Case Study: Linking restless nights with black dog days

Preventing depression is the aim of a new online-based sleep improvement clinical trial being run by the Black Dog Institute. Will Turner reports.

Research shows people with depression and anxiety are over-represented among the 10 percent of Australians who report ongoing problems with insomnia. Yet beyond hearsay, little is known about the the impact a better night’s sleep could have on keeping these disorders from taking root in the first place.

The Good Night Study will shed light on this issue by testing how a web-based training program to address insomnia affects the mental wellbeing of people who may be at risk of developing a mood disorder. Funded by the National Health and Medical Research Council (NHMRC), the study is being led by Professor Helen Christensen, the Black Dog Institute’s executive director.

“This is definitely the first trial of its kind not just in Australia but globally. Plenty of research has been done on how better sleep improves the health of people who are already depressed, or [otherwise healthy] people who suffer from insomnia. What makes our study novel is its focus on prevention,” she explained.

The study is being done in partnership with the Behavioural Health and Technology Laboratory at the University of Virginia in the United States, whose director Associate Professor Lee Ritterband developed the online program being tested in the trial.

“It’s an automated self care application with three aspects to it: sleep restriction, cognitive behaviour therapy and stimulus control,” said Prof. Christensen. Following twelve days of “intensive diarying” by the participant, she said the application enables users to identify and monitor their sleep patterns and provides tailored feedback on what needs to change in the three areas for those patterns to improve.

For instance the application’s cognitive behaviour therapy units help people assess the things in their life which may be causing them to worry into the early hours of the morning, and how to find ways to resolve those issues.

Prof. Christensen said the mix of behavioural, educational and cognitive approaches used in the program are a powerful combination to address sleep problems. However she noted many people do not have the time or money to get this assistance via face-to-face treatment, or can’t access clinics because of illness or geographic isolation.  

In light of these realities, Prof. Christensen said ehealth preventative programs make the best sense. “Once shown to be effective, programs like this need to be available online, otherwise it is too costly for a population. What’s more, costs become proportionately less the more it gets used, unlike face-to-face where someone has to pay for every interaction.”

Prof. Christensen said the trial is due to begin in January, and while 1,200 have already signed up they are looking for more people who are interested in participating. “As with any clinical trial we need to screen for suitability, but people can be assured they will come away with an improved ability to get a good night’s sleep,” she said.

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The Challenge: Establishing the linkage between insomnia and the onset of depression.

The Approach: Formulating a web-based sleep improvement intervention to assess how it impacts the mental wellbeing of people at risk of developing a mood disorder

The Outcomes: A world first clinical trial with significant potential as a future prevention program for population groups in Australia and internationally.

The Lessons Learned: Online preventative programs are highly economical and much more accessible for patients compared with face to face interventions.

The Upside for:

Clinicians: Able to assess the effectiveness of online delivery of educational, behavioural and cognitive approaches to address insomnia.

Patients: Have ready and cheap access to a suite of approaches to resolve their sleep and mental health issues.

The Organisation: Is continuing its global leadership in clinically sound e-mental health initiatives.