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Stott R, Pimm J, Emsley R, Miller CB, Espie CA. Does adjunctive digital CBT for insomnia improve clinical outcomes in an improving access to psychological therapies service? Behav Res Ther 2021; 144:103922. [PMID: 34246110 DOI: 10.1016/j.brat.2021.103922] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/08/2021] [Accepted: 06/29/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Insomnia has a bidirectional relationship with broader mental health functioning, including anxiety and depression. Yet, poor sleep has historically been neglected as a specific treatment target in mental health programmes (Freeman, Sheaves, Waite, Harvey, & Harrison, 2020). METHOD All patients over a 12-month period entering the Improving Access to Psychological Therapies (IAPT) service endorsing a 'poor sleep' questionnaire item at assessment, were offered a self-guided digital sleep intervention, Sleepio, in addition to routine care. Sleepio is based on the principles of Cognitive Behavioural Therapy for Insomnia (CBT-I). Propensity score matching established a non-Sleepio control group matched on demographic and baseline clinical measures. RESULTS Patients who signed up to Sleepio (n = 510) achieved significantly better outcomes on core clinical metrics (PHQ-9, GAD-7, WSAS) than controls. IAPT recovery rates1 (on PHQ-9 and GAD-7) were 64.7%, versus 58% in the control group. Duration of clinical contact time was marginally elevated overall in the Sleepio group but by less than 1 h CONCLUSIONS: Significant clinical benefit was associated with the introduction of an evidence-based digital sleep intervention alongside other mental health interventions for depression and anxiety. Widespread deployment was achieved with immediate availability, minimal additional clinical time or staff training. This approach provides a feasible and highly scalable model for improving mental health outcomes in clinical services.
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Affiliation(s)
- Richard Stott
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Big Health Ltd, San Francisco, USA, London, UK.
| | - John Pimm
- Oxford Health NHS Foundation Trust, Oxford, UK.
| | - Richard Emsley
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Christopher B Miller
- Big Health Ltd, San Francisco, USA, London, UK; Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
| | - Colin A Espie
- Big Health Ltd, San Francisco, USA, London, UK; Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
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252
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Kallestad H, Saksvik S, Vedaa Ø, Langsrud K, Morken G, Lydersen S, Simpson MR, Dørheim SK, Holmøy B, Selvik SG, Hagen K, Stiles TC, Harvey A, Ritterband L, Sivertsen B, Scott J. Digital cognitive-behavioural therapy for insomnia compared with digital patient education about insomnia in individuals referred to secondary mental health services in Norway: protocol for a multicentre randomised controlled trial. BMJ Open 2021; 11:e050661. [PMID: 34183350 PMCID: PMC8240575 DOI: 10.1136/bmjopen-2021-050661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Insomnia is highly prevalent in outpatients receiving treatment for mental disorders. Cognitive-behavioural therapy for insomnia (CBT-I) is a recommended first-line intervention. However, access is limited and most patients with insomnia who are receiving mental healthcare services are treated using medication. This multicentre randomised controlled trial (RCT) examines additional benefits of a digital adaptation of CBT-I (dCBT-I), compared with an online control intervention of patient education about insomnia (PE), in individuals referred to secondary mental health clinics. METHODS AND ANALYSIS A parallel group, superiority RCT with a target sample of 800 participants recruited from treatment waiting lists at Norwegian psychiatric services. Individuals awaiting treatment will receive an invitation to the RCT, with potential participants undertaking online screening and consent procedures. Eligible outpatients will be randomised to dCBT-I or PE in a 1:1 ratio. Assessments will be performed at baseline, 9 weeks after completion of baseline assessments (post-intervention assessment), 33 weeks after baseline (6 months after the post-intervention assessment) and 61 weeks after baseline (12 months after the post-intervention assessment). The primary outcome is between-group difference in insomnia severity 9 weeks after baseline. Secondary outcomes include between-group differences in levels of psychopathology, and measures of health and functioning 9 weeks after baseline. Additionally, we will test between-group differences at 6-month and 12-month follow-up, and examine any negative effects of the intervention, any changes in mental health resource use, and/or in functioning and prescription of medications across the duration of the study. Other exploratory analyses are planned. ETHICS AND DISSEMINATION The study protocol has been approved by the Regional Committee for Medical and Health Research Ethics in Norway (Ref: 125068). Findings from the RCT will be disseminated via peer-reviewed publications, conference presentations, and advocacy and stakeholder groups. Exploratory analyses, including potential mediators and moderators, will be reported separately from main outcomes. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT04621643); Pre-results.
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Affiliation(s)
- Håvard Kallestad
- Department of Mental Health Care, St Olavs Hospital University Hospital in Trondheim, Trondheim, Norway
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Simen Saksvik
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Øystein Vedaa
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Public Mental Health, Norwegian Institute of Public Health, Bergen, Norway
| | - Knut Langsrud
- Department of Mental Health Care, St Olavs Hospital University Hospital in Trondheim, Trondheim, Norway
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Gunnar Morken
- Department of Mental Health Care, St Olavs Hospital University Hospital in Trondheim, Trondheim, Norway
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Stian Lydersen
- Department of Mental Health Care, Norwegian University of Science and Technology, Trondheim, Norway
| | - Melanie R Simpson
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Signe Karen Dørheim
- Department of Mental Health Care, Stavanger University Hospital, Stavanger, Norway
| | - Bjørn Holmøy
- Department of Follo, Akershus University Hospital, Lorenskog, Norway
| | - Sara G Selvik
- Department of Mental Health Care, Namsos Hospital, Namsos, Norway
| | - Kristen Hagen
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Mental Health, Molde Hospital, Molde, Norway
| | - Tore Charles Stiles
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Allison Harvey
- Department of Psychology, University of California Berkeley, Berkeley, California, USA
| | - Lee Ritterband
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Børge Sivertsen
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Public Mental Health, Norwegian Institute of Public Health, Bergen, Norway
| | - Jan Scott
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
- Institute of Neuroscience, Newcastle University, Newcastle, UK
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253
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McLay LL, France KG, Blampied NM, Hunter JE, van Deurs JR, Woodford EC, Gibbs R, Lang R. Collateral Child and Parent Effects of Function‑Based Behavioral Interventions for Sleep Problems in Children and Adolescents with Autism. J Autism Dev Disord 2021; 52:2258-2273. [PMID: 34110556 DOI: 10.1007/s10803-021-05116-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2021] [Indexed: 11/25/2022]
Abstract
This study follows McLay et al., Journal of Autism and Developmental Disorders, (2020) to investigate whether the function-based behavioral sleep interventions received by 41 children and adolescents with autism spectrum disorder (ASD) produced collateral improvements in ASD severity, internalizing and externalizing symptoms and parent relationship quality, ratings of depression, anxiety and stress, and personal sleep quality. Concomitant with reduced sleep problem severity, improvements were found in children's internalizing and externalizing behavior and ASD symptom severity. Small improvements were also found in maternal sleep quality and parental stress. There was little change in parental relationship quality post-treatment, possibly reflecting high baseline scores. Overall, collateral benefits were generally small but positive, consistent with the limited extant research, and underscore the importance of investigating collateral effects across a range of variables.
