BOSTON—Objective sleep duration moderates the probability of remission among patients with comorbid depression and insomnia, according to research
presented at the 31st Annual Meeting of the Associated
Professional Sleep Societies. Sleep durations of greater
than five to six hours increase the likelihood that these
patients will achieve insomnia remission with cognitive
behavioral therapy for insomnia (CBT-I), but do not affect
the likelihood of depression remission. Sleep durations of
seven or more hours optimize the likelihood of insomnia
remission and depression remission in response to CBT-I.
In a 2015 consensus statement, the Sleep Research Society recommended seven or more hours of sleep per night
for adults younger than 60. Studies indicate that sleep durations of less than five hours and less than six hours are
associated with increased morbidity and poor treatment
response among patients with insomnia. “We wanted to
know what [sleep-duration] cutoffs … might be better
predictors of eventual insomnia and depression remission
through treatment,” said Jack Edinger, PhD, Professor of
Medicine at National Jewish Health in Denver.
An Analysis of the TRIAD Study
Dr. Edinger and colleagues conducted a secondary analysis
of the TRIAD study, which examined whether combined
treatment of depression and insomnia improves depression
and sleep outcomes in participants with both disorders.
Eligible participants met Diagnostic and Statistical Manual
of Mental Disorders (4th ed.) criteria for major depression
and primary insomnia, had a Hamilton Rating Scale for
Depression (HAMD- 17) score of 16 or greater, and had an
Insomnia Severity Index (ISI) score of 11 or greater. People
who had had psychotherapy in the previous four months,
or had failed or could not tolerate previous adequate trials of the study medications, were excluded. Participants
completed one night of baseline polysomnography before
entering the treatment phase of the study.
The study population included 104 participants (75
women) with a mean age of 47. Mean baseline HAMD- 17
score was 22, and mean baseline ISI score was 20. 6.
All participants received antidepressant medication (ie,
citalopram, sertraline, or venlafaxine). Patients were
randomized to CBT-I or sham (ie, a pseudodesensitiza-tion condition with sleep education). The investigators
assessed participants biweekly with the HAMD- 17 and
the ISI. The treatment period lasted for 16 weeks.
CBT-I Provided Benefits
Participants with five or more hours of sleep were more
likely to respond to CBT-I than participants with fewer
than five hours of sleep. Among participants with sleep
duration of five or more hours, insomnia remission
was more likely with CBT-I than with the control condition. The five-hour cutoff had no association with
Among participants with six or more hours of sleep,
those who received CBT-I were more likely to achieve insomnia remission than controls. The six-hour cutoff did
not affect the likelihood of depression remission, however.
Among participants with seven or more hours of
sleep, those randomized to CBT-I were more likely to
achieve insomnia remission and depression remission
“More research is needed to determine how best to
achieve depression remission in those patients with less
than seven hours of objective sleep duration prior to
starting treatment,” Dr. Edinger concluded. NR
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Sleep Duration Affects Likelihood of
Insomnia and Depression Remission
Sleep duration of less than seven hours may not influence depression remission in
patients with insomnia.