The effects of a sleep intervention in the early COVID-19 pandemic on insomnia and depressive symptoms: Results of a randomized controlled pilot study

The COVID-19 Pandemic increased the prevalence and severity of insomnia and depression symptoms. The effects of an insomnia intervention on future insomnia and depression symptoms delivered during an ongoing stressor, which may have precipitated the insomnia symptoms, is unknown. We conducted a two-arm randomized controlled pilot study to evaluate whether an insomnia intervention would improve the trajectory of insomnia and depression symptoms in the context of a global pandemic. Forty-nine individuals with clinically significant insomnia symptoms that emerged after the start of the COVID-19 Pandemic were randomized to one of two groups: one group received four sessions of Cognitive Behavioral Therapy for Insomnia (CBT-I) over five weeks via telehealth, and the other was assigned to a 28-week waitlist control group. Participants completed assessments of insomnia and depressive symptom severity at baseline (week 0) and at weeks 1-6, 12, and 28. Linear mixed-effects models were used to evaluate treatment efficacy. The MacArthur model was used to test whether improvement in insomnia symptoms mediated subsequent improvement in mood. The CBT-I group showed improved trajectories of insomnia (b = -1.03, p < 0.005, 95% CI [-1.53, -0.53]) and depressive symptoms (b = -0.47, p = 0.007, [-0.80, -0.13]) across the 28 weeks compared to the control group. The rate of improvement of insomnia symptoms during treatment mediated the subsequent improvement in depressive symptom severity following treatment (b = 2.10, p = 0.024, [0.30, 3.90]). Although the sample size was small, these results underscore the potential CBT-I in the context of an ongoing stressor to not only alleviate insomnia symptoms, but also improve depressive symptoms.