Treating insomnia improves mood state, sleep, and functioning in bipolar disorder: A pilot randomized controlled trial.

Abstract

Objective To determine if a treatment for interepisode bipolar disorder I patients with insomnia improves mood state, sleep, and functioning. Method Alongside psychiatric care, interepisode bipolar disorder I participants with insomnia were randomly allocated to a bipolar disorder–specific modification of cognitive behavior therapy for insomnia (CBTI-BP; n = 30) or psychoeducation (PE; n = 28) as a comparison condition. Outcomes were assessed at baseline, the end of 8 sessions of treatment, and 6 months later. This pilot was conducted to determine initial feasibility and generate effect size estimates. Results During the 6-month follow-up, the CBTI-BP group had fewer days in a bipolar episode relative to the PE group (3.3 days vs. 25.5 days). The CBTI-BP group also experienced a significantly lower hypomania/mania relapse rate (4.6% vs. 31.6%) and a marginally lower overall mood episode relapse rate (13.6% vs. 42.1%) compared with the PE group. Relative to PE, CBTI-BP reduced insomnia severity and led to higher rates of insomnia remission at posttreatment and marginally higher rates at 6 months. Both CBTI-BP and PE showed statistically significant improvement on selected sleep and functional impairment measures. The effects of treatment were well sustained through follow-up for most outcomes, although some decline on secondary sleep benefits was observed. Conclusions CBTI-BP was associated with reduced risk of mood episode relapse and improved sleep and functioning on certain outcomes in bipolar disorder. Hence, sleep disturbance appears to be an important pathway contributing to bipolar disorder. The need to develop bipolar disorder–specific sleep diary scoring standards is highlighted. Public Health Significance This study suggests that an intervention to improve sleep and circadian functioning reduces risk of relapse and improves sleep and overall functioning among individuals who meet diagnostic criteria for bipolar disorder.

Hypersomnia: an overlooked, but not overestimated, sleep disturbance in bipolar disorder

“…It further underscores the importance of hypersomnia in BD, which appears particularly relevant to BD I. Given that treatment of sleep disturbances may influence illness course in BD, providers should be mindful to assess and treat sleep disturbances in BD 5 6. Non-pharmacological approaches to hypersomnia treatment are sorely needed.…”

Correlates and prognostic relevance of sleep irregularity in inter-episode bipolar disorder

“…The study also showed that sleep irregularity might act as a risk factor for the prospective onset of major depressive episodes in bipolar disorder. A recent study showed that CBT-I was able to improve mood state, sleep, and functioning in bipolar disorder [36]. Further studies are needed to examine whether CBT-I can also reduce sleep irregularity and subsequently improve the outcome of bipolar disorder.…”

A Preliminary Study of Central Nervous System Arousal and Sleep Quality in Bipolar Disorder

“…Empirically supported treatments that address sleep quality in BPI have demonstrated considerable promise in reducing the number and severity of mood episodes [5]. Research focused on identifying individuals at high risk for sleep disturbances, and specific mechanisms related to sleep quality may allow for future development of an early detection and intervention program to attenuate the risk of the onset of a mood episode.…”

“…BPI manic episodes are characterized by sleep disturbances including "decreased need for sleep," while depressive episodes are characterized by "changes in sleep" and "fatigue or loss of energy" [4]. Accordingly, recent research has focused on sleep-specific interventions to reduce the risk of relapse in people with BPI [5]. A modified form of cognitive behavioral therapy for insomnia has been shown to be effective for reducing the hypomania/mania relapse rate, reducing the number of days in a bipolar episode, and early data suggest it may even lower the overall mood episode relapse rate [5].…”