Sleep training for adults prevents depression, study finds
Undergoing cognitive behavioral sleep training, which teaches you how to break bad habits in order to prepare your mind and body for a good night's sleep, may help prevent depression in older adults with insomnia, a new clinical trial has found.
"What is exciting about these findings is that they are among the first to demonstrate that treating insomnia with a behavioral strategy, not a pill, can prevent the development of depression in older adults," said sleep specialist Wendy Troxel, a senior behavioral scientist at RAND Corporation, who was not involved in the study.
The study's findings are "highly significant" because major depression is very common among older adults and "is associated with an increased risk of cognitive decline, disability, suicide and all-cause mortality," Troxel added.
Numerous studies have shown that insomnia is a major risk factor for depression, and "some 30% to 50% of older adults complain of insomnia," said study author Dr. Michael Irwin, a professor of psychiatry and biobehavioral sciences in the David Geffen School of Medicine at UCLA.
Adults in the randomized clinical trial who received cognitive behavior therapy for their insomnia were two times less likely to develop depression, Irwin said, adding that if remission from insomnia was sustained for three years, "there was an 83% reduction in the likelihood of developing depression."
"That's why this study is so important," Irwin said. "We have shown that we can actually target insomnia with cognitive behavior therapy and prevent depression from occurring."
Therapist involvement was key
The study, published Wednesday in the journal JAMA Psychiatry, randomly split adults over age 60 with insomnia but without depression into two groups. Every week for two months, a control group received eight weeks of basic sleep education, which taught sleep hygiene, characteristics of healthy sleep, sleep biology, and how stress can impact sleep. But there was no one-on-one training, Irwin said: "They had to take that information and figure out how to use it without our help."
The other group received a form of behavioral sleep training called CBT-1, administered in person in a group setting by trained therapists for eight weeks.
"The benefit of this treatment approach is that it used the most evidence-based behavioral treatment for insomnia, CBT-I, which has been proven to be as effective, longer lasting, and (have) fewer side effects than sleep medications -- which can be particularly problematic in older adults," Troxel said.
CBT-I has five components: Stimulus control, sleep restriction, sleep hygiene, relaxation and cognitive behavioral therapy. Sleep hygiene and relaxation involve good sleep habits -- going to bed and getting up at the same time each day, eliminating blue light and noise, taking warm baths or doing yoga for relaxation, and keeping the bedroom cool and free of electronic devices.
Stimulus control involves "getting people to get out of bed when they're not able to sleep," Irwin said. Most people stay in bed, fretting about not falling asleep, which then turns the bed into a negative space, he explained. Instead, people are taught to get up after 10 minutes of tossing and turning, do quiet, non-stimulating activites, and "not to come back to bed until they are sleepy."
Sleep restriction involves limiting time in bed to only the period a person sleeps, plus 30 minutes. It's another way to get people with insomnia to get up instead of lying in bed awake.
Cognitive therapy works to disrupt "dysfunctional thoughts and beliefs about sleep," Irwin said, such as "I can never sleep," or "I might die if I don't sleep tonight." A therapist works with the person to counter such illogical thinking, easing them back into a more realistic mindset that will allow them to relax and see the bed as a welcoming place.
"I really think a group setting is also really important," Irwin said, "because hearing other people's difficulties and how they are solving them can often help inform you about something that you may be dealing with."
A means to an end
At the end of two months, treatment ended, with no further intervention. However, the study then followed the 291 people for three years, checking in each month to ask about symptoms of depression.
The group that received CBT-I training with the help of a sleep coach often kept the training going in their own lives, Irwin said, with good results: "About a third of the people were still free of insomnia at the end of the three-year study."
The group which received sleep education did show "modest effects in improving and treating insomnia but (the improvements) were not durable. They didn't last," Irwin said.
"That's why CBT-I is so effective in person, because the therapist is helping that individual navigate and negotiate with themselves -- and it can be really hard work," Irwin added. "I believe that's also why CBT-I apps or online tools often don't work -- people get frustrated, disappointed or angry at themselves, and they basically stop the work."
The study's results show "a completely new and innovative way" of tackling the growing problem of depression, wrote Pim Cuijpers, a professor of Clinical Psychology at the Vrije Universiteit Amsterdam, and Dr. Charles Reynolds, a professor in geriatric psychiatry at the University of Pennsylvania Medical Center, in an editorial published alongside the study.
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"The stigma associated with major depression as a mental disorder is one of the main reasons for not seeking treatment," wrote Cuijpers and Reynolds, who were not involved in the study.
"This major finding offers exciting new opportunities for the prevention field and opens a new field of research into indirect preventive interventions for avoiding the stigma of mental disorders."
