Mental health and sleep experts are calling for greater access to Cognitive Behavioural Therapy for Insomnia (CBT-I), pointing to growing evidence that treating insomnia can also improve symptoms of depression, anxiety and day-to-day functioning.
More than one in five Australians aged 16-85, around 4.3 million people, experienced a mental health disorder in the previous 12 months, according to the Australian Institute of Health and Welfare. Anxiety disorders affected 17% of Australians and affective disorders, including depression, affected 8%. Over a lifetime, 43% of Australians experience a mental health disorder.
At the same time, an estimated one in seven (3.2 million) Australian adults lives with chronic insomnia.
The conditions frequently overlap. Australian research has found people reporting depression and/or anxiety are more than four times as likely to experience insomnia symptoms, while other research suggests around half of people with a mental health condition may also experience clinically significant insomnia.
The Australasian Sleep Association (ASA) says this overlap presents an important opportunity: instead of treating poor sleep simply as a symptom of mental ill health and waiting for it to improve, insomnia should be identified and treated directly.
Honorary Associate Professor Sara Winter of the Australasian Sleep Association says sleep should be considered alongside diet and physical activity as a fundamental, modifiable pillar of health.
“Sleep is not simply something that goes wrong because somebody has anxiety or depression. Insomnia can become a problem in its own right and can make other conditions more difficult to manage,” Assoc Prof Winter said.
“When someone isn’t sleeping properly, they can experience fatigue, poor concentration, irritability, hyperarousal, low mood and reduced energy. These are also symptoms we see in conditions such as anxiety and depression.
“Treating the insomnia allows us to remove some of that additional burden and get a clearer picture of what remains and needs to be addressed.”
Sleep disturbance is itself a recognised symptom of both generalised anxiety disorder and major depressive disorder. Other symptoms associated with these disorders – including fatigue, difficulty concentrating, irritability, reduced energy or changes in psychomotor activity – can also be exacerbated by inadequate sleep.
Assoc Professor Winter said treating insomnia should therefore form part of a broader approach to mental health rather than being regarded as an issue that can wait until other conditions have been addressed.
“Improving sleep isn’t a substitute for treating depression or anxiety where those conditions are present,” Professor Winter said.
“But it can give people greater energy, clearer thinking and improved mood and functioning, putting them in a stronger position to address the other issues they may be experiencing.
“CBT-I can provide relatively rapid improvements in sleep and help clear away some of the fog. We can then more clearly see what issues remain and make sure people receive the appropriate treatment for those conditions as well.”
Evidence goes beyond better sleep
Cognitive Behaviour Therapy for insomnia (CBT-I) is a structured, non-drug treatment that changes the behaviours, patterns and thoughts that perpetuate chronic insomnia.
Importantly, its benefits extend beyond sleep.
A major systematic review and network meta-analysis involving 86 studies and more than 15,000 participants found CBT-I also produced significant improvements in depressive symptoms, anxiety, fatigue, daytime sleepiness, quality of life, social and daytime functioning and mental state.
There is also emerging evidence that treating insomnia may help prevent some cases of depression.
A randomised clinical trial involving older adults with insomnia found that those receiving CBT-I were less likely to develop incident or recurrent major depression during three years of follow-up than participants receiving sleep education therapy.
“That’s why we need to stop thinking about sleep as an optional extra in mental health care,” Assoc Professor Winter said.
“Sleep, diet and physical activity are fundamental health behaviours. We wouldn’t ignore someone’s nutrition or physical health when considering their overall wellbeing, and we shouldn’t ignore chronic insomnia.”
