Insomnia is a clinical condition characterized by difficulty of initiating or maintaining sleep, often accompanied by daytime symptoms such as fatigue, anxiety, and depression. Among adults, insomnia is one of the most prevalent psychiatric conditions. Depending on the criteria used, the prevalence in the population varies between 30% and 48% having insomnia symptoms to around 6% fulfilling the criteria for the diagnosis.1,2
In studies of patients other psychiatric or mental health conditions rates of insomnia tend to be even higher. For example, around 80% of those with major depressive disorder complain of some type of sleep disruption ( either not able to sleep or sleeping too much and not feeling rested). Even after the major symptoms of depression are under control, for many insomnia may be long-lasting. 1,3 In a study by Mallon et al, 75% of participants with insomnia at baseline showed persistence of insomnia 12 years later.4
Insomnia causes considerable discomfort and decreases the working capacity of most individuals. It increases the risk of accidents and mortality, leading to high societal costs.5,6 Many psychiatric disorders that are associated with high rates of severe insomnia, associated with substantial functional impairment.7 Up to 70% of bipolar patients and 60% of adults with depression and anxiety suffer from insomnia.8,9 Continued sleep disturbance after successful treatment of affective episodes is a risk factor for relapse in both major depressive and bipolar disorders.9–11 Among patients with attention deficit hyperactivity disorder (ADHD), the prevalence of insomnia has been estimated at 6% to 80%, enhancing the burden of cognitive dysfunction, fatigue, and emotional symptoms.12 Insomnia is a core feature of generalized anxiety disorder, affecting 60% to 70% of patients with this diagnosis.13,14
The primary therapeutic interventions for insomnia are cognitive behavioral therapy and pharmacological treatment. Although sufficient for a majority of patients, about 40% do not respond to those standard treatments.15 There is certainly a need for additional therapies and tools for insomnia. The study below discusses the possible benefits of using a weighted blanket.
This study aimed to evaluate the effect of weighted chain blankets on insomnia and sleep-related daytime symptoms for patients with major depressive disorder, bipolar disorder, generalized anxiety disorder, and attention deficit hyperactivity disorder.
One hundred twenty patients were randomized (1:1) to either a weighted metal chain blanket or a light plastic chain blanket for 4 weeks. The outcome was evaluated using the Insomnia Severity Index as primary outcome measure and day and night diaries, Fatigue Symptom Inventory, and Hospital Anxiety and Depression Scale as secondary outcome measures. Sleep and daytime activity levels were evaluated by wrist actigraphy.
At 4 weeks, there was a significant advantage in Insomnia Severity Index ratings of the weighted blanket intervention over the light blanket (P < .001) with a large effect size (Cohen’s d 1.90). The intervention by the weighted blanket resulted in a significantly better sleep-maintenance, a higher daytime activity level, and reduced daytime symptoms of fatigue, depression, and anxiety. No serious adverse events occurred. During a 12-month open follow-up phase of the study, participants continuing to use weighted blankets maintained the effect on sleep, while patients switching from a light to a weighted blanket experienced an effect on Insomnia Severity Index ratings similar to that of participants using the weighted blanket from the beginning.
Weighted chain blankets are an effective and safe intervention for insomnia in patients with major depressive disorder, bipolar disorder, generalized anxiety disorder, or attention deficit hyperactivity disorder, also improving daytime symptoms and levels of activity.
CLINICAL TRIAL REGISTRATION:
Ekholm B, Spulber S, Adler M. A randomized controlled study of weighted chain blankets for insomnia in psychiatric disorders. J Clin Sleep Med. 2020;16(9):1567–1577.
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