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Affiliation(s)
- Laurie L McLay
- School of Health Sciences, University of Canterbury, Private bag 4800, Christchurch, New Zealand.
| | - Karyn G France
- School of Health Sciences, University of Canterbury, Private bag 4800, Christchurch, New Zealand
| | - Neville M Blampied
- Psychology Department, School of Psychology, Speech, and Hearing, University of Canterbury, Christchurch, New Zealand
| | - Jolene E Hunter
- School of Health Sciences, University of Canterbury, Private bag 4800, Christchurch, New Zealand
| | - Jenna R van Deurs
- School of Health Sciences, University of Canterbury, Private bag 4800, Christchurch, New Zealand
| | - Emma C Woodford
- School of Health Sciences, University of Canterbury, Private bag 4800, Christchurch, New Zealand
| | - Rosina Gibbs
- School of Health Sciences, University of Canterbury, Private bag 4800, Christchurch, New Zealand
| | - Russell Lang
- Department of Special Education, Center for Autism Research, Evaluation, and Support, Texas State University, San Marcos, TX, USA
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254
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Poor Sleep Quality and Its Relationship with Individual Characteristics, Personal Experiences and Mental Health during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18116030. [PMID: 34205195 PMCID: PMC8200012 DOI: 10.3390/ijerph18116030] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 05/24/2021] [Accepted: 06/02/2021] [Indexed: 02/06/2023]
Abstract
While the COVID-19 has dramatically altered our lifestyle and sleep practices, the links between sleep, individual characteristics, personal experiences and mental health during the pandemic require further examination. This cross-sectional, multi-methods study examined differences in language used to describe personal experiences, and mental health, based on sleep quality during the early stages of the pandemic. N = 1745 participants (mean age 42.97 ± 14.46 years) from 63 countries responded to the survey. Sleep quality was assessed using the Pittsburgh Sleep Quality Index and mental health was examined using the Patient Health Questionnaire-9, the State Trait Anxiety Inventory, the Perceived Stress Scale and the UCLA-Loneliness Scale. Quantitative analysis of qualitative, language content of personal experiences was conducted using free-text responses and comments to a question on the survey. Almost 50% of the participants reported poor sleep quality, which was linked to a more negative emotional tone and greater mentions of money or finance related words. Good sleepers reported more positive emotional tone in their experiences. Greater reports of clinical state anxiety, moderate depression and moderate stress were observed in poor sleepers, even after accounting for demographics and pandemic-related factors such as loneliness, financial concerns and risk of contracting COVID-19 disease. Results from this study highlight an urgent need for sleep-related public health interventions. Practitioner education, sleep screening for those with mental health conditions, and encouraging people to adopt digital tools may help to reduce the burden of poor sleep on mental health. While the pandemic itself is a stressful and uncertain time, improving sleep can support positive emotion regulation, improving mood and consequential action.
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255
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Crouse JJ, Ho N, Scott J, Martin NG, Couvy-Duchesne B, Hermens DF, Parker R, Gillespie NA, Medland SE, Hickie IB. Days out of role and somatic, anxious-depressive, hypo-manic, and psychotic-like symptom dimensions in a community sample of young adults. Transl Psychiatry 2021; 11:285. [PMID: 33986245 PMCID: PMC8119948 DOI: 10.1038/s41398-021-01390-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/25/2021] [Accepted: 04/14/2021] [Indexed: 02/03/2023] Open
Abstract
Improving our understanding of the causes of functional impairment in young people is a major global challenge. Here, we investigated the relationships between self-reported days out of role and the total quantity and different patterns of self-reported somatic, anxious-depressive, psychotic-like, and hypomanic symptoms in a community-based cohort of young adults. We examined self-ratings of 23 symptoms ranging across the four dimensions and days out of role in >1900 young adult twins and non-twin siblings participating in the "19Up" wave of the Brisbane Longitudinal Twin Study. Adjusted prevalence ratios (APR) and 95% confidence intervals (95% CI) quantified associations between impairment and different symptom patterns. Three individual symptoms showed significant associations with days out of role, with the largest association for impaired concentration. When impairment was assessed according to each symptom dimension, there was a clear stepwise relationship between the total number of somatic symptoms and the likelihood of impairment, while individuals reporting ≥4 anxious-depressive symptoms or five hypomanic symptoms had greater likelihood of reporting days out of role. Furthermore, there was a stepwise relationship between the total number of undifferentiated symptoms and the likelihood of reporting days out of role. There was some suggestion of differences in the magnitude and significance of associations when the cohort was stratified according to sex, but not for age or twin status. Our findings reinforce the development of early intervention mental health frameworks and, if confirmed, support the need to consider interventions for subthreshold and/or undifferentiated syndromes for reducing disability among young people.
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Affiliation(s)
- Jacob J Crouse
- Youth Mental Health & Technology Team, Brain and Mind Centre, University of Sydney, Sydney, Australia.
