The experience of sleep problems and their treatment in young people at ultra-high risk of psychosis: A thematic analysis

We view sleep disruption as a contributory causal factor in the development of psychotic experiences. Clinical trials indicate that psychological interventions targeting insomnia result in improvements in both sleep and psychotic experiences. The aim of this study was to gain the perspective of young people at ultra-high risk of psychosis on their sleep problems and associated psychological treatment. Interviews were conducted with 11 patients, aged 15–22 years, at ultra-high risk of psychosis who had received a psychological sleep intervention. Responses were analyzed using thematic analysis. Disrupted sleep timing and a lack of routine were the characteristic hallmarks of participants' sleep problems. Sleep disturbance, psychological wellbeing, and functioning had a reciprocal relationship. There were negative expectations prior to therapy, however meaningful improvements occurred in sleep, mood, and functioning. The active implementation of therapy techniques was highlighted as important. These findings indicate that the treatment of sleep problems is highly valued and has a meaningful impact on wellbeing in young people at ultra-high risk of psychosis

Sleep disorders in attention-deficit hyperactivity disorder and autism spectrum disorder : A pragmatic approach to assessment and management

Sleep is essential for survival and humans spend approximately one-third of their life asleep. Adequate sleep is needed to maintain both physical and psychological health. Routinely getting less than the recommended amount of sleep for your age can have profound negative effects on health, such as increasing the likeliness of psychiatric illness, diabetes, cardiovascular disease and stroke. In children and adults with neurodevelopmental disorders, the prevalence of sleep disorders is significantly higher than in the general population. Given the relationship between sleep and psychiatric disorders, it is essential that psychiatrists have knowledge of the principles of sleep medicine. In this article, we focus on the common sleep disorders found in those with attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) and give an overview of screening, diagnosis and management

Annual Research Review: Sleep problems in childhood psychiatric disorders – a review of the latest science

Background Hippocrates flagged the value of sleep for good health. Nonetheless, historically, researchers with an interest in developmental psychopathology have largely ignored a possible role for atypical sleep. Recently, however, there has been a surge of interest in this area, perhaps reflecting increased evidence that disturbed or insufficient sleep can result in poor functioning in numerous domains. This review outlines what is known about sleep in the psychiatric diagnoses most relevant to children and for which associations with sleep are beginning to be understood. While based on a comprehensive survey of the literature, the focus of the current review is on the latest science (largely from 2010). There is a description of both concurrent and longitudinal links as well as possible mechanisms underlying associations. Preliminary treatment research is also considered which suggests that treating sleep difficulties may result in improvements in behavioural areas beyond sleep quality. Findings To maximise progress in this field, there now needs to be: (a) greater attention to the assessment of sleep in children; (b) sleep research on a wider range of psychiatric disorders; (c) a greater focus on and examination of mechanisms underlying associations; (d) a clearer consideration ofdevelopmental questions and (e) large-scale well-designed treatment studies. Conclusions While sleep problems may sometimes be missed by parents and healthcare providers; hence constituting a hidden risk for other psychopathologies – knowing about these difficulties creates unique opportunities. The current excitement in this field from experts in diverse areas including developmental psychology, clinical psychology, genetics and neuropsychology should make these opportunities a reality

