Which first-line intervention is recommended for sleep disturbances in mood disorders?

• A. Benzodiazepines are first-line.
• B. Overnight sleep deprivation therapy.
• C. Pharmacologic augmentation with antipsychotics.
• D. CBT-I and sleep hygiene.

Answer: (D)

Sleep disturbances in mood disorders are most effectively addressed first with a structured behavioral approach that targets how we sleep, rather than relying on medications alone. The best initial intervention is cognitive behavioral therapy for insomnia (CBT-I) combined with solid sleep hygiene. CBT-I works by changing unhelpful thoughts about sleep and six key sleep behaviors: limiting time in bed to actual sleep time (sleep restriction), using the bed only for sleep and intimate activities (stimulus control), establishing a consistent wake time every day, creating a relaxing pre-sleep routine, and learning cognitive strategies to reduce worry about sleep. Sleep hygiene supports these changes with practical habits and environmental tweaks—regular schedules, a dark and quiet room, avoiding caffeine and heavy meals close to bedtime, and minimizing naps. This approach directly addresses the thoughts, behaviors, and routines that perpetuate insomnia and has strong, durable effects with far fewer risks than medications.

Benzodiazepines, while sometimes sedating, carry risks of dependence, tolerance, cognitive impairment, and potential mood destabilization, making them less suitable as a first-line option. Overnight sleep deprivation therapy is not a practical, generalizable first-line treatment. Pharmacologic augmentation with antipsychotics can help with sleep in certain contexts but adds metabolic and motor risks and is not a general first-line sleep treatment for mood disorders.