Insomnia

Chronic insomnia is a prevalent condition in the aging population, affecting almost a third of individuals aged 65 years or older. A certain class of medication called benzodiazepines are commonly used to treat this disorder. Their chronic use, however, is believed to have adverse effects on physical, mental and cognitive health, especially in the elderly. Weaning off this medication can be challenging. Cognitive Behavioral Therapy for Insomnia (CBT-I) is a psychological intervention that has been shown to improve sleep quality in a majority of insomniacs and has also been demonstrated to facilitate the withdrawal success from benzodiazepines. In this study, we will evaluate whether adding CBT-I along with a structured withdrawal from benzodiazepines will lead to better sleep and cognitive outcomes as compared to a withdrawal without CBT-I.

Insomnia is defined by difficulties to fall asleep and maintain sleep with daytime complaints. With more than 10% of the population complaining of chronic primary insomnia, it become urgent to find treatment. Nowadays, cognitive-behavioral therapy for insomnia (CBTi), a multimodal psychological intervention is the best treatment with more than 60% of efficacy. However, not everyone respond positively to the therapy, which might be explained by the heterogeneity of the disorder. To that end, we aimed at understand better the sub-clinical types of insomnia as well as predict response to treatment using objective (EEG, fMRI, actigraphy, inflammatory and circadian markers) as well as subjective measures (questionnaires, sleep diaries). Another focus is also to assess the impact of insomnia and different interventions (CBTi, relaxation) on daytime functioning (memory, attention).

Prevalence rates for sleep apnea syndrome (SAS) are reported to range from 10% to 40% in the general population. The most prescribed therapy, positive airway pressure, which has proven efficacy, has an adherence rate of about 50% and was expensive. In addition, recent studies suggest that about 40 – 60% of patients with diagnosed SAS also report insomnia symptoms. This association has raised the possibility that comorbid insomnia or sleep disruption may have an important negative impact on the success of obstructive sleep apnea treatment. In this context, new alternative therapies must be studied, in particular in the patients suffering from both SAS and insomnia. In this view, the goal of this work is to study cognitive-behavioral therapy and exercise training intervention among insomnia patients with comorbid SAS.