| | - Nicholas Ho
- Youth Mental Health & Technology Team, Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Jan Scott
- Youth Mental Health & Technology Team, Brain and Mind Centre, University of Sydney, Sydney, Australia
- Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle, UK
- Diderot University, Paris, France
- Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Baptiste Couvy-Duchesne
- QIMR Berghofer Institute of Medical Research, Brisbane, Australia
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Australia
- ARAMIS Laboratory, Paris Brain Institute, Paris, France
| | - Daniel F Hermens
- Thompson Institute, University of the Sunshine Coast, Birtinya, Australia
| | - Richard Parker
- QIMR Berghofer Institute of Medical Research, Brisbane, Australia
| | - Nathan A Gillespie
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Virginia, USA
| | - Sarah E Medland
- QIMR Berghofer Institute of Medical Research, Brisbane, Australia
| | - Ian B Hickie
- Youth Mental Health & Technology Team, Brain and Mind Centre, University of Sydney, Sydney, Australia
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256
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Jacob L, Smith L, Konrad M, Kostev K. Association between sleep disorders and osteoarthritis: A case-control study of 351,932 adults in the UK. J Sleep Res 2021; 30:e13367. [PMID: 33913215 DOI: 10.1111/jsr.13367] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/05/2021] [Accepted: 04/07/2021] [Indexed: 12/17/2022]
Abstract
This study aimed to analyse the association between sleep disorders and osteoarthritis in adults in the UK. This case-control study included patients aged ≥ 18 years who were diagnosed with osteoarthritis for the first time in one of 256 general practices in the UK between 1997 and 2016 (index date). Patients without osteoarthritis were matched (1:1) to those with osteoarthritis by sex, age, index year, general practice, observation time prior to index date (in years), obesity, injuries, and other types of arthritis. For patients without osteoarthritis, the index date was a randomly selected visit date between 1997 and 2016. The presence of sleep disorders prior to index date was assessed in the two groups. Finally, conditional logistic regression analyses were conducted to investigate the association between sleep disorders and osteoarthritis. This case-control study included 351,932 adults (61.5% women; mean [SD] age 64.9 [14.2] years). Overall, there was a significant association between sleep disorders and osteoarthritis (odds ratio = 1.25, 95% confidence interval = 1.22-1.29). This finding was corroborated in all sex and age subgroups, except in patients aged > 80 years. In terms of the type of sleep disorder, non-organic sleep disorders, hypersomnia and sleep apnea were associated to a significant extent with higher odds of developing osteoarthritis. Finally, the relationship between sleep disorders and osteoarthritis was significant in all osteoarthritis subgroups, except in that of patients with knee osteoarthritis. Based on these results, it can be concluded that sleep disorders may play a role in the development of osteoarthritis.
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Affiliation(s)
- Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Marcel Konrad
- FOM University of Applied Sciences for Economics and Management, Frankfurt, Germany
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257
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Impact of COVID-19 social-distancing on sleep timing and duration during a university semester. PLoS One 2021; 16:e0250793. [PMID: 33901264 PMCID: PMC8075219 DOI: 10.1371/journal.pone.0250793] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 04/13/2021] [Indexed: 12/17/2022] Open
Abstract
Social-distancing directives to contain community transmission of the COVID-19 virus can be expected to affect sleep timing, duration or quality. Remote work or school may increase time available for sleep, with benefits for immune function and mental health, particularly in those individuals who obtain less sleep than age-adjusted recommendations. Young adults are thought to regularly carry significant sleep debt related in part to misalignment between endogenous circadian clock time and social time. We examined the impact of social-distancing measures on sleep in young adults by comparing sleep self-studies submitted by students enrolled in a university course during the 2020 summer session (entirely remote instruction, N = 80) with self-studies submitted by students enrolled in the same course during previous summer semesters (on-campus instruction, N = 452; cross-sectional study design). Self-studies included 2–8 week sleep diaries, two chronotype questionnaires, written reports, and sleep tracker (Fitbit) data from a subsample. Students in the 2020 remote instruction semester slept later, less efficiently, less at night and more in the day, but did not sleep more overall despite online, asynchronous classes and ~44% fewer work days compared to students in previous summers. Subjectively, the net impact on sleep was judged as positive or negative in equal numbers of students, with students identifying as evening types significantly more likely to report a positive impact, and morning types a negative impact. Several features of the data suggest that the average amount of sleep reported by students in this summer course, historically and during the 2020 remote school semester, represents a homeostatic balance, rather than a chronic deficit. Regardless of the interpretation, the results provide additional evidence that social-distancing measures affect sleep in heterogeneous ways.
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258
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Vethe D, Scott J, Engstrøm M, Salvesen Ø, Sand T, Olsen A, Morken G, Heglum HS, Kjørstad K, Faaland PM, Vestergaard CL, Langsrud K, Kallestad H. The evening light environment in hospitals can be designed to produce less disruptive effects on the circadian system and improve sleep. Sleep 2021; 44:5909282. [PMID: 32954412 PMCID: PMC7953207 DOI: 10.1093/sleep/zsaa194] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/02/2020] [Indexed: 01/12/2023] Open
Abstract
STUDY OBJECTIVES Blue-depleted lighting reduces the disruptive effects of evening artificial light on the circadian system in laboratory experiments, but this has not yet been shown in naturalistic settings. The aim of the current study was to test the effects of residing in an evening blue-depleted light environment on melatonin levels, sleep, neurocognitive arousal, sleepiness, and potential side effects. METHODS The study was undertaken in a new psychiatric hospital unit where dynamic light sources were installed. All light sources in all rooms were blue-depleted in one half of the unit between 06:30 pm and 07:00 am (melanopic lux range: 7-21, melanopic equivalent daylight illuminance [M-EDI] range: 6-19, photopic lux range: 55-124), whereas the other had standard lighting (melanopic lux range: 30-70, M-EDI range: 27-63, photopic lux range: 64-136), but was otherwise identical. A total of 12 healthy adults resided for 5 days in each light environment (LE) in a randomized cross-over trial. RESULTS Melatonin levels were less suppressed in the blue-depleted LE (15%) compared with the normal LE (45%; p = 0.011). Dim light melatonin onset was phase-advanced more (1:20 h) after residing in the blue-depleted LE than after the normal LE (0:46 h; p = 0.008). Total sleep time was 8.1 min longer (p = 0.032), rapid eye movement sleep 13.9 min longer (p < 0.001), and neurocognitive arousal was lower (p = 0.042) in the blue-depleted LE. There were no significant differences in subjective sleepiness (p = 0.16) or side effects (p = 0.09). CONCLUSIONS It is possible to create an evening LE that has an impact on the circadian system and sleep without serious side effects. This demonstrates the feasibility and potential benefits of designing buildings or hospital units according to chronobiological principles and provide a basis for studies in both nonclinical and clinical populations.
