Concordia research clarifies who stands to benefit from insomnia treatment.

Did you know that some psychologists offer a recognized and legitimate professional treatment—called cognitive behavioural therapy for chronic insomnia (CBT-I)?

“However, it is difficult to access this treatment in the public health-care system, so patients often have to consult in the private system and pay over $600 for a series of CBT-I sessions,” said neurologist Thanh Dang-Vu, Associate Professor & Concordia University Research Chair in Sleep, Neuroimaging and Cognitive Health, Exercise Science.

“More than half of patients will improve with this treatment, but that also means that it doesn’t always work. This is why it’s important to identify which patients are likely to respond to CBT-I.”

Hoping to learn more, Dang-Vu and Jean-Philippe Gouin, associate professor of psychology, designed a study to help identify candidates who will respond well to CTB-I.

Their preliminary findings were published recently in the journal Sleep Medicine. The article is titled, "Sleep spindles may predict response to cognitive-behavioral therapy for chronic insomnia."

“We found that certain brainwaves produced during sleep (called spindles) may help identify a type of insomnia that is less responsive to standard psychological treatment,” explained Dang-Vu.

The study followed 24 chronic insomniacs who underwent six weeks of CBT-I treatment in small groups and spent nights at the PERFORM Centre Sleep Lab before and after the treatment.

“We recorded their brainwave activity during sleep, and particularly their sleep spindles, using an electroencephalogram (EEG),” said Dang-Vu, who is also a medical doctor and the associate director for clinical research at the Institut universitaire de gériatrie de Montréal.

Results revealed that patients with lower spindle activity have poor responses to CBT-I.

“This information could help us identify which patients to prioritize for this form of therapy,” said Dang-Vu.

“In addition, future treatments that would enhance sleep spindles, such as certain medications or even brain stimulation techniques, could be useful for those not currently responding to CBT-I.”

His findings also fit with an overarching theory of insomnia, which posits that insomniacs are in a psychophysiological state of hyperarousal.

“As CBT-I has been developed to target the psychological components of hyperarousal rather than its physiological components, it would be expected to be less effective for individuals with reduced spindle density.”

Dang-Vu’s study is ongoing and his team is seeking more participants with chronic insomnia. “We will be adding different measures such as memory tests and brain function using imaging. All participants will be able to follow a CBT-I treatment program during the course of the study.”