Cognitive behavioural therapy for insomnia reduces actigraphy and diary measured sleep discrepancy for individuals with comorbid insomnia and major depressive disorder: A report from the TRIAD study

Jan 6, 2024Sleep medicine

Cognitive behavioral therapy for insomnia reduces differences between sleep tracker and diary measures in people with insomnia and depression

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Abstract

Participants receiving cognitive behavioral therapy for insomnia (CBT-I) showed a greater reduction in actigraphy-diary discrepancies across all sleep metrics compared to those receiving sham therapy.

At baseline, sleep diary total sleep time was shorter by 1.1 hours compared to actigraphy.
Sleep onset latency and wake after sleep onset were longer in sleep diaries by an average of 21.64 minutes and 17.45 minutes, respectively.
CBT-I led to significant reductions in discrepancies in total sleep time, sleep onset latency, and sleep efficiency, with all differences being statistically significant.
Changes in sleep-related beliefs and attitudes during treatment mediated the differences in actigraphy-diary discrepancies for total sleep time, sleep onset latency, and sleep efficiency.
Discrepancy changes did not mediate improvements in insomnia symptoms.

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OBJECTIVE/BACKGROUND: Discrepancies between sleep diaries and actigraphy occur among individuals with insomnia. Cognitive behavioural therapy for insomnia (CBT-I) improves insomnia but the impact on discrepancy is unclear. This study examined CBT-I's effects on actigraphy-diary discrepancy and explored sleep-related beliefs and attitudes as a mediator.

PATIENTS/METHODS: Participants were 108 (age M±SD = 47.23 ± 12.42, 67.60 % female) adults with insomnia and major depressive disorder from the Treatment of Insomnia and Depression study. They were randomized to 7 sessions of CBT-I or sham Quasi-Desensitization Therapy for Insomnia (DTI), plus 16 weeks of antidepressants. Two weeks of actigraphy and sleep diary were collected at baseline, mid-treatment, end-treatment. Differences between sleep diary and actigraphy total sleep time (TST), sleep onset latency (SOL), wake after sleep onset (WASO), and sleep efficiency (SE) were calculated. Participants completed Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS) at baseline and mid-treatment.

RESULTS: At baseline, diary (versus actigraphy) TST was shorter (1.1 ± 1.41h), whilst SOL (21.64 ± 41.25min) and WASO (17.45 ± 61.99min) were longer. Mixed effects models using daily data showed that after adjusting for age and sex, participants in the CBT-I group (versus DTI) showed greater reduction in all actigraphy-diary discrepancy domains (all p-values<.01), reductions evident from mid-treatment. Group differences on actigraphy-diary discrepancy reductions in TST, SOL, and SE (not WASO) were mediated by changes in DBAS from baseline to mid-treatment (all p-values<.05). Changes in discrepancy did not mediate insomnia symptom changes (p-values>.39).

CONCLUSIONS: CBT-I reduced actigraphy-diary discrepancy in individuals with comorbid insomnia and depression; this reduction was associated with improved sleep-related attitudes, a therapeutic target of CBT-I.

CLINICAL TRIAL REGISTRATION: TRIAD (Treatment of Insomnia and Depression): Improving Depression Outcome by Adding Insomnia Therapy to Antidepressants. Prospectively registered with Clinical Trials (NCT00767624).

SUPPORT (IF ANY): MH078924, MH078961, MH079256.

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Cognitive behavioural therapy for insomnia reduces actigraphy and diary measured sleep discrepancy for individuals with comorbid insomnia and major depressive disorder: A report from the TRIAD study

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