Insomnia is a common sleep disorder that affects people of all ages, but it is more common among older adults. Depression is a common mental disorder that affects people of all ages, but it is more common among older adults. According to the World Health Organization (WHO), depression is the leading cause of disability worldwide and a major contributor to the overall burden of disease. Depression can have a significant impact on the quality of life, social functioning, and physical health of older adults.
Cognitive Behavior Therapy for Insomnia (CBT-I) is a non-pharmacological approach that aims to change behaviors and thoughts related to sleep problems. It typically involves several sessions with a therapist who helps patients develop a set of skills to improve their sleep quality. These skills include sleep hygiene, relaxation techniques, and sleep restriction therapy. Unlike medication, CBT-I has no side effects and has a lasting effect on sleep quality.
According to a recent clinical trial, treatment of insomnia with CBT-I can prevent depression in community-dwelling adults aged 60 years or older without depression but with insomnia.
The trial involved 291 older adults with insomnia disorder who were randomly assigned to either 2 months of CBT-I or sleep education therapy (SET). The primary outcome was time to incident major depressive disorder as diagnosed by interview and Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) criteria. The secondary outcome was sustained remission of insomnia disorder before the depression event or duration of follow-up.
The study showed that when adults with insomnia received cognitive behavioral therapy for insomnia and their insomnia went away and stayed away, they were less likely to become depressed compared to those who received sleep education therapy (SET) and did not experience sustained insomnia remission.
Specifically, out of the participants who received CBT-I, 19 (12.2%) developed incident or recurrent major depression, while 35 (25.9%) in the SET group did. This means that the overall benefit of CBT-I was consistent across different groups and the likelihood of depression was reduced by 51% in the CBT-I group compared to the SET group.
Moreover, remission of insomnia disorder continuously sustained before depression event or during follow-up was more likely in CBT-I participants compared with the SET participants. Those in the CBT-I group with sustained remission of insomnia disorder had an 82.6% decreased likelihood of depression compared with those in the SET group without sustained remission of insomnia disorder.
The findings of this randomized clinical trial indicate that treatment of insomnia with CBT-I has an overall benefit in the prevention of incidents and recurrent major depression in older adults with insomnia disorder. Community-level screening for insomnia concerns in older adults and wide delivery of CBT-I–based treatment for insomnia could substantially advance public health efforts to treat insomnia and prevent depression in this vulnerable older adult population.
Depression prevention is urgently needed, and such efforts have been neglected for older adults. The findings of this study suggest that treating insomnia may be beneficial in the prevention of depression in older adults. The study highlights the importance of addressing sleep problems as a preventive measure for depression in older adults.
The clinical trial shows that treatment of insomnia with CBT-I can prevent depression in community-dwelling adults aged 60 years or older without depression but with insomnia. The study provides valuable insights into the benefits of non-pharmacological approaches to treating insomnia and preventing depression in older adults. The findings of this study could help inform public health policies and interventions aimed at preventing depression in vulnerable older adults.