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Affiliation(s)
- Daniel Vethe
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.,Division of Mental Health Care, St. Olav's University Hospital, Trondheim, Norway
| | - Jan Scott
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.,Institute of Neuroscience, University of Newcastle, Newcastle, UK
| | - Morten Engstrøm
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Clinical Neurophysiology, St. Olav's University Hospital, Trondheim Norway
| | - Øyvind Salvesen
- Unit of Applied Clinical Research, Norwegian University of Science and Technology, Trondheim, Norway
| | - Trond Sand
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Clinical Neurophysiology, St. Olav's University Hospital, Trondheim Norway
| | - Alexander Olsen
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Gunnar Morken
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.,Division of Mental Health Care, St. Olav's University Hospital, Trondheim, Norway
| | - Hanne S Heglum
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.,Novelda AS, Trondheim, Norway
| | - Kaia Kjørstad
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.,Division of Mental Health Care, St. Olav's University Hospital, Trondheim, Norway
| | - Patrick M Faaland
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.,Division of Mental Health Care, St. Olav's University Hospital, Trondheim, Norway
| | - Cecilie L Vestergaard
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.,Division of Mental Health Care, St. Olav's University Hospital, Trondheim, Norway
| | - Knut Langsrud
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.,Division of Mental Health Care, St. Olav's University Hospital, Trondheim, Norway
| | - Håvard Kallestad
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.,Division of Mental Health Care, St. Olav's University Hospital, Trondheim, Norway
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259
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Fritz EM, Kreuzer M, Altunkaya A, Singewald N, Fenzl T. Altered sleep behavior in a genetic mouse model of impaired fear extinction. Sci Rep 2021; 11:8978. [PMID: 33903668 PMCID: PMC8076259 DOI: 10.1038/s41598-021-88475-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/13/2021] [Indexed: 02/03/2023] Open
Abstract
Sleep disturbances are a common complaint of anxiety patients and constitute a hallmark feature of post-traumatic stress disorder (PTSD). Emerging evidence suggests that poor sleep is not only a secondary symptom of anxiety- and trauma-related disorders but represents a risk factor in their development, for example by interfering with emotional memory processing. Fear extinction is a critical mechanism for the attenuation of fearful and traumatic memories and multiple studies suggest that healthy sleep is crucial for the formation of extinction memories. However, fear extinction is often impaired in anxiety- and trauma-related disorders-an endophenotype that is perfectly modelled in the 129S1/SvImJ inbred mouse strain. To investigate whether these mice exhibit altered sleep at baseline that could predispose them towards maladaptive fear processing, we compared their circadian sleep/wake patterns to those of typically extinction-competent C57BL/6 mice. We found significant differences regarding diurnal distribution of sleep and wakefulness, but also sleep architecture, spectral features and sleep spindle events. With regard to sleep disturbances reported by anxiety- and PTSD patients, our findings strengthen the 129S1/SvImJ mouse models' face validity and highlight it as a platform to investigate novel, sleep-focused diagnostic and therapeutic strategies. Whether the identified alterations causally contribute to its pathological anxiety/PTSD-like phenotype will, however, have to be addressed in future studies.
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Affiliation(s)
- Eva Maria Fritz
- Department of Pharmacology and Toxicology, Institute of Pharmacy and CMBI, University of Innsbruck, Innsbruck, Austria
| | - Matthias Kreuzer
- Department of Anesthesiology and Intensive Care, School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Alp Altunkaya
- Department of Anesthesiology and Intensive Care, School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Nicolas Singewald
- Department of Pharmacology and Toxicology, Institute of Pharmacy and CMBI, University of Innsbruck, Innsbruck, Austria
| | - Thomas Fenzl
- Department of Pharmacology and Toxicology, Institute of Pharmacy and CMBI, University of Innsbruck, Innsbruck, Austria.
- Department of Anesthesiology and Intensive Care, School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany.
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260
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How does cognitive behavioural therapy for insomnia work? A systematic review and meta-analysis of mediators of change. Clin Psychol Rev 2021; 86:102027. [PMID: 33887655 DOI: 10.1016/j.cpr.2021.102027] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 02/11/2021] [Accepted: 03/22/2021] [Indexed: 12/23/2022]
Abstract
Insomnia is prevalent and debilitating, comprising sustained difficulties initiating or maintaining sleep. Cognitive-behavioural therapy for insomnia (CBT-I) is a multicomponent intervention recommended as the first-line treatment, but the mediators of change remain unclear. This systematic review and meta-analysis aimed to synthesise and evaluate the evidence for potential mediators of CBT-I. Searches were performed for studies published until February 2021, reporting on mediation analyses with CBT-I. Seventeen unique samples of adults with insomnia (20 studies, N = 3125) were included. Two-stage structural equation modelling was applied to the available data, where 7 studies examined the cognitive mediator, 'dysfunctional beliefs about sleep', 5 studies examined a hyperarousal mediator, and 3 studies examined the behavioural mediator, 'time in bed'. There was evidence in support of changes in dysfunctional beliefs as a cognitive mediator of insomnia symptom improvement following CBT-I. There was more limited evidence in support of changes in hyperarousal-related mediators, and no significant effect of time in bed as a mediator. Numerous studies recorded diary-based measures of potential behavioural mediators, but analyses of these variables were not typically conducted. The most serious limitation of the evidence base is that the temporal precedence of mediator changes cannot be established. Future studies should consider: i) using mid-treatment measurements of mediator changes; ii) reporting on mediator psychometric properties; and iii) explicitly stating analyses as pre-specified or exploratory.
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261
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Ciren W, Yu W, Nima Q, Xiao X, Zhou J, Suolang D, Li Y, Zhao X, Jia P, Yang S. Social capital and sleep disorders in Tibet, China. BMC Public Health 2021; 21:591. [PMID: 33765991 PMCID: PMC7992333 DOI: 10.1186/s12889-021-10626-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 03/15/2021] [Indexed: 12/30/2022] Open
Abstract
Objective Sleep plays an important role in the health and well-being of middle aged and elderly people, and social capital may be one of the important factors for sleep disorders. This study aimed to understand the relationship between social capital and sleep disorders in a unique region of China –Tibet that generally has the disadvantaged economic status compared to other parts of China. Methods The study was based on Tibetan data from The China Multi-Ethnic Cohort (CMEC) and was conducted from May 2018 to September 2019. A total of 3194 Tibetans aged > 50 were selected from the community population by multi-stage stratified cluster sampling. Social capital was measured using two validated health-related social capital scales, family/community and society.. Sleep disorders were measured as the presence of disorders of initiating and maintaining sleep, early morning awakening, or daytime dysfunction. Logistic regression models were applied to examine the association between social capital and sleep disorders. Results 39.9% (1271/3194) of the participants had sleep disorders. In addition, after controlling for all potential variables, family social capital was significantly negatively associated with sleep disorders (OR = 0.95, P < 0.05), while community and society social capital was not associated with sleep disorders. Then, when we did all the sex-stratified analyses, the significant association between social capital and sleep disorders was found only in women (OR = 0.94, P < 0.05), while no association was found in males; neither males nor females showed any association with community and society social capital. Conclusion Our study would help to better understand the extent of health inequality in China, and guide future interventions, strategies and policies to promote sleep quality in low-income areas, taking into account both the role of Tibetan specific cultural traditions, lifestyles and religious beliefs in social capital and the gender differences in social capital. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10626-x.
