Treating Insomnia in patients with comorbid psychiatric disorders: A focused review

Despite its known negative effects on physical and mental health, insomnia is an often-ignored condition. Insomnia is both a risk factor for, and a symptom of, several psychiatric disorders and a predictor of death by suicide, making it an important target for intervention. It is the position of the American College of Physicians and the American Academy of Sleep Medicine that the first-line treatment for sleep continuity disturbance should be Cognitive-Behavioral Therapy for Insomnia (CBT-I); however, medical, psychiatric, and psychological communities remain largely unaware of the existence and effectiveness of this therapy. The purposes of this article are to review the following: (a) literature on the relationship between insomnia and psychological health; (b) official guidelines and recommendations for the treatment of insomnia; (c) typical delivery of CBT-I; (d) evidence for the efficacy of CBT-I in insomnia that occurs cormbid with depression, anxiety, posttraumatic stress disorder, bipolar disorder, and psychotic conditions; and (e) need and opportunities for additional education and training.