Sleep Dysfunction in Adolescents at High Risk for Psychosis

Sleep dysfunction is a pervasive and distressing symptom in schizophrenia, yet little is known regarding the extent to which problematic sleep is present prior to the onset of illness, or how sleep impairment may relate to symptoms in at-risk individuals. The current thesis explores two primary aims. First, I examined whether adolescents at ultra high-risk (UHR; n = 33) for psychosis display increased sleep dysfunction (duration, continuity, latency, efficiency, total movement counts, disturbances, quality) on subjective (Pittsburgh Sleep Quality Index; PSQI) and objective (actigraphy) measures compared to healthy controls (HC; n = 33), and if present, how sleep disturbances relate to symptoms (positive, negative, disorganized) among UHR youth. Second, magnetic resonance (MRI) and diffusion tensor (DTI) imaging were employed to determine if neural structures (thalamus) and tracts (anterior thalamic radiations) underlying sleep function are abnormal in UHR adolescents compared to HC participants, and if so, how neural abnormalities relate to sleep impairment in UHR youth. An exploratory aim examined relationships between subjective and objective measures of sleep disturbance in UHR youth. Results indicated that UHR adolescents displayed increased latency, greater disturbances, decreased efficiency, disrupted continuity, and increased sleep movements compared to HC youth. Reduced duration, increased latency, and decreased quality predicted elevated negative symptoms in UHR youth, and decreased efficiency, disrupted continuity, and increased movements during sleep predicted increased positive and disorganized symptoms. Bilateral thalamus volume reductions were found in UHR compared to HC adolescents, and these abnormalities predicted increased latency, decreased efficiency, reduced sleep quality, disrupted continuity, and increased movements among UHR youth. There were no group differences in anterior thalamic radiation integrity; however, in UHR patients, integrity decreases predicted greater disturbances, reduced quality, decreased efficiency, disrupted continuity, and increased movements. UHR adolescents accurately reported sleep efficiency, and subjective report of disturbances predicted sleep movements. These results suggest that sleep dysfunction occurs during the pre-psychotic period, and may play a role in the developmental diathesis-stress cascade driving schizophrenia onset. In addition, the relationship of disrupted sleep to psychosis symptoms in UHR youth indicates that prevention and intervention strategies may be improved by targeting sleep stabilization in the pre-psychotic period

Overnight Delta Dynamics Associated with Daytime Psychomotor Performance in Adults with Insomnia and Healthy Controls.

Purpose: Sleep is vital to cognition, yet underlying mechanisms remain unclear. Although sleep duration and continuity are two well-established contributors, additional factors-including homeostatic sleep drive processes-may also underlie cognition-related sleep restoration. This study investigates the relative contributions of sleep EEG factors to psychomotor functioning in adults with insomnia and healthy controls (HC) to identify the most significant sleep factors supporting psychomotor functioning. Materials and Methods: Adults with insomnia (n = 37) and HC (n = 39) completed 3 nights of polysomnography and a complex psychomotor task (switching attention task; SAT). Univariate correlations identified the most significant predictors (traditional PSG, spectral EEG, initial delta peak, and overnight delta decline) of SAT performance, which were then entered into multivariable linear regressions examining whether predictors remained significant after accounting for shortened/fragmented sleep and whether relationships differed across groups. Results: In addition to greater wake after sleep onset (WASO; r = 0.33), a slower overnight delta decline (r = 0.50) and a lower initial delta peak (r = -0.38) were the most significant predictors of poorer SAT performance. Both overnight delta decline (F(7, 68) = 12.52, p < 0.001) and initial delta peak (F(7, 68) = 7.85, p = 0.007) remained significant predictors after controlling for demographics, total sleep time, and WASO. Relationships were analogous across subject groups. Conclusion: Findings suggest that, in addition to sleep duration and continuity, processes related to recovery from and dissipation of homeostatic sleep drive may support psychomotor performance and broadly support daytime functioning in individuals with and without insomnia. Future research may examine overnight delta dynamics as transdiagnostic processes supporting cognition-related sleep restoration across a range of clinical populations

Optimizing computation of overnight decline in delta power: Evidence for slower rate of decline in delta power in insomnia patients

ObjectiveTo determine the best of commonly used methods for computing the rate of decline in non-rapid eye movement (NREM) sleep EEG delta power overnight (Delta Decline) in terms of vulnerability to missing data and to evaluate whether this rate is slower in insomnia patients than healthy controls (HC).MethodsFifty-one insomnia patients and 53 HC underwent 6 nights of polysomnography. Four methods for estimating Delta Decline were compared (exponential and linear best-fit functions using NREM (1) episode mean, (2) peak, and (3) total delta power and (4) delta power for all available NREM epochs). The best method was applied to compare groups on linear and exponential rates of Delta Decline.ResultsBest-fit models using all available NREM epochs were significantly less vulnerable to deviation due to missing data than other methods. Insomnia patients displayed significantly slower linear and exponential Delta Decline than HC.ConclusionsComputing Delta Decline using all available NREM epochs was the best of the methods studied for minimizing the effects of missing data. Insomnia patients display slower Delta Decline, which is not explained by differences in total sleep time or wake after sleep onset.SignificanceThis study supports using all available NREM epochs in Delta Decline computation and suggests a slower rate in insomnia