August 28, 2022
There are two common conditions that older adults may suffer from at the same time…depression and sleep difficulty, known as insomnia. A full 10 percent of adults over the age of 60 have been diagnosed with a major depressive disorder. Many symptoms accompany depression and they can include a loss of interest in activities that were once pleasurable, depressed mood, difficulty concentrating, weight gain or loss, thoughts about being worthless, and even thoughts about death or suicide.
One of the most common symptoms that accompanies depression is also a disturbance in sleep. These symptoms can vary from individual to individual and range from difficulty falling asleep and staying asleep, to waking up too early or even sleeping too much. Research shows that sleep disturbances and depression are tightly related, with 70 percent of older adults over 65 reporting at least one of these sleep symptoms. Insomnia doubles the risk of a diagnosis of depression.
When depressed patients are treated for their insomnia, many of these patients actually show improvement, not only in sleep, but in their mood as well. An Australian study that looked at patients who were suffering from both depression and insomnia who got a type of therapy known as CBT-I that was directed only at their insomnia and not their depression. CBT stands for cognitive behavioral therapy and is a well-known therapeutic treatment for a variety of mental health conditions, in particular, depression. CBT-I was developed using the techniques of CBT but treats insomnia only and no other symptoms. Astonishingly, 61 percent of the patients who received this insomnia-focused therapy got better, some so much so that their depression went into remission!
A question that naturally arises from this research is whether treatment of insomnia could actually prevent depression? A study done in early 2022 looked at just this question by enrolling 291 people who had insomnia but not depression. The researchers then randomly assigned the participants into two groups. One group got insomnia-focused therapy and the other group, serving as the control group, got a general sleep education program. Then the research team followed up with the participants in each group every six months for a full three years to see if any of them developed depression.
The results? Over the three-year period in which the researchers followed the participants, 12 percent of the group that received insomnia-focused therapy developed depression. The sleep education-only group fared much worse, with 26 percent of this group going on to develop depression. The researchers concluded from the data that with the insomnia-focused therapy (CBT-I) there was a 60 percent reduction in the chance of developing depression.
So what might these studies mean for you?
Medicine is moving rapidly towards focusing more on prevention, rather than trying to play catch up when a disease has already made its appearance and has gotten a head start. Many people, in particular older adults, have had a very difficult time during these pandemic years and the anxiety and uncertainty brought on by the pandemic has increased the rate of depression.
If you have been diagnosed with depression and also have insomnia, there is a good chance you could benefit greatly by undergoing treatment with a therapist who is skilled in CBT-I. If you have insomnia and are not depressed, CBT-I treatment could act as a preventative to depression. Of course, there are many other benefits of treating insomnia, including reducing the very real distress millions of people feel who suffer from this disorder, and decreasing the likelihood of cognitive impairment as a result.
If you do want to pursue this, be sure you find a provider that is trained and specializes in CBT-I. Do not confuse a sleep hygiene education program for CBT-I, as it’s important you find a qualified and experienced professional. Sweet dreams!