Insomnia and mental health problems go hand in hand. It’s firmly established now that insomnia can be a causal factor in depression and that treatment for insomnia can improve both sleep and mood.
A new study shows that insomnia may also be a causal factor in psychotic experiences such as paranoia and hallucinations, and that CBT for insomnia (CBT-I) may lead to better mental health. Here’s a quick look at the research and what it suggests for us.
Sleep and Mood: An Intimate Relationship
People with mood disorders and other mental health problems often experience insomnia. Until recently their trouble sleeping was viewed as a symptom or a consequence of the mental health problem. Successful treatment of that problem would take care of the insomnia, too—or so they thought.
Then along came research that upset the apple cart. It showed that insomnia was sometimes a causal factor in depression, and that treatment with CBT for insomnia (CBT-I) helped to resolve both problems better than treatment for depression alone. This led to a related question: could other psychiatric symptoms linked with insomnia—paranoia, hallucinations, anxiety, mania—be triggered in part by insomnia and could treatment with CBT-I head off their development?
Paranoia and hallucinations have strong links to insomnia. Researchers in the UK recruited 3,755 university students with insomnia from 26 different college campuses to see if treating their insomnia with CBT-I would lessen their risk of experiencing these psychotic symptoms.
Randomly the researchers divided student participants into two equal groups. One served as a control group. Students in the other group participated in an individualized online insomnia treatment program called Sleepio.
Similar to other research-based online insomnia treatments (SHUTi and CBT for Insomnia, for example), Sleepio is a 6-week program that delivers CBT-I over the internet. It includes behavioral components such as sleep restriction and stimulus control; cognitive components that challenge unhelpful beliefs; and education about sleep and sleep hygiene.
Student participants in both groups also took a battery of pencil and paper tests at four different times during the 6-month study period to assess the severity of their insomnia symptoms and the state of their mental health. Statistical analysis of the data included looking at whether reductions in insomnia symptoms correlated with better mental health outcomes.
Insomnia Treatment Improves Sleep, Reduces Psychotic Symptoms
Here are the main results, all statistically signficant. Compared with participants in the control group, participants who underwent the Sleepio treatment ended the program with
- greatly improved sleep
- fewer experiences of paranoia and hallucinations
The results of this relatively large study led to the following claims:
- Online insomnia treatment programs like Sleepio work for university-age students with trouble sleeping. They’re inexpensive and can be accessed at home.
- While insomnia might not be the principal cause of psychotic experiences, it may well be a contributing cause.
- CBT-I may have promise as an early intervention for some psychiatric problems.
Caveats for the Sleepless Whether or Not Mental Health Is an Issue
CBT-I, for all its effectiveness, involves commitment to a weeks-long process and the discipline to follow a rigorous set of guidelines. In this study there was a 50% drop-out rate among participants assigned to the Sleepio program—higher than the dropout rate for the control group. Feeling sleep deprived and lacking stamina, some insomniacs may be unsuccessful at completing a CBT-I program in the absence of face-to-face coaching and encouragement from a trained sleep therapist.
But 50% of the participants stuck with the Sleepio program long enough to reap sleep benefits. This success rate is comparable to that found in research on other web-based insomnia treatment programs.
Our options do not stop with online treatment programs. I’ve found it’s also possible to improve sleep by following instructions in books about CBT-I (see, for example, The Insomnia Workbook by Stephanie Silberman, The Insomnia Answer by Paul Glovinsky and Arthur Spielman, or chapter 8 of my book, The Savvy Insomniac). I myself used CBT-I to improve my sleep after reading a training guide for sleep therapists (Cognitive Behavioral Treatment of Insomnia: A Session-by-Session Guide by Michael Perlis and colleagues).
Regardless of how it’s accessed, CBT-I remains our best defense against sleepless nights and draggy days—and it may also preserve our mental health and well-being.
If you’ve tried CBT-I, how did you access treatment and how useful was it in helping to improve your sleep?