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Reading of the Week: Better Sleep, Less Psychosis? The Freeman et al. Study on Sleep & CBT

From the Editor

If students sleep better, are they less likely to have mental health problems like paranoia?

In this week’s Reading, we look at a new study from The Lancet Psychiatry. In this single-blind, randomized controlled trial, Oxford professor Daniel Freeman et al. consider students from 26 universities with insomnia, assigning them CBT (offered over the internet) or the usual care.

Spoiler alert: the students with CBT did better.

Sleep: good for babies, teddy bears, and students

In this Reading, we review that paper and consider the broader implications.

DG

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Reading of the Week: Insomnia and Its Treatment

Cognitive behavioral therapy for insomnia (CBT-I) is a multicomponent treatment package that usually includes stimulus control, sleep restriction, and cognitive therapy and has emerged as the most prominent nonpharmacologic treatment for chronic insomnia. Previous meta-analyses have found that CBT-I improves sleep parameters and sleep quality at post treatment and follow-up for adults and older adults. Most of these studies selected individuals with primary insomnia, excluding patients with co-morbid psychiatric and medical conditions. However, patients with insomnia who present to internists and primary care physicians are likely to report comorbid conditions associated with the sleep disturbance. Furthermore, insomnia was previously conceptualized as a symptom arising from the comorbid disorder and treatment was targeted at the underlying disorder. However, accumulating evidence indicates that insomnia can have a distinct and independent trajectory from the comorbid disorder, thus indicating a need for separate treatment from the comorbid condition.

So begins this week’s Reading, which considers CBT-I for people with insomnia. Here’s a quick summary: big study, big journal – and big relevance to your patients.

This week’s Reading: “Cognitive Behavioral Therapy for Insomnia Comorbid With Psychiatric and Medical Conditions: A Meta-analysis” by Jade Q. Wu et al. was just published in JAMA Internal Medicine. Find the paper here.

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Wu et al. consider a very common problem: insomnia. Many patients – whether they have mental health issues or physical health issues – struggle with insomnia. Boston University health economist Austin Frakt has written about his insomnia for The New York Times. He notes that he decided to receive treatment when:

One weekend afternoon a couple of years ago, while turning a page of the book I was reading to my daughters, I fell asleep. Continue reading