title: Treating insomnia improves mood state, sleep, and functioning in bipolar disorder: a pilot randomized controlled trial.
abstract: OBJECTIVE
  To determine if a treatment for interepisode bipolar disorder I patients with insomnia improves mood state, sleep, and functioning.
  
  
  METHODS
  Alongside psychiatric care, interepisode bipolar disorder I participants with insomnia were randomly allocated to a bipolar disorder-specific modification of cognitive behavior therapy for insomnia (CBTI-BP; n = 30) or psychoeducation (PE; n = 28) as a comparison condition. Outcomes were assessed at baseline, the end of 8 sessions of treatment, and 6 months later. This pilot was conducted to determine initial feasibility and generate effect size estimates.
  
  
  RESULTS
  During the 6-month follow-up, the CBTI-BP group had fewer days in a bipolar episode relative to the PE group (3.3 days vs. 25.5 days). The CBTI-BP group also experienced a significantly lower hypomania/mania relapse rate (4.6% vs. 31.6%) and a marginally lower overall mood episode relapse rate (13.6% vs. 42.1%) compared with the PE group. Relative to PE, CBTI-BP reduced insomnia severity and led to higher rates of insomnia remission at posttreatment and marginally higher rates at 6 months. Both CBTI-BP and PE showed statistically significant improvement on selected sleep and functional impairment measures. The effects of treatment were well sustained through follow-up for most outcomes, although some decline on secondary sleep benefits was observed.
  
  
  CONCLUSIONS
  CBTI-BP was associated with reduced risk of mood episode relapse and improved sleep and functioning on certain outcomes in bipolar disorder. Hence, sleep disturbance appears to be an important pathway contributing to bipolar disorder. The need to develop bipolar disorder-specific sleep diary scoring standards is highlighted.
authors.affiliation: Department of Psychology, University of California, Berkeley.
authors.forename: Allison G
authors.initials: AG
authors.lastname: Harvey
authors.affiliation: Department of Psychology, University of California, Berkeley.
authors.forename: Adriane M
authors.initials: AM
authors.lastname: Soehner
authors.affiliation: Department of Psychology, University of California, Berkeley.
authors.forename: Kate A
authors.initials: KA
authors.lastname: Kaplan
authors.affiliation: Department of Psychology, University of California, Berkeley.
authors.forename: Kerrie
authors.initials: K
authors.lastname: Hein
authors.affiliation: Department of Psychology, University of California, Berkeley.
authors.forename: Jason
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Psychology, University of California, Berkeley.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Kanady
authors.affiliation: Department of Psychiatry, School of Medicine, University of California, San Francisco.
authors.forename: Descartes
authors.initials: D
authors.lastname: Li
authors.affiliation: Graduate School of Education, University of California, Berkeley.
authors.forename: Sophia
authors.initials: S
authors.lastname: Rabe-Hesketh
authors.affiliation: Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University.
authors.forename: Terence A
authors.initials: TA
authors.lastname: Ketter
authors.affiliation: Department of Psychiatry, School of Medicine, University of California, San Francisco.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Neylan
authors.affiliation: Department of Psychiatry, University of Pittsburgh.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Buysse
mesh_terms: D000328:Adult; D000339:Affect / Q000502:physiology*; D001714:Bipolar Disorder / Q000150:complications / Q000523:psychology*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012890:Sleep / Q000502:physiology*; D007319:Sleep Initiation and Maintenance Disorders / Q000150:complications / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome