Dr David Morawetz
Counselling Psychologist in Private Practice
It has been well documented that depression can cause insomnia.
However, in my clinical experience, the reverse is also true:
long-standing insomnia can often cause depression.
The aim of this study is to test the hypothesis that, for many
people suffering from both depression and insomnia, treating
the insomnia successfully without medication can cause the
depression to lift as well.
The sample consisted of 86 consecutive patients who presented
as suffering from chronic insomnia. Two thirds of these people
were also suffering from depression at intake.
During an initial hour-long interview, self-report estimates
of key sleep parameters were recorded, and the Beck Depression
Inventory was administered. The subjects then used the "Sleep
Better Without Drugs" self-help program (a book and three audio
cassettes) at home to improve their sleep. At follow-up six to
eight weeks later, the sleep parameters were recorded again, and
the Beck Depression Inventory was administered again.
For a person's sleep to be classified as having "improved
significantly", he or she must have fulfilled one or more of
the following strict criteria: a reduction of at least two hours
in the time taken to fall asleep; an increase of at least two
hours in total sleep time during the night; a reduction of at
least eight in the number of wakings during the night; elimination
of usage of sleeping medication with no deterioration in key sleep
parameters. On these strict criteria, 87% of all
subjects were sleeping significantly better at follow-up.
The key finding of the study is that 70% of
the insomnia sufferers who were depressed before treatment and
learned to sleep significantly better were no longer depressed, or
were significantly less depressed, once their sleep had improved.
By contrast, among people who did not learn to sleep significantly
better, none (0%) experienced a significant reduction in depression.
For many people who suffer from both chronic insomnia and depression,
treating the insomnia successfully without medication can eliminate or
significantly reduce the depression.
* This paper was presented at the National Conference of the
Australasian Sleep Association, Melbourne, 2000. The results have been published
in Australian Journal of Counselling Psychology, 3, 1, 2001 pp.19-24.
(a journal of The Australian Psychological Society); and in
Sleep Research Online, 5, 2, 2003 pp 77-81
The full text of the paper is available here.
The researcher, Dr David Morawetz, is the author of
"Sleep Better Without Drugs", the self-help insomnia
treatment program that is used in this study.