Kate Johnson

June 16, 2011

June 16, 2011 (Minneapolis, Minnesota) — Insomniac patients with suicide ideation show significantly reduced suicide risk after undergoing sleep-focused cognitive-behavioral therapy (CBT), a new study shows.

"This is the first study to our knowledge to reveal that a sleep-focused intervention has a therapeutic impact on suicide risk specifically," reported Rebecca Bernert, PhD, a fellow in the Department of Psychiatry and Behavioral Sciences at Stanford University in California.

The study was presented here at SLEEP 2011, the 25th Anniversary Meeting of the Associated Professional Sleep Societies.

Predictor of Suicide

Sleep disturbance is a powerful predictor of suicide and is listed among the top 10 warning signs of suicide by the Substance Abuse Mental Health Services Administration, explained Dr. Bernert.

"Sleep disturbance is highly visible in the weeks preceding death — predicting up to a 7-fold increased risk according to psychological autopsy studies — even after controlling for the influence of depressed mood," she said.

Indeed, a recent study by her group (currently under review) showed that among 311 individuals at high risk for suicide, a specifically designed sleep index was more sensitive at predicting suicide ideation than was assessment of traditional risk factors, such as depression and hopelessness.

"This was a really striking finding to us, that even after controlling for baseline suicidal symptoms, just this very gross measure of sleep disturbance — which could be insomnia, or could be poor sleep quality — really predicted increases in suicidal ideation and actual suicide attempts within a very brief time frame of 1 month," she said.

The current study was an open-label, uncontrolled, behavioral treatment trial of CBT for insomnia among 303 adult patients (aged 18 to 88 years) from a community outpatient sleep clinic who were seeking treatment after referral for insomnia.

Slightly more than half (57%) of the participants were female, with a median age of 49 years, and individuals with comorbid psychiatric or sleep disturbances were not excluded.

The participants underwent weekly 90-minute sessions of group CBT for 5 weeks and then 2 sessions delivered biweekly.

The Beck Depression Index (BDI) and the Insomnia Severity Index were among the tests administered at baseline and again at the conclusion of treatment.

CBT produced a significant reduction (P < .001) in suicide ideation among a subgroup of 65 patients whose baseline BDI scores endorsed suicidal ideation, said Dr. Bernert.

In addition, in the group as a whole, CBT resulted in significantly lower (P < .001) BDI scores compared with baseline.

These findings provide compelling preliminary rationale for the development and testing of a sleep-targeted intervention designed to prevent suicidal behaviors.

"These findings provide compelling preliminary rationale for the development and testing of a sleep-targeted intervention designed to prevent suicidal behaviors," concluded Dr. Bernert.

She said sleep disturbances appear to be an important therapeutic target because "they are unique in a number of ways…. And compared to other known risk factors for suicide — for example, a suicide attempt history — are uniquely modifiable, amenable to treatment, and arguably less stigmatized."

Powerful, Simple Treatment

This study stands out both for its impressive results and its implications, said Allison Harvey, moderator of the session, professor of psychology and director of the Golden Bear Sleep and Research Clinic at the University of California, Berkeley, California.

"This CBT for insomnia is such a powerful simple treatment," she told Medscape Medical News. Over such a huge sample, with a big age range, it was such a short treatment and very powerful, she added, and the effect size for reducing suicidal symptoms was quite large.

The study was supported in part by National Institutes of Health National Research Service Award ( Postdoctoral Fellowship T32 MH019938-16. Dr. Bernert and Dr. Harvey have disclosed no relevant financial relationships.

The 25th anniversary meeting of the Associated Professional Sleep Societies. Abstract #O716. Presented June 14, 2011.


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