cognitive behavioral therapy for insomnia in older adults

19 A study of 289 twin pairs found that sleep problems at age 8 predicted depression at age 10, with some indication that this association might be due to genes. Johnson, Roth & Breslau 19 found that, among youth age 13–16 with comorbid insomnia and depression, insomnia preceded depression in 69% of the sample there was a significant association between prior insomnia and onset of depression even after adjusting for gender, race/ethnicity, and any prior anxiety disorder. Research on poor sleep as a predictor of later depression in youth lagged behind the adult literature but increased in the past decade. 17 Lastly, a recent meta-analysis of 23 cross-sectional studies in older adults found that self-reported sleep disturbances increased the risk of the onset of depression (relative risk = 1.92) and persistent sleep disturbances increased the risk of the development (RR = 3.90), recurrence (RR = 7.70), and worsening (RR = 1.46) of depression in older adults.

It found that persistent sleep disturbance (defined as presence of insomnia symptoms across three time points during a year-long period) was associated with depression the following year. 16 The second study focused on a sample of community dwelling older adults. It found that persistence of insomnia symptoms (in this study defined as insomnia at 2 or more time points) significantly increased the rate in which depression occurred over 6 years. The first of these two studies was conducted among non-depressed adults in Korea. 15 The three other studies suggest that persistence of insomnia symptoms might be particularly relevant to the prediction of future depressive episodes. 15 The study found a bidirectional relationship between depression and insomnia symptoms. 14 The second was a large study of over 24,000 adults, using prospective data collected at two time points ten years apart. The first of these studies was a population-based sample of twins, which found that subjective poor sleep increased the risk of disability retirement due to depression 10–20 years later. 1 Four studies published since then are consistent with this conclusion. 12, 13 In a 2011 meta-analysis of 21 studies that prospectively evaluated poor sleep as a risk factor for a new depressive episode, Baglioni and colleagues concluded that presence of insomnia symptoms among adults without depression represents a significant risk for developing depression later. For reviews, see Riemann and Voderholzer and Franzen. Longitudinal epidemiologic studies in adults found that disturbed sleep and insomnia increase the risk of a future episode of major depressive disorder one to three years later. Poor sleep prospectively predicts depression Overall the data we review support the idea that insomnia may be instigating, maintaining, and exacerbating depression. The research reviewed in this manuscript highlights some of the progress made over the past five years that elucidates this complex relationship between depression and insomnia as well as challenges in the treatment of insomnia when comorbid with depression. Furthermore, presence of residual poor sleep among those who remit from depression constitute a significant risk for a future depressive episode. Persistence of insomnia symptoms is common among those with incomplete remission of depression (94.6%) 8 and even among those who fully remit following antidepressant therapy (72%) 9 this suggests that treatment for depression does not provide sufficient sleep remedy.

2 During depressive episodes as many as 67–84% of adults and 57% of children and adolescents report difficulties initiating or maintaining sleep 3– 5 and more severe insomnia symptoms are independently associated with greater functional impairment 6 and depressive symptom severity 7. Specifically, insomnia constitutes a risk for a future depressive episode among non-depressed individuals 1 and its nocturnal symptoms are likely prodromal symptoms of depression among those who remitted from a depressive episode. The relationship between sleep and depression is bidirectional, complex, and apparent across the course of depression.

Cognitive behavioral therapy for insomnia in older adults