研究发现成人睡眠训练可预防抑郁症
一项新的临床试验发现，接受认知行为睡眠训练，教你如何改掉坏习惯，让你的身心为一夜好眠做好准备，可能有助于预防失眠的老年人的抑郁症。
“这些发现令人兴奋的是，它们是首批证明用行为策略而非药物治疗失眠症可以预防老年人患抑郁症的人之一，”睡眠专家温迪·特罗克塞尔 (Wendy Troxel) 说，他是该研究的高级行为科学家。兰德公司，谁没有参与这项研究。
该研究的结果“非常重要”，因为重度抑郁症在老年人中非常普遍，并且“与认知能力下降、残疾、自杀和全因死亡的风险增加有关，”特罗克塞尔补充道。
大量研究表明，失眠是抑郁症的主要危险因素，“大约 30% 到 50% 的老年人抱怨失眠，”研究作者、大卫格芬学院精神病学和生物行为科学教授迈克尔欧文博士说。加州大学洛杉矶分校医学博士。
欧文说，随机临床试验中，接受认知行为治疗失眠的成年人患抑郁症的可能性降低两倍，并补充说，如果失眠的缓解持续三年，“患抑郁症的可能性会降低 83%。沮丧。”
“这就是为什么这项研究如此重要，”欧文说。 “我们已经证明，我们实际上可以通过认知行为疗法来治疗失眠，并预防抑郁症的发生。”
治疗师的参与是关键
该研究于周三发表在 JAMA Psychiatry 杂志上，将 60 岁以上患有失眠但没有抑郁症的成年人随机分为两组。连续两个月，对照组每周接受八周的基础睡眠教育，教授睡眠卫生、健康睡眠的特征、睡眠生物学以及压力如何影响睡眠。但是没有一对一的培训，欧文说：“他们不得不在没有我们帮助的情况下获取这些信息并弄清楚如何使用它。”
另一组接受了一种称为 CBT-1 的行为睡眠训练，由训练有素的治疗师在小组环境中亲自实施，为期八周。
“这种治疗方法的好处在于它使用了最基于证据的失眠行为治疗方法 CBT-I，它已被证明与睡眠药物相比同样有效、持续时间更长，并且（具有）更少的副作用——这对老年人来说尤其成问题，”特罗克塞尔说。
CBT-I 有五个组成部分：刺激控制、睡眠限制、睡眠卫生、放松和认知行为疗法。睡眠卫生和放松涉及良好的睡眠习惯——每天在同一时间睡觉和起床，消除蓝光和噪音，洗个热水澡或做瑜伽放松，保持卧室凉爽，远离电子设备。
刺激控制涉及“让人们在无法入睡时起床，”欧文说。他解释说，大多数人都呆在床上，担心睡不着，然后把床变成了一个消极的空间。相反，人们被教导在 10 分钟的辗转反侧后起床，进行安静、非刺激性的活动，以及“直到困了才回到床上”。
睡眠限制包括将在床上的时间限制在一个人的睡眠时间加上 30 分钟。这是让失眠患者起床而不是躺在床上醒来的另一种方法。
欧文说，认知疗法可以打破“关于睡眠的功能失调的想法和信念”，例如“我永远无法入睡”或“如果我今晚不睡觉，我可能会死”。治疗师会与患者一起对抗这种不合逻辑的想法，让他们恢复到更现实的心态，让他们放松，并将床视为一个受欢迎的地方。
“我真的认为团队环境也非常重要，”欧文说，“因为听到别人的困难以及他们如何解决这些困难通常可以帮助你了解你可能正在处理的事情。”
一个达到目的的手段
两个月后，治疗结束，没有进一步干预。然而，该研究随后对这 291 人进行了三年的跟踪调查，每个月都进行检查以询问抑郁症的症状。
欧文说，在睡眠教练的帮助下接受 CBT-I 培训的那组人经常在他们自己的生活中继续接受培训，并取得了不错的效果：“大约三分之一的人在三年结束时仍然没有失眠。 ——一年的学习。”
接受睡眠教育的小组确实表现出“在改善和治疗失眠方面的适度效果，但（改善）并不持久。它们没有持续下去，”欧文说。
“这就是 CBT-I 对人如此有效的原因，因为治疗师正在帮助那个人导航和与自己谈判——这真的很辛苦，”欧文补充道。 “我相信这也是 CBT-I 应用程序或在线工具通常不起作用的原因——人们对自己感到沮丧、失望或生气，他们基本上停止了工作。”
阿姆斯特丹自由大学临床心理学教授 Pim Cuijpers 和阿姆斯特丹大学老年精神病学教授 Charles Reynolds 博士写道，该研究的结果显示了解决日益严重的抑郁症问题的“一种全新的创新方法”。宾夕法尼亚医学中心，在与研究一起发表的社论中。
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“与作为精神障碍的重度抑郁症相关的污名是不寻求治疗的主要原因之一，”未参与该研究的 Cuijpers 和 Reynolds 写道。
“这一重大发现为预防领域提供了令人兴奋的新机会，并为避免精神障碍污名化的间接预防干预研究开辟了新领域。”
