Treating insomnia improves depression, maladaptive thinking, and hyperarousal in postmenopausal women: comparing cognitive-behavioral therapy for insomnia (CBTI), sleep restriction therapy, and sleep hygiene education

Abstract

Introduction.-Depression increases during menopause, and subclinical depressive symptoms increase risk for major depression. Insomnia is common among postmenopausal women and increases depression-risk in this already-vulnerable population. Recent evidence supports the efficacy of cognitive-behavioral therapy for insomnia (CBTI) to treat menopausal insomnia, but it remains unclear whether treating insomnia also alleviates co-occurring depressive symptoms and depressogenic features. This trial tested whether CBTI improves depressive symptoms, maladaptive thinking, and somatic hyperarousal in postmenopausal women with insomnia, and whether sleep restriction therapy (SRT)-a single component of CBTI-is equally efficacious. Materials and methods. Single-site, randomized controlled trial. 117 postmenopausal women (56.34±5.41 years) with peri-or-postmenopausal onset of chronic insomnia were randomized to 3 treatment conditions: sleep hygiene education control (SHE), SRT; and CBTI. Blinded assessments were performed at baseline, posttreatment, and 6-month follow-up. Results.-CBTI produced moderate-to-large reductions in depressive symptoms, whereas SRT produced moderate reductions but not until 6 months posttreatment. Treatment effects on maladaptive thinking were mixed. CBTI and SRT both produced large improvements in dysfunctional beliefs about sleep, but weaker influences on presleep cognitive arousal, rumination, and worry. Presleep somatic arousal greatly improved in the CBTI group and moderately improved *

Digital cognitive behavioral therapy for insomnia promotes later health resilience during the coronavirus disease 19 (COVID-19) pandemic

“…In light of the pressing mental health needs associated with the COVID-19 pandemic, the significance of these results is difficult to overstate. They add to a growing literature suggesting that behavioral insomnia treatment improves health [ 39 , 44 , 58–61 ], and provide the first prospective evidence that dCBT-I increases health resilience during later stressors—in this case the COVID-19 pandemic.…”

1084 Depression and Stress Generation: Can Sleep Quality Bridge the Gap?

“…These results, coupled with the abundance of research that demonstrates bidirectional relationships between sleep, depression, and stressors, suggest that sleep difficulties may represent a pivotal intervention point for individuals seeking treatment for depression. Targeting sleep could help improve the mood symptoms associated with depression while fostering the cognitive resources necessary to navigate through a potentially perilous world safely (Alhola & Polo-Kantola, 2007;Kalmbach et al, 2019). Current evidence-based treatments for depression (e.g., Cognitive Behavioral Therapy and Acceptance and Commitment Therapy), place little emphasis on targeting sleep, and in general, sleep intervention is often sequestered from psychopathology treatment (Beck, 2011;Hayes, Strosahl, & Wilson, 1999).…”

Psycho-educational interventions focused on maternal or infant sleep for pregnant women to prevent the onset of antenatal and postnatal depression: a systematic review

“…Although the effectiveness of sleep intervention during pregnancy is unclear at this time, it may be more di cult to improve postpartum outcomes by interventions started during pregnancy, because there is a time lag between pregnancy and the postpartum period. Considering the evidence that postpartum interventions of CBT-I and sleep hygiene education for mothers with insomnia showed effectiveness for reducing PND [36], postnatal women or patients with insomnia possibly be more eligible than pregnant women. However, the fact that two RCTs in THE antenatal period were included in this study might indicate that prevention in the antenatal period has gradually attracted attention, although the number of RCT designed studies provided for all pregnant women remains limited.…”

“…Maternal mood might also be protected by sleep interventions. CBT-I has been shown to be effective for reducing depressive symptoms not only among people with insomnia in general [35][36][37][38][39], but also among postpartum women with insomnia [40], although research on cognitive-behavioral sleep interventions is still in its infancy. One RCT designed study of postnatal education focusing on maternal and infant sleep showed signi cant effectiveness for the reduction of risk of high depression scores (adjusted odds ratio = 0.57, 95% con dence interval; 0.34 to 0.94) [32].…”