Treating Insomnia Improves Depression, Maladaptive Thinking, and Hyperarousal in Postmenopausal Women: Comparing Cognitive-Behavioral Therapy for Insomnia (CBTI), Sleep Restriction Therapy, and Sleep Hygiene Education

Publication date: Available online 28 December 2018

Source: Sleep Medicine

Author(s): David A. Kalmbach, Philip Cheng, J.Todd Arnedt, Jason R. Anderson, Thomas Roth, Cynthia Fellman-Couture, Reg A. Williams, Christopher L. Drake

Abstract

Introduction

Depression increases during menopause, and subclinical depressive symptoms increase risk for major depression. Insomnia is common among postmenopausal women and increases depression-risk in this already-vulnerable population. Recent evidence supports the efficacy of cognitive-behavioral therapy for insomnia (CBTI) to treat menopausal insomnia, but it remains unclear whether treating insomnia also alleviates co-occurring depressive symptoms and depressogenic features. This trial tested whether CBTI improves depressive symptoms, maladaptive thinking, and somatic hyperarousal in postmenopausal women with insomnia, and whether sleep restriction therapy (SRT)—a single component of CBTI—is equally efficacious.

Materials and methods

Single-site, randomized controlled trial. 117 postmenopausal women (56.34±5.41 years) with peri-or-postmenopausal onset of chronic insomnia were randomized to 3 treatment conditions: sleep hygiene education control (SHE), SRT; and CBTI. Blinded assessments were performed at baseline, posttreatment, and 6-month follow-up.

Results

CBTI produced moderate-to-large reductions in depressive symptoms, whereas SRT produced moderate reductions but not until 6 months posttreatment. Treatment effects on maladaptive thinking were mixed. CBTI and SRT both produced large improvements in dysfunctional beliefs about sleep, but weaker influences on presleep cognitive arousal, rumination, and worry. Presleep somatic arousal greatly improved in the CBTI group and moderately improved in the SRT group. Improvements in depression, maladaptive thinking, and hyperarousal were linked to improved sleep. SHE produced no durable treatment effects.

Conclusions

CBTI and SRT reduce depressive symptoms, dysfunctional beliefs about sleep, and presleep somatic hyperarousal in postmenopausal women, with CBTI producing superior results. Despite its cognitive emphasis, cognitive arousal did not respond strongly or durably to CBTI.

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