Shirah Vollmer MD

The Musings of Dr. Vollmer

Sleeping Your Way To Health

Posted by Dr. Vollmer on November 19, 2013

 

http://www.nytimes.com/2013/11/19/health/treating-insomnia-to-heal-depression.html?hpw&rref=health&_r=0

 

“Curing insomnia in people with depression could double their chance of a full recovery, scientists are reporting. The findings, based on an insomnia treatment that uses talk therapy rather than drugs, are the first to emerge from a series of closely watched studies of sleep and depression to be released in the coming year.”

 

Sleep is important. Yep! Sleep can help mood. Yep! “Insomnia treatment that uses talk therapy,” Nope! “The therapy that Dr. Manber, Dr. Carney and the other researchers are using is called cognitive behavior therapy for insomnia, or CBT-I for short. The therapist teaches people to establish a regular wake-up time and stick to it; get out of bed during waking periods; avoid eating, reading, watching TV or similar activities in bed; and eliminate daytime napping.” CBT-I, a “T” therapy is NOT “talk therapy”. The patient is taught life skills, which help with depression. That is fine! Being taught is not the same as talking, as a form of therapy. This is more aptly described as “listening therapy,” as the patient is told how to change their habits. I could write a letter to the New York Times, but I decided to rant here instead. Helping people to sleep is a worthwhile endeavor, but to compare this intervention to the Prozac revolution is absurd. “In the four larger trials expected to be published in 2014, researchers had participants keep sleep journals to track the effect of the CBT-I therapy, writing down what time they went to bed every night, what time they tried to fall asleep, how long it took, how many awakenings they had and what time they woke up.” Many depressed patients cannot follow-though with sleep journals or any tracking measure, for that matter. The severely depressed often have psychomotor retardation which makes doing tasks, including tracking, overwhelming and anxiety-producing. Again, I am all for tools to help healthful living, but the marketing and the limitations of these tools needs to be clear. need to be understood.

3 Responses to “Sleeping Your Way To Health”

  1. Jon said

    Go good sleep! It is indeed important and necessary.

    Yes, there is a fundamental difference between listening and talking – the difference between treating symptomatic problems and root problems. . The behavior modification of the CBT-I is indeed treating the symptom of insomnia. However, a proper understanding of why that insomnia occurs needs to be deeper understood by exploring the psyche.

  2. Ashana M said

    If the results turn out to be consistent, this is an improvement over what we’ve been doing to treat depression in terms of improving the quality of people’s lives. Or is improving quality of life not the point?

    As far as comparing it to the “Prozac revolution,” I’m not sure that’s saying much, as the evidence for the effectiveness of anti-depressant medication is not very strong–as I’m sure you’re aware. Unless the article was referring to the shift in thinking about it: understanding that insomnia can cause or maintain depression (and that it’s not just a symptom) is just as big an idea as understanding that chemicals in your brain affect mood.

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