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Affiliation(s)
- Wangla Ciren
- Lhasa Chengguan District Center for Disease Control and Prevention, Lhasa, 850000, China
| | - Wanqi Yu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Qucuo Nima
- Center for Disease Control and Prevention of Tibet autonomous region, Lhasa, 850000, China.
| | - Xiong Xiao
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Junmin Zhou
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Deji Suolang
- Center for Disease Control and Prevention of Tibet autonomous region, Lhasa, 850000, China
| | - Yajie Li
- Center for Disease Control and Prevention of Tibet autonomous region, Lhasa, 850000, China
| | - Xing Zhao
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Peng Jia
- Department of Land Surveying and Geo-Informatics, The Hong Kong Polytechnic University, Hong Kong, China.,International Institute of Spatial Lifecourse Epidemiology (ISLE), Hong Kong, China
| | - Shujuan Yang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China. .,International Institute of Spatial Lifecourse Epidemiology (ISLE), Hong Kong, China.
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262
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İçel S, Başoğul C. Effects of progressive muscle relaxation training with music therapy on sleep and anger of patients at Community Mental Health Center. Complement Ther Clin Pract 2021; 43:101338. [PMID: 33639518 DOI: 10.1016/j.ctcp.2021.101338] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 02/16/2021] [Accepted: 02/16/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The objective is to examine the effects of progressive muscle relaxation training and music therapy applied to chronic psychiatric patients attending the Community Mental Health Center (CMHC) on their anger level and sleep quality. METHODS The sample of the study consisted of 66 chronic psychiatric patients (n = 32 in the control group; n = 34 in the intervention group). Progressive muscle relaxation training with music therapy were implemented in the intervention group as 2 sessions per week for 3 months. RESULTS A statistically significant difference was found between the pre-test and post-test mean scores of the intervention group (p ≤ .001). After the intervention, a statistically significant difference was found between the PSQI, anger-in, anger-out, anger-control, and trait anger scale scores of the two groups (p ≤ .001). CONCLUSION Relaxation training and music therapy are effective in controlling anger and increasing sleep quality in chronic psychiatric patients. CLINICAL TRIAL NUMBER NCT04620122.
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Affiliation(s)
- Sema İçel
- Gaziantep Islamic Science and Technology University, Faculty of Health Sciences, Midwifery Department, Gaziantep, Turkey.
| | - Ceyda Başoğul
- Adıyaman University, Faculty of Health Sciences, Department of Psychiatric Nursing, Adıyaman, Turkey.
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263
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Thompson EC, Jay SY, Andorko ND, Millman ZB, Rouhakhtar PR, Sagun K, Han SC, Herman B, Schiffman J. Sleep quality moderates the association between psychotic-like experiences and suicidal ideation among help-seeking university students. Psychiatry Res 2021; 296:113668. [PMID: 33401091 PMCID: PMC8482876 DOI: 10.1016/j.psychres.2020.113668] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 12/19/2020] [Indexed: 02/07/2023]
Abstract
Suicide is a leading cause of death for young adults, and college-enrolled students are at markedly high risk for suicide. Psychotic-like experiences (PLEs) and sleep difficulties are prevalent among college students and have been linked to increased suicidal ideation (SI). This cross-sectional study examined the relation between PLEs and SI, moderated by sleep quality, in a sample of 442 students at a university counseling center. The Behavioral Health Measure-43 (BHM-43) was used to evaluate mental health symptoms, including sleep quality and SI. The PRIME Screen-Revised was used to measure PLEs. Regression results indicated that higher PRIME scores statistically predicted greater SI. There was a significant interaction between PRIME and sleep quality in predicting SI. Among individuals with greater sleep difficulties, PLEs were positively, significantly associated with SI. The PRIME was not a significant predictor of SI at lower levels of sleep difficulties (i.e. better sleep quality). This interaction effect remained significant when controlling for age and the BHM-43 depression and bipolar subscales. Findings suggest that sleep difficulties may be linked to increased SI for individuals with PLEs, and better sleep may be protective. Further research is needed to explore treatment targeting PLEs and/or sleep to mitigate suicide risk among university students.
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Affiliation(s)
- Elizabeth C. Thompson
- Department of Psychology, University of Maryland, Baltimore County, Catonsville, MD, 21250
| | - Samantha Y. Jay
- Department of Psychology, University of Maryland, Baltimore County, Catonsville, MD, 21250
| | - Nicole D. Andorko
- Department of Psychology, University of Maryland, Baltimore County, Catonsville, MD, 21250
| | - Zachary B. Millman
- Department of Psychology, University of Maryland, Baltimore County, Catonsville, MD, 21250
| | | | - Kristin Sagun
- Counseling Center, University of Maryland, Baltimore County, Catonsville, MD, 21250
| | - Susan C. Han
- Counseling Center, University of Maryland, Baltimore County, Catonsville, MD, 21250
| | - Bruce Herman
- Counseling Center, University of Maryland, Baltimore County, Catonsville, MD, 21250
| | - Jason Schiffman
- Department of Psychology, University of Maryland, Baltimore County, Catonsville, MD, 21250
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264
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Association of Sleep Architecture and Physiology with Depressive Disorder and Antidepressants Treatment. Int J Mol Sci 2021; 22:ijms22031333. [PMID: 33572767 PMCID: PMC7866255 DOI: 10.3390/ijms22031333] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 01/25/2021] [Accepted: 01/27/2021] [Indexed: 01/27/2023] Open
Abstract
Sleep problems are frequently associated with the principal diagnostic criteria for many mental disorders. Alterations in the sleep of depressive patients are of high clinical significance because continuous sleep problems raise the chance of relapse, recurrence, or suicide, as well as the need for augmenting medications. Most antidepressants have been proven to influence the sleep architecture. While some classes of antidepressants improve sleep, others may cause sleep impairment. The successful treatment of depressive disorder also requires an understanding of the effects of antidepressants on sleep. This article briefly reviews the physiology of sleep and the typical alterations in the sleep architecture in depressive patients and updates the different effects of the majority of antidepressants including novel drugs in clinical practice on sleep. The summary of the updated scientific findings of the relationship between depression and sleep disturbances could be clinically beneficial in choosing the best medication for depressive patients with concurrent sleep disorders.
