This thesis explores the pharmacological and psychological treatment of both primary insomnia and insomnia secondary to depression. The first study, in a double blind placebo controlled trial, compares the effects of two anti-depressants, nefazodone and paroxetine, on the sleep of patients with moderate to severe depression. The second study described is a cross over trial that investigates whether nefazodone compared to placebo has beneficial effects on sleep in patients with primary insomnia. The final chapter explores the treatment of primary insomnia or secondary insomnia (e.g. insomnia secondary to depression) using a cognitive behaviour therapy group approach. In the first study, nefazodone was found, compared to paroxetine, to increase sleep efficiency, total sleep time and decrease number of awakenings as measured objectively by polysomnography. These effects were evident early in treatment, by day 3. In the second study nefazodone was not found, compared to placebo, to increase sleep efficiency, total sleep time or decrease number of awakenings in patients with primary insomnia. In the third study, patients with primary insomnia did report improvements in dysfunctional attitudes and beliefs about insomnia and improvements in energy/vitality and mental health, as measured by the SF36 quality of life scale, after attending group cognitive behavioural therapy (CBT). Sleep parameters were not significantly improved when compared pre and post CBT. The findings described in this thesis have led to further work to test the efficacy of trazodone (nefazodone's sister drug) in a placebo controlled trial for primary insomnia and the continued running of the CBT insomnia group with a view to supporting patients with chronic insomnia.
|Date of Award||2007|