CBT-I protocols for insomnia co-morbid with other mental disorders

Insomnia is a frequent co-morbidity of many mental disorders: Almost 70% of patients with mental disorders find it difficult to fall asleep or maintain sleep. Insomnia increases the risk of a negative course of the mental disorder and of poorer treatment efficacy. Cognitive behavioural therapy for insomnia (CBT-I) is effective for the reduction of insomnia in this patient group and has been recommended as a first-line treatment in European and American treatment guidelines. Among different mental disorders, depression is the best investigated co-morbidity (see Chapter 12). A wide range of studies demonstrates the efficacy of CBT-I for the reduction of insomnia. Whereas some studies found a positive effect of CBT-I also on depressive symptoms, other studies could not replicate these effects. Treatment efficacy of CBT-I has also been demonstrated for patients with post-traumatic stress disorder, bipolar disorder and schizophrenia. For depression, bipolar disorder and schizophrenia, research suggests that CBT-I may contribute to the prevention of further episodes of the disease. More research is needed to evaluate the efficacy of CBT-I for patients with yet under-investigated co-morbidities such as ADHD.