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265
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Radhakrishnan A, Govindaraj R, Sasidharan A, Ravindra PN, Yadav R, Kutty BM. People with dyssomnia showed increased vulnerability to CoVID-19 pandemic: a questionnaire-based study exploring the patterns and predictors of sleep quality using the latent class analysis technique in Indian population. Sleep Med 2021; 79:29-39. [PMID: 33485259 PMCID: PMC7834060 DOI: 10.1016/j.sleep.2020.12.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 12/20/2020] [Accepted: 12/30/2020] [Indexed: 01/07/2023]
Abstract
INTRODUCTION CoVID-19 pandemic and the subsequent lockdown have impacted the sleep quality and the overall wellbeing of mankind. The present epidemiological study measured various aspects of sleep disturbance such as sleep quality, daytime impairments, negative emotionality, sleep hygiene, and well-being associated with CoVID-19 pandemic among the Indian population. METHODS This cross-sectional voluntary online survey (using Google form) was communicated across the country from 4th June to 3rd July 2020 through mail and social media applications. The responses received (N = 450) were categorized and validated using the latent class analysis and logistic regression tests respectively, and the classes and subclasses derived were profiled. These techniques are used for the first time in a CoVID-19 sleep study. RESULTS Out of the three classes derived from the LCA, people with severe dyssomnia belonging to class 1 (33.3%) showed high daytime impairments, negative emotionality and high vulnerability towards CoVID-19 pandemic measures. In addition, the two subclasses derived from the severe dyssomnia group; one with negative emotionality predominance and the other with excessive daytime sleepiness, were similarly affected by CoVID-19 measures. People with moderate dyssomnia (class 2, 28.5%) showed frequent arousals with daytime impairments and the majority (38.2%) which fell in to class 3, the 'no dyssomnia' category, were not impacted by CoVID-19 pandemic. CONCLUSION People with existing sleep problems or those who were vulnerable to the same were the ones affected by CoVID-19 pandemic. Those with inadequate emotional coping styles have showed heightened vulnerability. Proper medical and cognitive interventions are highly recommended for this population. No or moderate dyssomnia categories (class 3 and 2 respectively) were less impacted by CoVID-19.
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Affiliation(s)
- Arathi Radhakrishnan
- Centre for Consciousness Studies, Department of Neurophysiology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Ramajayam Govindaraj
- Centre for Consciousness Studies, Department of Neurophysiology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Arun Sasidharan
- Centre for Consciousness Studies, Department of Neurophysiology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - P N Ravindra
- Centre for Consciousness Studies, Department of Neurophysiology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Bindu M Kutty
- Centre for Consciousness Studies, Department of Neurophysiology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India.
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266
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Hashemzadeh I, Marquez-Arrico JE, Hashemzadeh K, Navarro JF, Adan A. Circadian Functioning and Quality of Life in Substance Use Disorder Patients With and Without Comorbid Major Depressive Disorder. Front Psychiatry 2021; 12:750500. [PMID: 34777054 PMCID: PMC8586202 DOI: 10.3389/fpsyt.2021.750500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/27/2021] [Indexed: 01/04/2023] Open
Abstract
Aim: Although a relationship between circadian disruption and development of several psychiatric disorders, such as major depressive disorder (MDD) and substance use disorder (SUD), has been observed, knowledge on this area is scarce yet. Therefore, this study aims to analyze the circadian functioning and quality of life (QOL) in SUD patients with and without comorbid MDD, two highly prevalent clinical entities with difficult therapeutic management. Methods: One hundred sixty-three male patients under treatment, 81 with SUD and 82 with SUD comorbid major depressive disorder (SUD + MDD), were evaluated. For the circadian functioning assessment, we calculated Social Jet Lag (SJL) and used the reduced Morningness-Eveningness Questionnaire (rMEQ) and the Pittsburgh Sleep Quality Index (PSQI). QOL was measured using the shortened version of the World Health Organization's Quality of Life Questionnaire (WHOQOL-BREF). We collected sociodemographic and clinical variables to evaluate their possible influence on the circadian functioning. Intergroup differences among the variables were examined by different analyses of covariance (ANCOVA and MANCOVA). The possible relationships of quantitative clinical variables with rMEQ, PSQI, and WHOQOL-BREF were explored using bivariate correlation analysis. Results: Lower SJL appears in the SUD + MDD group compared with SUD. The intermediate-type was more prevalent in the SUD group, while a higher percentage of morning-type patients was found in the SUD + MDD. Sleep quality (including latency and daytime dysfunction) was worse for SUD + MDD patients than for SUD even after controlling age and age of SUD onset variables. Last, QOL was poorer in patients with SUD + MDD and, for them, psychological health had a negative relationship with SJL and severity of depression. Conclusions: Our data support and extend previous findings indicating that SUD + MDD is associated with worse clinical characteristics, more sleep problems, and poorer QOL than SUD patients. These results underline the importance of a precise assessment of these measurements in future studies conducted in SUD patients with/without MDD comorbidity that could be considered from a therapeutic point of view.
