Treating insomnia in severe mental illness – what does the research say?

Sleep Matters Perth Blog

In a new text book published this month, Prof Flavie Waters, Dr Melissa Ree from Sleep Matters, and Ms Vivian Chiu (UWA) have summarised the existing scientific evidence for the use of Cognitive behaviour Therapy for Insomnia (CBT-I) in people with psychosis. They have also developed the Sleep Well, Feel Well with Psychosis Program which is an adapted treatment for Insomnia.

The book a details instructions for delivering the session by session CBT-I program. “The authors provide a clear step-by-step treatment manual so that clinicians can learn the “Sleep Well, Feel Well with Psychosis” program.  The authors also provide highly useful resource packs to be used with clients, including sleep diaries, charts, and activity materials.  I highly recommend this book to all clinicians seeking a thorough, straightforward tool for improving the sleep of their clients with schizophrenia and other psychotic disorders.” (Prof Aaron Beck).


I certainly hope that this book will be a useful addition for clinicians working with psychiatric patients. Here is a little background rationale for the research program:

The sleep disorder Insomnia was once viewed as a mere symptom of other conditions. This lead to the belief that if the underlying condition is treated, that the insomnia will disappear.  Many Insomnia suffers can vouch for the fact (which is backed up by science eg. Carney et al, 2007), that insomnia can develop a life of its own: It can persist for years after the trigger for the insomnia has resolved. In this case the insomnia needs to be addressed directly – with an insomnia-specific treatment.

Thankfully, scientists and clinicians now agree that it is important to treat insomnia in its own right, even when there are other conditions present. It is a distinct problem with it’s own set of maintaining factors that can and should be treated.

Insomnia sufferers should be able to access treatment specifically for their poor sleep. Indeed, clinical trial data which has accumulated over the last two decades demonstrates that treating Insomnia significantly improves quality of life, mood, anxiety, general health, and daytime functioning.  This is even when the Insomnia occurs in the context of other disorders. For example, a study of patients with depression and Insomnia found that those who had their Insomnia treated had a faster response to antidepressant medication.

Recently, research has supported the (psychological) treatment of Insomnia in people with psychotic disorders (e.g., schizophrenia).  Psychotic disorders are usually severe mental disorders that cause abnormal thinking and experiences. Two of the main symptoms are delusions (unusual beliefs) and hallucinations (eg. seeing or hearing things that aren’t there). While medication is a mainstay of treatment in these disorders, therapeutic guidelines for psychosis also recommend that psychological & behavioural therapies be offered alongside medications (National Collaborating Centre for Mental Health, 2014). Our research suggests that psychological and behavioural treatments should be offered to improve sleep in people with psychosis.  It not only improves sleep, but daytime functioning, confidence, and quality of life.

Dr Melissa Ree at Sleep Matters continues to be active in the field of sleep research. See here for other publications.

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