Insomnia, Depression, Anxiety - Why Insomnia Treatment Comes First

Insomnia and trouble sleeping is a common problem that occurs along with depression, anxiety & stress.

In fact, trouble sleeping is a feature of most mental health problems, with up to 90% of mood disorder patients experiencing symptoms of insomnia.

So how do you treat insomnia along with depression, anxiety and stress?

It’s often assumed by patients, medical professionals, and many mental health providers that when insomnia depression and/or anxiety appear together, insomnia is caused by the depression or anxiety condition. The idea is that the insomnia is just a symptom and if you address the depression and anxiety the insomnia will clear up by itself.

But is there any scientific evidence backing up this idea?

The answer may surprise you.

Research shows that sleep problems tend to remain for many people even after their depression, anxiety or stress has been successfully treated - up to 71% of people in some studies.

So insomnia with depression, anxiety doesn’t resolve by itself.

This isn’t actually surprising. Your health provider should know this if they are keeping up to date.

All the major diagnostic manuals removed terms like “primary” and “secondary” insomnia almost 10 years ago to reflect that chronic insomnia is a standalone condition that requires specific treatment, with the most effective treatment being Cognitive Behavioral Therapy for Insomnia, aka CBTi.

But what about the other way around?

If treating depression and anxiety doesn’t clear up the insomnia, what if you treat the insomnia first? Does insomnia treatment improve depression, anxiety & stress?

Be prepared for more surprises…..

A recent study of more than 450 insomnia patients in Australia has confirmed that treating insomnia and sleep problems with Cognitive Behavioral Therapy for Insomnia (CBTi) can also help resolve insomnia, depression, anxiety & stress.

The study looked at 455 ‘real world’ insomnia patients, following them from pre-treatment to 3 month follow-up.

The researchers found:

• CBTi improved insomnia equally in those with and without depression, anxiety, and stress;

• CBTi improved insomnia equally regardless of the severity of a patient’s depression, anxiety, or stress;

• Symptoms of depression, anxiety, and stress showed moderate-to-large improvement following CBTi;

• Symptoms of depression, anxiety, and stress reduced by 41%-43% on average following CBTi treatment.

Lead researcher, Dr Alexander Sweetman said:

“With COVID-19 and many other stressors in life, treating the worst effects of insomnia may have a transformative effect on a person's wellbeing, mental health and lifestyle"

Flinders Professor Leon Lack, added:

“Cognitive Behavioral Therapy for insomnia, CBTi, is recommended as the most effective and first-line treatment of insomnia.”

So what do we make of all this?

Well, first, you can treat insomnia and sleep problems with CBTi and get solid results for the insomnia regardless of how bad the person’s other mental health problems are.

Second, because insomnia treatment with CBTi helps improve depression, anxiety, and stress symptoms, but not vice versa, it makes sense to treat insomnia and sleep problems first if a person has insomnia, depression, anxiety and or stress.

In the words of the researchers:

“healthcare professionals should be encouraged to screen patients with psychiatric symptoms for insomnia, and if present, refer patients to a psychologist for CBTi to improve sleep and psychological symptoms”.

The study was published in the journal SLEEP MEDICINE, (Sweetman et al, 2020)