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Affiliation(s)
- Iman Hashemzadeh
- Department of Clinical Psychology and Psychobiology, School of Psychology, University of Barcelona, Barcelona, Spain
| | - Julia E Marquez-Arrico
- Department of Clinical Psychology and Psychobiology, School of Psychology, University of Barcelona, Barcelona, Spain
| | - Kosar Hashemzadeh
- Department of Psychology, Fasa Branch, Islamic Azad University, Fasa, Iran
| | | | - Ana Adan
- Department of Clinical Psychology and Psychobiology, School of Psychology, University of Barcelona, Barcelona, Spain.,Institute of Neurosciences, University of Barcelona, Barcelona, Spain
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267
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Singh S, Jadhav S, Subramanyam A, Raut N. A study of quality of sleep, quality of life, and cognition in elderly: Healthy control, depressed and with mild neurocognitive disorder. JOURNAL OF GERIATRIC MENTAL HEALTH 2021. [DOI: 10.4103/jgmh.jgmh_35_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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268
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Cellini N, Conte F, De Rosa O, Giganti F, Malloggi S, Reyt M, Guillemin C, Schmidt C, Muto V, Ficca G. Changes in sleep timing and subjective sleep quality during the COVID-19 lockdown in Italy and Belgium: age, gender and working status as modulating factors. Sleep Med 2020; 77:112-119. [PMID: 33348298 PMCID: PMC9183798 DOI: 10.1016/j.sleep.2020.11.027] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/18/2020] [Accepted: 11/29/2020] [Indexed: 01/16/2023]
Abstract
Italy and Belgium have been among the first western countries to face the Coronavirus disease 2019 (COVID-19) emergency, imposing a total lockdown over the entire national territories. These limitations have proven effective in slowing down the spread of the infection. However, the benefits obtained in public health have come with huge costs in terms of social, economic, and psychological well-being. In the current study, we aimed to investigate how the period of home confinement affected self-reported sleep characteristics in Italians and Belgians, with special regard to sleep timing and subjective quality. Using an online survey we collected data from 2272 participants, 1622 Italians (Mage = 34.1 ± 13.6 years, 1171 F), and 650 Belgian (Mage = 43.0 ± 16.8 years, 509 F). Participants reported their sleep pattern (eg, bedtime, risetime) and perceived sleep quality during and, retrospectively, before the lockdown. During the lockdown, sleep timing was significantly delayed, time spent in bed increased, and sleep quality was markedly impaired in both Italians and Belgians. The most vulnerable individuals appeared to be women, subjects experiencing a more negative mood, and those perceiving the pandemic situation as highly stressful. However, the two samples differed in the subgroups most affected by the changes, possibly because of the different welfare systems of the two countries. In fact, in the Italian sample sleep quality and timing underwent significant modifications especially in unemployed participants, whereas in the Belgian sample this category was the one who suffered less from the restrictions. Considering that the novel coronavirus has spread across the whole globe, involving countries with different types of health and welfare systems, understanding which policy measures have the most effective protective role on physical and mental health is of primary importance.
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Affiliation(s)
- Nicola Cellini
- Department of General Psychology, University of Padova, Padova, Italy; Department of Biomedical Sciences, University of Padova, Padova, Italy; Padova Neuroscience Center, University of Padova, Padova, Italy; Human Inspired Technology Center, University of Padova, Padova, Italy.
| | - Francesca Conte
- Department of Psychology, University of Campania "L. Vanvitelli", Caserta, Italy
| | - Oreste De Rosa
- Department of Psychology, University of Campania "L. Vanvitelli", Caserta, Italy
| | - Fiorenza Giganti
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Firenze, Firenze, Italy
| | - Serena Malloggi
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Firenze, Firenze, Italy
| | - Mathilde Reyt
- GIGA-Cyclotron Research Centre-In Vivo Imaging, University of Liège, Liège, Belgium; Psychology and Cognitive Neuroscience Research Unit, University of Liège, Liège, Belgium
| | - Camille Guillemin
- GIGA-Cyclotron Research Centre-In Vivo Imaging, University of Liège, Liège, Belgium; Psychology and Cognitive Neuroscience Research Unit, University of Liège, Liège, Belgium
| | - Christina Schmidt
- GIGA-Cyclotron Research Centre-In Vivo Imaging, University of Liège, Liège, Belgium; Psychology and Cognitive Neuroscience Research Unit, University of Liège, Liège, Belgium
| | - Vincenzo Muto
- GIGA-Cyclotron Research Centre-In Vivo Imaging, University of Liège, Liège, Belgium; Psychology and Cognitive Neuroscience Research Unit, University of Liège, Liège, Belgium
| | - Gianluca Ficca
- Department of Psychology, University of Campania "L. Vanvitelli", Caserta, Italy
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269
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Stress-induced sleep-like inactivity modulates stress susceptibility in mice. Sci Rep 2020; 10:19800. [PMID: 33188274 PMCID: PMC7666172 DOI: 10.1038/s41598-020-76717-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/28/2020] [Indexed: 11/09/2022] Open
Abstract
Severe environmental and social stress induces dysregulation of sleep along with mood and cognitive disturbances. However, the role and mechanism of this sleep dysregulation remain elusive. Here we evaluated sleep-like inactivity measured by voluntary movements and its relationship to social behaviors in mice without or with social defeat stress as well as the stressed mice with subsequent sleep deprivation. Social defeat stress immediately induced sleep-like inactivity with decreased body temperature. In the social interaction test, the control mice showed high social interest and its correlation with social sniffing intensity, the latter of which indicates positive valence of social sniffing. After the stress, these social characteristics were maintained in stress-resilient mice, but disrupted in stress-susceptible mice, leading to social avoidance. Sleep deprivation after the stress decreased social sniffing intensity along with reduced social interest, but enhanced the exploratory activity with the positive valence of social sniffing. We also found by c-Fos immunohistochemistry that the stress activated sleep-related brain regions, the dorsomedial hypothalamus and ventrolateral periaqueductal gray. Collectively, these findings show that stress activates sleep-related brain regions and induces sleep-like inactivity, contributing to multiple roles of stress-induced sleep for social behaviors.
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270
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Waite F, Kabir T, Johns L, Mollison J, Tsiachristas A, Petit A, Černis E, Maughan D, Freeman D. Treating sleep problems in young people at ultra-high-risk of psychosis: study protocol for a single-blind parallel group randomised controlled feasibility trial (SleepWell). BMJ Open 2020; 10:e045235. [PMID: 33172953 PMCID: PMC7656948 DOI: 10.1136/bmjopen-2020-045235] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/06/2020] [Accepted: 10/07/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Effective interventions, targeting key contributory causal factors, are needed to prevent the emergence of severe mental health problems in young people. Insomnia is a common clinical issue that is problematic in its own right but that also leads to the development and persistence of psychotic experiences. The implication is that treating sleep problems may prevent the onset of psychosis. We collected initial case series data with 12 young people at ultra-high-risk of psychosis. Post-intervention, there were improvements in sleep, depression and psychotic experiences. Now we test the feasibility of a randomised controlled trial, with a clinical aim to treat sleep problems and hence reduce depression, psychotic experiences, and prevent transition to psychosis. METHODS AND ANALYSIS A randomised controlled feasibility trial will be conducted. Forty patients aged 14 to 25 years who are at ultra-high-risk of psychosis and have sleep disturbance will be recruited from National Health Service (NHS) mental health services. Participants will be randomised to receive either a novel, targeted, youth-focussed sleep intervention in addition to usual care or usual care alone. Assessor-blinded assessments will be conducted at baseline, 3 months (post-intervention) and 9 months (follow-up). The eight-session psychological intervention will target the key mechanisms which disrupt sleep: circadian rhythm irregularities, low sleep pressure, and hyperarousal. To gain an in-depth understanding of participants' views on the acceptability of the intervention and study procedures, 16 participants (n=10 intervention, n=6 control) will take part in qualitative interviews. Analyses will focus on feasibility outcomes (recruitment, retention, and treatment uptake rates) and provide initial CI estimates of intervention effects. Thematic analysis of the qualitative interviews will assess the acceptability of the intervention and trial procedures. ETHICS AND DISSEMINATION The trial has received ethical approval from the NHS Health Research Authority. Findings will be disseminated through peer-reviewed publications, conference presentations, and lay networks. TRIAL REGISTRATION NUMBER ISRCTN85601537.
