Sleep therapy aids the mind

NEW YORK — Doctors have been looking to improve the effectiveness of depression treatment for decades, and this weekend they got a break from an unexpected quarter: behavioral sleep medicine.

Psychologists reported Saturday that a particular short-term therapy for insomnia could double the likelihood that people recover from the mood disorder — putting a spotlight on a little-known approach to poor sleep.

“I think it’s increasingly likely that this kind of sleep therapy will be used as a possible complement to standard care,” said Dr. John M. Oldham, chief of staff at the Menninger Clinic in Houston. “We are the court of last resort for the most difficult-to-treat patients, and I think sleep problems have been extremely under-recognized as a critical factor.”


For the time being, experts say, the treatment, known as cognitive behavioral therapy for insomnia, or CBT-I, is not widely available.

Most insurers cover it, and the rates for private practitioners are roughly the same as for any psychotherapy, ranging from $100 to $250 an hour, depending on the therapist. But the American Board of Sleep Medicine has certified just 400 practitioners of behavioral treatment, mostly psychologists, in the United States.

And the need is great. Depression is the most common mood disorder, affecting some 18 million American adults in any given year. Most also have insomnia, and four studies of CBT-I for depression, in combination with medication, are nearing completion.

“There aren’t many of us doing this therapy,” said Shelby Harris, the director of the behavioral sleep medicine program at Montefiore Medical Center in New York, who also has a private practice in Tarrytown, N.Y. “I feel like we all know each other.”

That may change soon. According to preliminary results, one of the four studies has found that when CBT-I cures insomnia — it does so 40 percent and 50 percent of the time, previous work suggests — it powerfully complements the effect of antidepressant drugs.


In the past year, the American Psychological Association has recognized sleep psychology as a specialty, and the Department of Veterans Affairs has begun a program to train about 600 sleep specialists, said Michael T. Smith, a professor at the Johns Hopkins School of Medicine and president of the Society of Behavioral Sleep Medicine.

Insomnia disorder is defined as at least three months of poor sleep that causes problems at work, at home, or in relationships.

“There’s been a huge recognition that insomnia especially cuts across a wide variety of medical disorders, and there’s a need to address it,” Smith said.

CBT-I is not a single technique but a collection of complementary ideas. One is called stimulus control, which involves breaking the association between being in bed and activities like watching television or eating. Another is sleep restriction: setting a regular “sleep window” and sticking to it.