Treating insomnia improves mood state, sleep, and functioning in bipolar disorder: a pilot randomized controlled trial

Abstract

Objective: To determine if a treatment for interepisode bipolar disorder I patients with insomnia improves mood state, sleep, and functioning.

Method: Alongside psychiatric care, interepisode bipolar disorder I participants with insomnia were randomly allocated to a bipolar disorder-specific modification of cognitive behavior therapy for insomnia (CBTI-BP; n = 30) or psychoeducation (PE; n = 28) as a comparison condition. Outcomes were assessed at baseline, the end of 8 sessions of treatment, and 6 months later. This pilot was conducted to determine initial feasibility and generate effect size estimates.

Results: During the 6-month follow-up, the CBTI-BP group had fewer days in a bipolar episode relative to the PE group (3.3 days vs. 25.5 days). The CBTI-BP group also experienced a significantly lower hypomania/mania relapse rate (4.6% vs. 31.6%) and a marginally lower overall mood episode relapse rate (13.6% vs. 42.1%) compared with the PE group. Relative to PE, CBTI-BP reduced insomnia severity and led to higher rates of insomnia remission at posttreatment and marginally higher rates at 6 months. Both CBTI-BP and PE showed statistically significant improvement on selected sleep and functional impairment measures. The effects of treatment were well sustained through follow-up for most outcomes, although some decline on secondary sleep benefits was observed.

Conclusions: CBTI-BP was associated with reduced risk of mood episode relapse and improved sleep and functioning on certain outcomes in bipolar disorder. Hence, sleep disturbance appears to be an important pathway contributing to bipolar disorder. The need to develop bipolar disorder-specific sleep diary scoring standards is highlighted.

Figure 1

CONSORT diagram illustrating the flow of participants with bipolar disorder Type I and insomnia through the study. Note. CBTI-BP = cognitive behavior therapy for insomnia modified for bipolar disorder; PE = psychoeducation.

Figure 2

●●●. CBTI-BP = cognitive behavior therapy for insomnia modified for bipolar disorder; PE = psychoeducation. ^a Significant difference between treatment groups (Fisher's exact: p = .036). ^b Marginally significant difference between treatment groups (Fisher's exact: p = .075). ^c Significant difference between treatment groups, t(39) = 2.28, p = .028.