#MEDICINE FOR INSOMNIA AND ANXIETY MANUAL#
In the Diagnostic and Statistical Manual for Mental disorders, fifth edition (DSM-5), sleep disturbances are one of the diagnostic criteria for generalized anxiety disorder, which is characterized by excessive anxiety and worry about certain events or activities.
Likewise, insomnia is also the most prevalent sleep disturbance associated with anxiety disorders as poor sleep quality has been found among adults with anxiety disorders. As a result, insomnia can be considered a subsequent risk factor for depression due to its bidirectional relationship with depression. Sleep disturbances are detected among 90% of patients with clinical depression 9, and those with insomnia are ten times more likely to experience clinical depression 10. Those with insomnia reported increased odds of depression and anxiety as compared to those without 8. Various cross-sectional and longitudinal research have presented insomnia to be associated with an increased risk of mood and anxiety disorders as well as suicide. Recently, epidemiologic studies have reported that insomnia predicts the development of major depression, anxiety, and suicide. Despite its high prevalence and potentially severe consequences, only a limited number of people seek treatment for insomnia 5.ĭepression and anxiety are the most common comorbid mental disorders associated with insomnia which can also exacerbate the sleep disorder 6, 7. Apart from fatigue, insomnia has also been associated mental disorders, low work productivity, and cognitive impairment. Such sleep disturbances may cause clinically significant distress or impairment in social, occupational, or other areas of functioning. Insomnia disorder is defined by the Diagnostic and Statistical Manual of Mental Disorders – IV (DSM-IV) as the complaint for difficulty in initiating or maintaining sleep, or restorative sleep for at least 1 month 4. These numbers are greater among patients, with reports estimating 69% prevalence among primary care patients 3. Insomnia is one of the most common sleep disorders, posing a significant public health concern, with an estimated prevalence of 10–30% among adults in the general population 1, 2.
Specifically, the study demonstrated significant effects on the above symptoms when considering treatment adherence and implementing fully automated dCBT-I. The results demonstrated that digital intervention for insomnia yielded significant effects on alleviating depressive and anxiety symptoms as well as insomnia symptoms. Furthermore, additional subgroup analysis on studies that have used the fully automated dCBT-I treatment without the support of human therapists reported significant treatment effects for depression, anxiety, and sleep outcomes. When considering treatment adherence, the treatment effects of those in the high adherent groups identified a more robust outcome, showing greater effect sizes than those in the low adherent groups for depression, anxiety, and sleep outcomes. In total, 2504 articles were identified after duplicate removal, and 22 RCTs were included in the final meta-analysis. The PubMed, PsycINFO (Ovid), Embase, and Cochrane databases were searched for randomized controlled trials (RCTs) on adult patients with insomnia also having reported measures of depressive or anxiety symptoms. Despite research into the development of digital cognitive behavioral therapy for insomnia (dCBT-I), research into the outcomes of dCBT-I on insomnia and the associated clinical conditions of depression and anxiety have been limited.
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