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Depression and Insomnia

New research shows that treating insomnia can help treat depression.

Medication or Therapy to Treat Insomnia

Insomnia can be treated in two very different ways: with medication or with cognitive behavioral therapies. In studies, medications have been shown to shorten the time it takes for people with insomnia to fall asleep. They can also help people stay asleep.

Cognitive behavioral therapy for insomnia, or CBT-I, has also been shown to be effective. This therapy is aimed at encouraging healthier behaviors and more positive and realistic thought processes around sleep. It encourages better sleep habits such as going to bed at the same time at night and eliminating distractions from the bedroom. CBT-I also helps people replace negative thoughts (“I’ll never fall asleep”) with positive alternatives (“It’s normal to take a little while to fall asleep“).

Which Insomnia Treatment Works Best for Depression?

Which approach -- medication or therapy -- works best? Each has its plusses and minuses. Studies have shown that insomnia medication can help jump-start better sleep by taking effect quickly. So it is often prescribed for people who have become very anxious about not sleeping. “But we also know that when people go off sleep medications, their sleep problems often recur,” Perlis says.

Sleep-related cognitive behavioral therapy, in contrast, takes more time to begin working. (A standard course of therapy typically takes about 8 to 12 weeks). But research shows that the benefits of CBT-I are more durable and longer lasting.

“That makes sense,” says Kuo.  “With cognitive behavioral therapy, you’re learning a skill set. Once you master it, you have it for the rest of your life.” A 2004 study published in the Archives of Internal Medicine concluded that for young and middle-aged patients in particular, CBT-I was more effective than sleeping pills in helping people fall asleep faster and sleep more soundly through the night.

Finding a specialist trained in sleep-related cognitive behavioral therapy isn’t always easy, however, since the field is relatively new. (For a nationwide list, check out the American Academy of Sleep Medicine at www.aasmnet.org). Cost is also an issue. While health insurance plans typically pay for insomnia drugs, many policies don’t cover psychotherapy.

Cognitive-behavioral therapy also takes work on the part of a patient. “But as I tell my patients, the work you put into it can really pay off long-term by permanently improving the quality of sleep,” Kuo says. Better sleep can boost your energy and improve your outlook on life. And as the latest research shows, it can also prevent or ease depression.

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Reviewed on July 06, 2010

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