Baseer Maroof, LCSW · Raleigh, NC · Adults 21+
With other conditions
Insomnia rarely shows up alone. It still deserves its own treatment, and it still responds.
In short
- Insomnia often travels with anxiety, depression, ADHD and trauma. It’s not just a symptom; it gets its own treatment.
- Insomnia roughly doubles the risk of later depression.
- CBT-I still works when another condition is present.
- For trauma nightmares, imagery rehearsal therapy (IRT) has strong support.
CBT-I still works alongside other conditions
Wu 2015 meta-analysis. CBT-I also produced a smaller improvement in the other condition, larger for psychiatric than medical ones.
Anxiety & depression
Insomnia comes first, often
Across 21 longitudinal studies, people with insomnia had about twice the odds of later developing depression (OR 2.60). (Baglioni 2011)
What I do differently
With anxiety, the cognitive work carries more weight: worry time, dropping the safety behaviors, accepting wakefulness instead of fighting it (ACT skills help here). With depression, the fixed rise time doubles as behavioral activation. Low mood loves a late, unstructured morning.
ADHD
Often a late clock
In a study of adults with ADHD, most had sleep-onset insomnia, and that group had a later sleep period and later melatonin onset than controls. Their body clock ran late. (Van Veen 2010)
Practically, a consistent rise time, morning light and a planned wind-down help more than willpower. Talk to your doctor about timing of stimulant doses, and before using melatonin.
Trauma & nightmares
CBT-I in PTSD
In a trial of 45 adults with PTSD, 8 sessions of CBT-I led to full insomnia remission in 41% vs 0% on a waitlist, holding at 6 months. (Talbot 2014)
Imagery rehearsal therapy (IRT)
You pick a recurring nightmare, change the story however you like while awake, and rehearse the new version for a few minutes daily. In 168 women with PTSD, 3 sessions of IRT cut nightmare frequency with a large effect. The AASM recommends IRT for PTSD-related nightmares and nightmare disorder. (Krakow 2001; Morgenthaler 2018)
Sequencing
If nightmares are the main problem, IRT may come first; if lying awake is, CBT-I. Trauma therapy itself often improves sleep too. These work side by side.
Toddlers & solo dads
What the data show
In a German panel tracking 2,118 fathers, sleep fell about 13 minutes a night in the first 3 months after a birth (mothers lost about 62), and didn’t fully return to baseline even 4–6 years later. (Richter 2019)
When the kid wakes you, that isn’t insomnia
If you fall right back asleep after the 3 a.m. wake-up, that’s a sleep opportunity problem. If you lie awake for an hour after, or can’t fall asleep even when the house is quiet, that’s insomnia, and CBT-I still applies.
Adapting CBT-I as a solo dad
- Pick a rise time you can hold even on custody-switch days.
- The 20-minute rule still works: get up, read in dim light near the kid’s room.
- Do worry time early, after bedtime routine and before your own wind-down.
- Protect your window. Late-night scrolling “me time” is often what’s eating it.
Sources
All sources, linked7 references⌄
- Wu JQ, Appleman ER, Salazar RD, Ong JC (2015). Cognitive behavioral therapy for insomnia comorbid with psychiatric and medical conditions: a meta-analysis. JAMA Intern Med 175(9):1461–1472. pubmed.ncbi.nlm.nih.gov/26147487/
- Baglioni C, et al. (2011). Insomnia as a predictor of depression: a meta-analytic evaluation of longitudinal epidemiological studies. J Affect Disord 135(1–3):10–19. pubmed.ncbi.nlm.nih.gov/21300408/
- Van Veen MM, et al. (2010). Delayed circadian rhythm in adults with attention-deficit/hyperactivity disorder and chronic sleep-onset insomnia. Biol Psychiatry 67(11):1091–1096. pubmed.ncbi.nlm.nih.gov/20163790/
- Talbot LS, et al. (2014). Cognitive behavioral therapy for insomnia in posttraumatic stress disorder: a randomized controlled trial. Sleep 37(2):327–341. pubmed.ncbi.nlm.nih.gov/24497661/
- Krakow B, et al. (2001). Imagery rehearsal therapy for chronic nightmares in sexual assault survivors with posttraumatic stress disorder: a randomized controlled trial. JAMA 286(5):537–545. pubmed.ncbi.nlm.nih.gov/11476655/
- Morgenthaler TI, et al. (2018). Position paper for the treatment of nightmare disorder in adults: an AASM position paper. J Clin Sleep Med 14(6):1041–1055. pmc.ncbi.nlm.nih.gov/articles/PMC5991964/
- Richter D, et al. (2019). Long-term effects of pregnancy and childbirth on sleep satisfaction and duration of first-time and experienced mothers and fathers. Sleep 42(4):zsz015. pubmed.ncbi.nlm.nih.gov/30649536/
Related on this site