Sleep and Mental Health: A research update
Whilst it is common knowledge that poor sleep and mental health are linked, there is much still to be discovered about the prevalence, assessment, and treatment of sleep problems. Dr Sophie Faulkner gives us the latest updates in sleep and mental health research at GMMH.
In this article:
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Information about the L-DART sleep study and recently published research
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Watch our video about Obstructive Sleep Apnoea and its treatments
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Watch presentations from the ‘Closing the Sleep Gap’ event
Research tells us that people with severe mental illnesses have much higher rates of sleep disorders than the general population. This leads to even larger physical health inequalities such as obesity, diabetes, and poor cardiovascular health. This is what we call the ‘sleep gap’.
It has long been thought that poor sleep was a side effect of mental health problems. However, we now know that poor sleep can impact or contribute to the development of mental health problems, as well as hinder recovery.
There is a lack of evidence-based treatments for poor sleep experienced by people with mental illness, and – both in specialist mental health services and general practice – clinicians often lack confidence or training in how to assess and treat sleep problems in this group of people. Whist we may be aware of the frequency of these problems, identifying the type of sleep problem which may lead to better diagnosis.
Sleep research has advanced significantly in recent years, and we want to make sure that clinical staff have the information that they need to help reduce health inequalities for people with severe mental illness.
L-DART sleep study
Light-Dark and Activity Rhythm Therapy (L-DART) is a twelve-week therapy delivered by an occupational therapist. It was originally designed to improve sleep in people with a schizophrenia spectrum disorder – a group of which over 50% experience sleep problems – but there is potential for it to be relevant for people with other mental health problems too.
L-DART is a therapy that takes into account the service user’s behaviours around sleep, light and activities to create a personalised programme that includes observing and making changes to:
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The level of light they are exposed to at various points across the day
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The type and timing of activities
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A person’s sleep schedule
The therapy incorporates some elements of Cognitive Behavioural Therapy (CBT) for insomnia, including sleep scheduling, avoiding or reducing naps, and increasing the association of bed with sleep through ‘stimulus control’. Using current knowledge of our circadian rhythms, L-DART looks to change light exposure and activity patterns to treat sleep disorders.
A small initial study of L-DART was carried out in 2021 across people with a range of different sleep problems. The study measured rest activity patterns with a smartwatch, ambient light with sensors, as well as a questionnaire to measure sleep, mental health and wellbeing. These measures were taken before therapy, during the therapy programme and after 6 months with a view to seeing if a larger research study would be possible.
Finding participants for the study was extremely fast and no participants dropped out of the study during the programme, indicating a need for more sleep therapies and research. Overall, participants were satisfied with the therapy and indicated they would recommend it to someone else with a similar problem. Whilst this was a small study to see whether participants would take part in L-DART and stick with the therapy, it makes a case for a larger study to be done, to test whether the therapy is effective.
A recent study carried out by researchers at GMMH and University of Manchester examined the attitudes and challenges that mental health staff and service users have in taking up therapies such as L-DART.
Two linked surveys were undertaken, one looking at sleep problems and treatment wishes, and the other looking at barriers and facilitators to receiving therapies such as L-DART. The results showed that there was a demand for non-medicinal treatments such as behavioural therapy across the board.
However, the awareness and understanding of sleep disorders were surprisingly different between service users and staff. The studies found that on average staff under-reported sleep problems such as hypersomnia, night-eating and obstructive sleep apnoea (OSA) compared to insomnia-related problems. The surveys indicated that there is a need for sleep education among staff to provide greater confidence to identify and address sleep problems.
You can read this research here (open access): Faulkner, S.M., Drake, R.J., Eisner, E. et al. Sleep problems and referral intentions in mental health services: service user self-report and staff proxy report surveys. BMC Psychiatry 23, 583 (2023). https://doi.org/10.1186/s12888-023-04817-6
Obstructive Sleep Apnoea
Our research has shown that sleep apnoea, a potentially serious condition in which people repeatedly stop breathing while sleeping, may be under-detected in people with mental illness. Mental health staff reported 1.1% of their clients had Obstructive Sleep Apnoea (OSA) compared to 7.4% of service users.
When it is detected (or suspected by a partner or carer), many service users are hesitant to have an assessment due to their beliefs and expectations about what the assessment may include, or how invasive treatments can be.
David Jones, Sleep Service Manager at MFT, and GMMH’s Sophie Faulkner, Occupational Therapist and Sleep Researcher, explain what OSA is, why it’s important to get tested, and busts some of the myths around getting assessed and treated for OSA.
Including testimonials from service users, this video also explains what treatment there is for people who are diagnosed with sleep apnoea and how this could help you get a better night’s sleep.
Closing the Sleep Gap event
Closing the Sleep Gap in Mental Health event on 13th January 2023 for clinicians who work with people with serious mental health problems, including in specialist mental health services, primary care, and general practice. The event was run by researchers from GMMH, Newcastle-upon-Tyne NHS Foundation Trust and funded by the Knowledge Mobilisation award from the Closing the Gap Network.
Sleep – What is it and why do we do it?
Dr Hugh Selsick, Consultant in Psychiatry and Sleep Medicine, Insomnia and Behavioural Sleep Medicine Clinic, UCLH
Sleep Disorders
Dr Kirstie Anderson, Consultant Neurologist, Regional Sleep Service at Newcastle-upon-Tyne NHS Foundation Trust
Obstructive Sleep Apnoea in people living with schizophrenia
Dr Megan Kalucy, Psychiatrist at the University of New South Wales in Sydney
Obstructive Sleep Apnoea and Bipolar Disorder
Dr Guillermo Perez Algorta and Dr Amy Brown from the Division of Health Research at Lancaster University
Insomnia Treatment
Louise Berger, Occupational Therapist and Insomnia Service Lead at Royal Surrey NHS Foundation Trust
Circadian Rhythm and Sleep-Wake Disorders and their Treatment
Bryn Morris, Senior Sleep Physiologist from Wythenshawe/Trafford General Hospital
Sleep Related Beliefs
Dr Lydia Pearson, Research Associate, JUICE (Youth Mental Health Research Unit) and Trial Manager for BARTII, Greater Manchester Mental Health NHS Foundation Trust
Hypersomnia
Dr Lydia Pearson, Research Associate, JUICE (Youth Mental Health Research Unit) and Trial Manager for BARTII, Greater Manchester Mental Health NHS Foundation Trust
Dr Sophie Faulkner, Specialist Occupational Therapist Researcher, GMMH
Sleep Scales and Measurement
Dr Lydia Pearson, Research Associate, JUICE (Youth Mental Health Research Unit) and Trial Manager for BARTII, Greater Manchester Mental Health NHS Foundation Trust
Dr Katy Bourne, Clinical Psychologist, GMMH
Dr Sophie Faulkner, Specialist Occupational Therapist Researcher, GMMH
Effects of Psychiatric Medications on Sleep
Dr Hugh Selsick, Consultant in Psychiatry and Sleep Medicine, Insomnia and Behavioural Sleep Medicine Clinic, UCLH
