How sleep training can ease symptoms of depression in older adults

There’s nothing like getting a good night’s sleep, but catching enough Zzzs can be a challenge for many of us. Factors that can interfere include work stress, family responsibilities and illness.

While some of us develop our own habits to ensure a night of sound sleep, others can really struggle, putting them at risk of developing depression.

The good news is, you’re not doomed to toss and turn every night. Preparing your mind and body for a good night's sleep may help prevent depression, according to a clinical trial of adults aged 60 years or older with insomnia. While this study, published in JAMA Psychiatry, focused on older people, it may offer some interesting insights for all of us.

To get to the root of what is causing insomnia in patients, the study highlighted cognitive behavioural therapy - or CBT - as an alternative to sleeping pills.

CBT is designed to tackle negative thought cycles by identifying the way you react to certain situations and helping to discover alternatives. Concerning insomnia, the aim is to break negative thought patterns associated with bedtime, such as “I can never sleep.”

The study, published in the journal JAMA Psychiatry, discusses a group of over-60s who received a form of behavioural sleep training called CBT-I for eight weeks. CBT-I therapists work with the patient to ease them into a different frame of mind where they see their bed as a welcoming place.

A control group received eight weeks of basic sleep education without the help of professional trainers, whereas the CBT-I group received eight weeks of training by therapists in person and within a group setting.

The randomized clinical trial found that adults receiving CBT for insomnia were two times less likely to develop depression.

“There was an 83% reduction in the likelihood of developing depression,” said the study’s author, Michael Irwin, a professor of psychiatry and bio-behavioural sciences at the David Geffen School of Medicine at UCLA.

“That’s why this study is so important,” he told CNN. We have shown that we can actually target insomnia with cognitive behaviour therapy and prevent depression from occurring.”

In addition to CBT, four other components exist in CBT-I.

1. Sleep hygiene. Going to bed and getting up at the same time every day, plus eliminating blue light and noise after a certain time.

2. Relaxation. Taking warm baths or doing yoga for relaxation and not exercising physically or mentally too close to bedtime.

3. Stimulus control. Getting out of bed to do non-stimulating activities when unable to fall asleep to ensure the bed doesn’t become a negative space.

4. Sleep restriction. Only being in bed for sleep plus an extra 30 minutes.

Why now?

Insomnia seems to be affecting more of us lately, as findings from a 2021 US sleep assessment survey by Goodpath reveals 89% of respondents are sleep-deprived.

In the UK, a growing number of people reporting mental health concerns prompted the National Institute for Health and Care Excellence (NICE) to update its guidelines for treating and managing depression in adults for the first time in 12 years. The guidelines now offer patients a “menu” of options, including cognitive behavioural therapy before medication.

And it seems more of us are seeking sleep tips after COVID-19 lockdowns. Formute Health found search terms such as ‘How to fall asleep quickly’ almost doubled from January to August 2020.

In regards to the clinical trial, the group that received the CBT-I training kept the training ongoing in their lives after the study, with positive results.

“About a third of the people were still free of insomnia at the end of the three-year study,” says Irwin.