![]() ![]() 27 Insomnia symptoms, especially ones that appear early, are associated with depression symptom severity. More than half of depressed patients have difficulty falling asleep, wake up frequently during the night, or experience early morning awakenings. Third, insomnia patients with comorbid disorders such as a history of substance abuse or chronic illness who take other medication for their original disorder may be able to avoid the risks of side effects and drug interactions from sleep medication. Second, CBTI as a non-pharmacological treatment may help decrease the concerns of both patients and doctors regarding long-term use of sleep medication. Additionally, treatment of insomnia may also prevent the recurrence of symptoms of comorbid illnesses, such as depressive episodes. 17 First, CBTI treats insomnia symptoms, which subsequently may lead to the alleviation of symptoms of comorbid physical and psychiatric illnesses. 17, 24– 26 Based on previous research indicating sleep deprivation negatively affects the immune system, pain perception, metabolism, cognitive function and mood, CBTI is helpful for insomnia patients that have comorbid physical and mental illnesses for the following reasons. The prevalence of insomnia comorbid with chronic illnesses such as chronic pain, cardiovascular disease, diabetes, AIDS, and cancer ranges from 16–82%, which is higher than the general population. Similar research can be found with physical disorders. Considering that many psychiatric disorders list sleep symptoms as part of diagnostic criteria, it is conceivable that treatment insomnia in individuals with psychiatric disorders may help alleviate symptoms of the comorbid disorder. “Recurrent distressing dreams of the event” and “difficulty falling or staying asleep” are also listed as diagnostic criteria for post-traumatic stress disorder. ![]() ![]() 23 In addition, “decreased need for sleep” is listed for bipolar disorder, while “sleep disturbance” and “being easily fatigued” is listed for generalized anxiety disorder. For example, major depressive disorders lists “insomnia and hypersomnia every day” and “fatigue or loss of energy every day”, and Substance Abuse and Mental Health Services (SAMSHA) lists insomnia as one of the 10 ten warning signs of individuals who are at high risk for suicide. Based on criteria of the DSM-5, it is evident that many psychiatric disorders include sleep symptoms as a part of the diagnosis. As mentioned above, a large proportion of insomnia patients also have comorbid psychiatric disorders. With the increasing number of studies showing the effectiveness of CBTI, there have been an increase in studies interested in showing how treating insomnia through CBTI can also alleviate symptoms from comorbid psychiatric disorders by treating insomnia. To summarize, we can carefully conclude that CBTI can be an effective and adjunctive treatment option for individuals who are dependent on sleep medication. Patients also had a significant decrease in sleep onset latency, wake after sleep onset, severity of insomnia symptoms, and dysfunctional beliefs about sleep, in addition to an increase in sleep efficiency. 18– 21 In another study that administered CBTI to chronic insomnia patients who were taking sleep medication, 23.5% of the patients successfully stopped taking their medication without specific instructions to decrease their medication intake. Additionally, compared to pharmacological treatment, research indicates that CBTI maintained long-term treatment effects, and were also preferred more by insomnia patients. 17 comparing pharmacological treatments to CBTI, results indicated that CBTI also had short-term effects that were similar to pharmacological treatment. However, CBTI is also widely acknowledged as an effective treatment for insomnia, and research has accumulated over the past 20 years about its effectiveness. Currently, the most common treatment for insomnia is using benzodiazepine receptor blockers and sedative antidepressants. ![]()
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