An intervention designed to target sleep pressure, circadian rhythms and hyperarousal through a series of hour-long sessions with a psychologist could be beneficial for adolescents and young adults at very high risk of psychosis, according to a new study. Clinical application may be possible.1
Proof-of-concept data from a research team at the University of Oxford show that the psychological SleepWell intervention under investigation has been shown to reduce insomnia and other symptoms when combined with usual care in participants aged 14-25 years undergoing psychiatric treatment. were associated with reduced sleep disturbances and psychotic experiences. medical service.
The results suggest that targeted interventions may be an effective treatment for sleep problems in young mental health patients who are most at risk of psychosis.
The interplay between sleep and mental health is powerful and well-documented.in an interview with HCP Live Last year, Gina Poe, Ph.D., Eleanor Leslie Professor of Innovative Brain Research at UCLA, found that a factor that significantly impacts sleep health in people with psychiatric illness is the transition of sleep spindles to the rapid eye movement (REM) phase, in which sleep spindles occur. described as a transition. And the brain is essentially “reformatted and updated with new information.”2
“It’s very important for mental health,” explained Poe. “For example, people with schizophrenia have few, very small or short sleep spindles.” In fact, she suggests that restoring sleep spindles in such patients may benefit memory and learning. It cited a study from a Boston lab that showed that
Researchers led by Dr. Felicity Waite, DClinPsy, BSc, Department of Experimental Psychology, University of Oxford Realize a Randomized Controlled Trial Evaluating the Benefits of Sleepwell for Reducing Psychotic Experiences in Very High-Risk Adolescents and Young Adults sought to establish feasibility and acceptability. psychosis. They further aimed to provide a proof-of-concept of potential clinical efficacy with SleepWell.
The SleepWell intervention is delivered by a psychologist, undergoes weekly clinical supervision, and aims to promote daytime activity in patients, resulting in greater nighttime fatigue. This is accomplished by encouraging daily movement and exercise through wearable technology feedback and establishing morning routines that improve the patient’s circadian rhythm.
Identified very high-risk young mental health patient populations often experience poor outcomes with depression and other conditions. Current treatments for these patients are limited, and new approaches are needed, Waits et al. write.
The researchers concluded that “the occurrence of non-specific sleep disturbances common to mental health problems may have special implications when considered from a network perspective. is understood to reflect a dynamic network of interacting symptoms.” “This means that targeting these common factors may result in fewer specific treatment goals and benefits across a network of symptoms.”
The research team conducted a parallel-group, single-blind, randomized, controlled feasibility assessment across two UK National Health Service (NHS) trusts. Eligible patients were aged 14-25 years, had a history of mental health service use, and were deemed to be at very high risk of psychosis by a comprehensive assessment of risk mental status. In addition, the patient had a self-reported Insomnia Severity Index (ISI) score greater than or equal to her 15 and had current sleep disturbances.
The researchers randomized patients 1:1 to SleepWell plus usual care or usual care alone. Patients randomly assigned to the intervention program received approximately 8-hour sessions over 12 weeks. Waite et al. evaluated patient outcomes at 0, 3, and 9 months. Key feasibility component outcomes include patient identification, recruitment, retention, treatment acceptance, and data completion. Treatment acceptability was measured according to the Abbreviate Acceptability Rating Profile (AARP).
Regarding clinical component outcomes, the team sought safety outcomes in all patients with insomnia as the primary endpoint at 3 and 9 months per ISI.
The team examined 67 young patients in mental health care from November 2020 to January 2022. Of these, 40 (60%) were included in the study because they were at very high risk of psychosis. The mean age of patients was 16.9 years, and 19 patients (48%) were identified as male or female, respectively. The majority of patients were Caucasian (80%). The researchers randomly assigned 21 patients to sleepwell and 19 to single usual care.
All but one patient (98%) completed the primary outcome assessment at 3 and 9 months. All patients provided data at one or more of her follow-up visits. Another 20 (95%) of her patients in the SleepWell group received her 4 or more sessions of the prespecified minimum therapeutic dose.
The median treatment acceptability per AARP was 48, the maximum score possible on this scale. Regarding clinical outcomes, the SleepWell intervention group had a reduction in the severity of insomnia at 3 months compared to usual care (ISI mean difference, -8.12, 95% CI, -11.60 to -4.63). reported. This difference persisted after 9 months (ISI-adjusted mean difference, -5.83; 95% CI, -3.81 to -1.52).
Regarding safety outcomes, 8 adverse events were reported in 6 participants, 4 (19%) of whom received SleepWell. He had one serious adverse event in his SleepWell group leading to hospitalization. Another patient in the sole usual care unit transitioned to psychosis. Neither event was related to study treatment or procedures.
The investigators concluded the randomized controlled trial of Sleepwell as a potentially viable targeted psychological sleep therapy for young patients at very high risk of psychosis.
“Patients may continue to participate in the trial and be evaluated by a masked rater,” they wrote. “We found preliminary evidence of a high uptake of sleep therapy and a sustained reduction in sleep disturbances. Definitive multicenter trials are now needed.”
- Waite F, Chernis E, Kabir T, et al. Targeted psychotherapy for sleep problems in young people at very high risk of psychosis in the UK (SleepWell): a parallel-group, single-blind, randomized controlled feasibility study. Lancet Psychiatry. 2023;10(9):706-718. Doi: 10.1016/S2215-0366(23)00203-1
- Kunzmann K. Gina Poe, Ph.D.: Impact of mental illness on sleep health. HCP Live. Published May 27, 2022. https://www.hcplive.com/view/gina-poe-how-psychiatric-diseases-impact-sleep-health