Impact Of Phenotypic Heterogeneity Of Insomnia On The Patients’ Response To Cognitive-Behavioral Therapy For Insomnia: Current Perspectives
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Insomnia is one of the most common mental disorders and the most frequent sleep disorder encountered in clinical practice, with a prevalence of about 7% in the European population. Insomnia Disorder (ID) is defined as a disturbance of sleep initiation or maintenance, followed by a feeling of non-restorative sleep and several diurnal consequences ranging from occupational and social difficulties to cognitive impairment. Cognitive-Behavioral Therapy for Insomnia (CBT-I) is considered the first-choice therapy for this disorder because its effectiveness has been proven to be greater in the long term with fewer side effects in comparison to pharmacotherapy. Although its effectiveness has been well established, it has been reported that nearly 40% of patients do not achieve remission after treatment. This finding could be the consequence of heterogeneity of ID between patients. It has been proposed that this heterogeneity might be ascribable to indices that are not related to sleep quality and quantity, such as comorbidities, life events, and personality traits. However, several works focused on the role of sleep markers, in particular objective total sleep time, for the phenotypization of ID and treatment response. The aim of this work is to summarize the available scientific literature regarding the impact of ID subtype on CBT-I response.
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Mood symptoms such as depression and anxiety, which are related to poor attendance in CBT-I, may contribute to inconsistent wake times during behavior therapy within CBT-I.
“Specifically, mood symptoms such as depression and anxiety, which are related to poor attendance in CBT-I, may also contribute to inconsistent wake times during behavior therapy within CBT-I.6,7”
From Comparison of Acceptance and Commitment Therapy (ACT) and Cognitive Behavior Therapy (CBT) for Chronic Insomnia: A Pilot Randomized Controlled Trial (2023) · cites this paper as [7]
In “Drop-Out, Adherence, And Attendance Predictors” (page not provided), the review reports that anxiety and depression symptoms were associated with lower CBT-I attendance, while depression was linked to more inconsistent wake times. It does not report a link between anxiety and inconsistent wake times, so that part of the claim is unsupported. (LLM, conf=0.88)
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Self-citationFrom night-to-night and from person-to-person: dynamic phenomena of insomnia
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Sleepless hours: the lived experience of chronic insomnia and anxiety across the US care spectrum
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The SMART-of-1 approach to personalized treatment trials
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Potential value of slow‐wave sleep in management of chronic insomnia disorder
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- Authors
- Galbiati, A., Sforza, M., Fasiello, E., Castronovo, V., & Ferini-Strambi, L.
- Affiliations
- Vita-Salute San Raffaele University (IT)
- IRCCS Ospedale San Raffaele (IT)
- Corresponding author
- Galbiati, Andrea
- Venue
- Nature and Science of Sleep
- Publisher
- Informa UK Limited
- Published
- 2019-11
- Volume
- Volume 11
- Pages
- 367-376
- ISSN
- 1179-1608 (ISSN-L)
- PMC
- PMC6890191
- OpenAlex
- W2991541757
- Cited by
- 38
- References
- 81
- Citations by year
- 2026: 9 · 2025: 5 · 2024: 3 · 2023: 9 · 2022: 4 · 2021: 6 · 2020: 1 · 2017: 1
- FWCI
- 0.41
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Nature and Science of Sleep (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
- Archivio Istituzionale della Ricerca - Università Vita-Salute San Raffaele (submittedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- insomnia, cognitive behavioral therapy for insomnia, treatment response, phenotypic heterogeneity, insomnia subtypes, total sleep time, comorbidities, personality traits, life events, treatment remission
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