms of depression, anxiety, and suicidal ideation.

If you are interested in trying this program you can sign up using this link.

For More Information

Best Treatment for Chronic Insomnia

Insomnia Treatment Reduces Brain Stress

Internet Therapies Generate Interest

Sleep Therapy and Depression

References

Christensen H, Batterham PJ, Gosling JA, Ritterband LM, Griffiths KM, Thorndike FP, Glozier N, O’Dea B, Hickie IB, Mackinnon AJ. Effectiveness of an online insomnia program (SHUTi) for prevention of depressive episodes (the GoodNight Study): a randomised controlled trial. Lancet Psychiatry. 2016 Apr;3(4):333-41. doi: 10.1016/S2215-0366(15)00536-2. Epub 2016 Jan 28. PubMed PMID: 26827250.

Best Treatment for Chronic Insomnia

Mature woman frustrated while trying to sleep

What is the best treatment for chronic insomnia?

The American College of Physicians has just published the results of a careful review of all of the research in this area.

The preferred treatment for insomnia is cognitive behavioral therapy (CBTi) which we offer through this website – read about it at the bottom of this page.

In their review, ACP notes that overall many frequently prescribed medications have quite poor evidence supporting their effectiveness.

Low-to-moderate quality evidence demonstrated that doxepin, suvorexant (Belsmora), eszopiclone (Lunesta), zolpidem (Ambien), and extended-release zolpidem (Ambien XR) each improved total sleep time (by approximately 15–45 minutes).

The other medications that are commonly prescribed do not have adequate evidence to support their effectiveness.

Better quality evidence supports the effectiveness of CBTi in improving multiple aspects of sleep quality.

CBTi can be given in individual therapy, group therapy or using an online program (of which SHUTi is the one most frequently recommended and the one we provide access to).

References

Qaseem A et al. Management of chronic insomnia disorder in adults: A clinical practice guideline from the American College of Physicians. Ann Intern Med 2016 May 3; [e-pub]. (http://dx.doi.org/10.7326/M15-2175)

 

 

 

Chronic Insomnia Treatments

chronic insomnia treatmentsA recent study confirms that cognitive behavioral therapy is effective for chronic insomnia and is often more effective than medications.

“What surprises us is that there isn’t more awareness of this treatment’s effectiveness and that there haven’t been more attempts to make the treatment more available to patients,” James M. Trauer of the Melbourne Sleep Disorders Centre in Australia told Reuters Health by email.

The researchers analyzed 20 randomized, controlled trials of cognitive behavioral therapy to determine what effects it had on the sleep of people with chronic insomnia not caused by an underlying medical condition.

The researchers note perhaps 15% of people have chronic insomnia. Chronic insomnia is associated with health, mental health and cognitive impairments.

The 20 studies included more than 1,000 patients.

On average, people in the therapy groups reduced the time it takes to fall asleep by 19 minutes after treatment and spent 26 fewer minutes waking up in the night according to an online report of the study posted June 8th in Annals of Internal Medicine.

You might be thinking that that’s not much of an effect.

However recent meta-analysis of 105 studies of medications for chronic insomnia (Buscemi – see reference below) found that on average medications commonly used for insomnia were associated with falling asleep about 11 minutes faster than before treatment, which is slightly more than half the improvement seen in the study of cognitive behavioral therapy.

The authors of the study of cognitive behavioral therapy suggests that cognitive behavioral therapy should be the first treatment option selected. Instead, in clinical practice it’s often not mentioned at all.

Part of the problem is that cognitive behavioral therapy for insomnia is surprisingly difficult to access in many parts of the country.

For more than a year we’ve been offering readers of this blog access to an excellent program of online cognitive behavioral therapy that many have found leads to significant long term improvement in their sleep.

Using this program requires work and a certain amount of commitment but the results are enduring.

This link takes you to information about that program (at the bottom of the page).

References

Trauer JM, Qian MY, Doyle JS, W. Rajaratnam SM, Cunnington D. Cognitive Behavioral Therapy for Chronic Insomnia: A Systematic Review and Meta-analysis. Ann Intern Med. [Epub ahead of print 9 June 2015] doi:10.7326/M14-2841

The efficacy and safety of drug treatments for chronic insomnia in adults: a meta-analysis of RCTs. Buscemi N, Vandermeer B, Friesen C, Bialy L, Tubman M, Ospina M, Klassen TP, Witmans M. J Gen Intern Med. 2007 Sep;22(9):1335-50. Epub 2007 Jul 10. PMID: 17619935 itive behavioral therapy is relatively unfamiliar to and underused by medical practitioners.”

Insomnia Treatment Reduces Brain Stress

Insomnia TreatmentInsomnia treatment may have long-term beneficial effects on the health of your brain. Study in the Journal Biological Psychiatry published in February, 2015 looked at 123 older adults with chronic insomnia who were randomized to one of two active treatments (twice-weekly cognitive behavioral therapy for insomnia (CBTi) for 4 months or a relaxation therapy) or a control group who received educational sessions about sleep hygiene.

Both active treatments were associated with improvements in insomnia. CBTi was associated with the most durable improvements. Those who received this treatment had sleep improvements that were maintained for at least 16 months after the intervention (the length of the study), whereas the results from the relaxation therapy gradually diminished after the treatment was over.

Compared with the control, CBT-I reduced systemic inflammation, as measured by C-reactive protein, as well as pro-inflammatory gene expression.

Steven Dubovsky reviewing the article in Journal Watch Psychiatry, writes that:

” Older — and probably all — patients with insomnia should be offered one of these evidence-based treatments and should probably be monitored for depression and medical consequences of inflammation.”

We offer access to an online CBTi treatment which, while not as intensive as the one study, has been shown to have significant beneficial effects that are also very durable, and you can receive this treatment in the privacy of your own home. For more information click here – CBTi Online – SHUTi.

REFERENCE

1. Irwin MR et al. Cognitive behavioral therapy and tai chi reverse cellular and genomic markers of inflammation in late life insomnia: A randomized controlled trial. Biol Psychiatry 2015 Feb 4; [e-pub]. (http://dx.doi.org/10.1016/j.biopsych.2015.01.010)