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Affiliation(s)
- Felicity Waite
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, Oxfordshire, UK
| | | | - Louise Johns
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - Jill Mollison
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Apostolos Tsiachristas
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK
| | - Ariane Petit
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Emma Černis
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - Daniel Maughan
- Oxford Health NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - Daniel Freeman
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, Oxfordshire, UK
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271
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Sleep Disturbances in Patients with Persistent Delusions: Prevalence, Clinical Associations, and Therapeutic Strategies. Clocks Sleep 2020; 2:399-415. [PMID: 33118525 PMCID: PMC7711969 DOI: 10.3390/clockssleep2040030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/12/2020] [Accepted: 10/12/2020] [Indexed: 11/17/2022] Open
Abstract
Sleep disturbances accompany almost all mental illnesses, either because sound sleep and mental well-being share similar requisites, or because mental problems lead to sleep problems, or vice versa. The aim of this narrative review was to examine sleep in patients with delusions, particularly in those diagnosed with delusional disorder. We did this in sequence, first for psychiatric illness in general, then for psychotic illnesses where delusions are prevalent symptoms, and then for delusional disorder. The review also looked at the effect on sleep parameters of individual symptoms commonly seen in delusional disorder (paranoia, cognitive distortions, suicidal thoughts) and searched the evidence base for indications of antipsychotic drug effects on sleep. It subsequently evaluated the influence of sleep therapies on psychotic symptoms, particularly delusions. The review’s findings are clinically important. Delusional symptoms and sleep quality influence one another reciprocally. Effective treatment of sleep problems is of potential benefit to patients with persistent delusions, but may be difficult to implement in the absence of an established therapeutic relationship and an appropriate pharmacologic regimen. As one symptom can aggravate another, comorbidities in patients with serious mental illness all need to be treated, a task that requires close liaison among medical specialties.
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272
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Affiliation(s)
- Joseph Firth
- Division of Psychology and Mental Health, University of Manchester, Manchester, U.K. (Firth); NICM Health Research Institute, Western Sydney University, Westmead, Australia (Firth); MRC Integrative Epidemiology Unit, University of Bristol, and Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, U.K. (Wootton); Department of Psychiatry, University of Toronto, and Centre for Addiction and Mental Health, Toronto (Carvalho)
| | - Robyn E Wootton
- Division of Psychology and Mental Health, University of Manchester, Manchester, U.K. (Firth); NICM Health Research Institute, Western Sydney University, Westmead, Australia (Firth); MRC Integrative Epidemiology Unit, University of Bristol, and Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, U.K. (Wootton); Department of Psychiatry, University of Toronto, and Centre for Addiction and Mental Health, Toronto (Carvalho)
| | - Andre F Carvalho
- Division of Psychology and Mental Health, University of Manchester, Manchester, U.K. (Firth); NICM Health Research Institute, Western Sydney University, Westmead, Australia (Firth); MRC Integrative Epidemiology Unit, University of Bristol, and Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, U.K. (Wootton); Department of Psychiatry, University of Toronto, and Centre for Addiction and Mental Health, Toronto (Carvalho)
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273
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Salehinejad MA, Majidinezhad M, Ghanavati E, Kouestanian S, Vicario CM, Nitsche MA, Nejati V. Negative impact of COVID-19 pandemic on sleep quantitative parameters, quality, and circadian alignment: Implications for health and psychological well-being. EXCLI JOURNAL 2020; 19:1297-1308. [PMID: 33192213 PMCID: PMC7658458 DOI: 10.17179/excli2020-2831] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 09/08/2020] [Indexed: 12/12/2022]
Abstract
The COVID-19 pandemic has spread worldwide, affecting millions of people and exposing them to home quarantine, isolation, and social distancing. While recent reports showed increased distress and depressive/anxiety state related to COVID-19 crisis, we investigated how home quarantine affected sleep parameters in healthy individuals. 160 healthy individuals who were in home quarantine in April 2020 for at least one month participated in this study. Participants rated and compared their quantitative sleep parameters (time to go to bed, sleep duration, getting-up time) and sleep quality factors, pre-and during home quarantine due to the COVID-19 pandemic. Furthermore, participants' chronotype was determined to see if sleep parameters are differentially affected in different chronotypes. Time to fall asleep and get-up in the morning were significantly delayed in all participants, indicating a significant circadian misalignment. Sleep quality was reported to be significantly poorer in all participants and chronotypes. Poor sleep quality included more daily disturbances (more sleep disturbances, higher daily dysfunctions due to low quality of sleep) and less perceived sleep quality (lower subjective sleep quality, longer time taken to fall asleep at night, more use of sleep medication for improving sleep quality) during home quarantine. Home quarantine due to COVID-19 pandemic has a detrimental impact on sleep quality. Online interventions including self-help sleep programs, stress management, relaxation practices, stimulus control, sleep hygiene, and mindfulness training are available interventions in the current situation.
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Affiliation(s)
- Mohammad Ali Salehinejad
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany.,Institute for Cognitive & Brain Sciences, Shahid Beheshti University, Tehran, Iran
| | | | - Elham Ghanavati
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany.,Department of Psychology, Ruhr-University Bochum, Bochum, Germany
| | | | - Carmelo M Vicario
- Department of Cognitive Sciences, University of Messina, Messina, Italy
| | - Michael A Nitsche
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany.,Department of Neurology, University Medical Hospital Bergmannsheil, Bochum, Germany
| | - Vahid Nejati
- Department of Psychology, Shahid Beheshti University, Tehran, Iran
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