The depression – anxiety – insomnia connection

Are you suffering from any of these symptoms?

• Tired during the day
• Can’t concentrate
• Irritable
• Moody

Do you often back out of activities with family and friends because you feel a lack of energy and then feel depressed and isolated?

Are you having sleep issues, such as:

• Tossing and turning as you try so hard to fall asleep
• Becoming anxious about how you’re going to be able to function the next day as you watch the clock for hours, still not able to sleep

We sat down with psychologist and insomnia treatment provider, Dr. Debra Haldeman, Ph.D., to get some insights on the link between depression, anxiety, and insomnia, and to learn about the new first-line treatment.

What’s the latest research showing on the connection between depression, anxiety, and insomnia?
DH: There was a fascinating study done. Nine hundred people were diagnosed with major depression. When they were more accurately diagnosed, only 28% of these people had depression, the other 628 people had insomnia. I believe that successful sleep contributes greatly to physical and psychological health, so I often encourage my patients who tell me about their sleep issues and then we work to get the sleep on track. It creates a tremendous relief for the patient and has the additional benefit of helping improve other areas of concern.

Insomnia is usually treated with medication. What issues do you see with that?
DH: The problem with sleep medications is that they are not adequately researched, they can cause unhealthy, even life-threatening, side effects – especially for the age 60+ population, they are not designed for long-term use, and they don’t treat the causes of insomnia. Medications are like sleep band-aids – remove the medication and the insomnia is back. Some of the most popular sleep medications – Sonata, Lunesta, and Ambien – have recently been black-boxed by the FDA. When a medication is “black boxed” it means that the FDA is using its strongest warning label before taking the product off market because the side effects can cause such serious health risks. We don’t know the consequences of long-term sleep medication use, and although there is no actual research to prove it, there is a strong suspicion that it may be linked to Alzheimer’s disease.

Wow, those are serious issues! What’s the alternative for people with insomnia?
DH: I’ve discovered a specialized form of cognitive behavioral therapy called CBT-I (Cognitive Behavioral Therapy for Insomnia). This is a very effective talk therapy treatment, easy to do in 4-6 sessions, uses no medication, and has long-lasting success, beyond treatment. CBT-I is no longer considered “A” treatment for insomnia, it is recommended by medical associations and professional organizations as “THE” effective, first-line treatment for insomnia. This means that before a physician prescribes medication to treat insomnia, the first step should be to have a person try CBT-I.

So, CBT-I uses no medication, but what else makes the CBT-I approach to insomnia different?
DH: CBT-I helps people regain quality of sleep they thought was lost to them forever. Many people complain about difficulty falling asleep, staying asleep, and who are feeling tired and fatigued during the day. CBT-I strategies are designed to help people re-experience sleepiness – people with insomnia are tired, but not sleepy – and regain the ability to create restorative sleep. Many people with insomnia have dysfunctional thoughts about sleep such as: “I must get 8 hours of sleep to feel rested during the day”, or, “I can’t function during the day if I don’t sleep well.” Most people with insomnia also experience anxiety about their inability to sleep. The “C” in CBT-I helps correct the irrational thoughts, it also helps reduce the anxiety that creates an “aroused state” that annoyingly appears at bedtime or during the middle of the night. The “B” in CBT-I are the behavioral strategies that are utilized to help retrain the brain to associate bed with sleep and help improve sleep efficiency – the ability to match the time you are in bed with the time you are asleep.

Who comes to you for help with insomnia and what changes have you seen in your clients from CBT-I?
DH: People with insomnia suffer – they begin to worry that their ability to sleep is broken and they are helpless to fix it. It is not uncommon for me to see someone who has endured problematic sleep for 10+ years. It is a miserable experience. Often my patients have tried multiple medications. Before long they have acquired a stash of sleeping pills. This type of use creates a psychological dependence. And all sleep medications have side effects, some more problematic than others. Most doctors and patients prefer trying CBT-I to using prescription sleep medicine.

The good news is, CBT-I works! The CBT-I participant is retrained to associate bed with sleep, to experience that feeling of sleepiness at night, to utilize the body’s natural processes for sleeping normally again. The insomnia is resolved! All is right in the world again – at least as far as their sleep is concerned. It is very gratifying for me as a therapist to see the successful effectiveness of CBT-I helping someone experience healthy, normal sleep.