Insomnia and stress: Moving beyond diathesis stress

ABSTRACT

Introduction: While the negative consequences of insomnia are welldocumented, a strengths-based understanding of how sleep can promote health promotion is still emerging and much-needed. Correlational evidence has connected sleep and insomnia to resilience;however, this relationship has not yet been experimentally tested. This talk will examine resilience as an ingredient and outcome of insomnia treatment Methods: Participants were randomized to either digital Cognitive Behavioral Therapy for insomnia (dCBT-I;n = 358) or sleep education control (n = 300), and assessed at pre-treatment, post-treatment, and one-year follow-up. Change in self-reported resilience was tested across the time points, and also examined as a mechanism driving insomnia and depression as outcomes. A follow-up study during the COVID-19 pandemic further examined the protective effect of dCBT-I. Result(s) DCBT-I resulted in greater improvements in resilience compared to the sleep education control. The improved resilience was a significant mediator of reduced insomnia and depression severity following treatment. Furthermore, improved resilience following dCBT-I also reduced insomnia and depression at one-year follow-up by lowering latent risk. Sensitivity analyses indicated that each point improvement in resilience following treatment reduced the odds of insomnia relapse and incident depression one year later by 76% and 65% respectively. Finally, those who previously received dCBT-I demonstrated greater resilience via protection from insomnia, depression, and COVID-19 specific stress. Conclusion(s) Improved resilience is a contributing mechanism to treatment gains following dCBT-I and may further protect against longer-term insomnia and depression by reducing risk.