Dysfunctional Cognitions about Sleep in Psychiatric Patients

Abstract

The optimal management of sleep problems is a significant challenge, particularly in patients with psychiatric illness, because disturbed sleep is a known risk factor for relapse. This study used the short Dysfunctional Beliefs and Attitudes Scale to assess beliefs about sleep in adults with acute psychiatric disorders (N=100) recruited from inpatient and outpatient clinics. The subjects showed highly dysfunctional beliefs and attitudes about sleep and held diverse opinions about, but had low confidence in, their own capacity for optimal sleep management. They did not report excessive daytime sleepiness. We conclude that individuals with acute psychiatric illness worry significantly about their sleep and hold more dysfunctional beliefs about sleep than people without psychiatric illness. The absence of excessive daytime sleepiness in this sample, although counterintuitive, is consistent with findings in other studies. Given that two thirds of the sample expressed interest in non-pharmacological strategies to better manage their sleep problems, cognitive reshaping therapies appear to have clinical potential as alternatives to hypnosedative medication once a comprehensive sleep workup has excluded a physical sleep disorder such as obstructive sleep apnea. Dysfunctional beliefs and high concern about sleep offer potential targets for psychotherapy.

Sleep Disorders Among People With Schizophrenia: Emerging Research

“…We think this is likely, based on recent research revealing that many individuals with serious mental illnesses prefer to be engaged in shared decision-making regarding mental health treatments, particularly to be offered options and asked their opinions about treatment options [72,73]. Furthermore, a recent study found that people receiving active treatment for psychiatric illnesses (e.g., schizophrenia spectrum, affective, neurotic, stress-related, and somatoform disorders) expressed a desire to partake in behavioral sleep treatments [70]. Future research is needed to investigate the specific treatments that people with schizophrenia spectrum disorders desire and how providers can collaborate with clients to optimally partake in shared decisionmaking around sleep treatment decisions in a manner that capitalizes on their self-identified needs and motivation.…”

“…Sleep plays an important role in cognitive, brain, immune, metabolic, and cardiovascular functions, each of which are generally compromised in people with schizophrenia spectrum disorders; furthermore, they find sleep disorders distressing and are motivated to try new solutions [70,71]. More research is needed to tailor and implement nonpharmacological sleep treatments to make them maximally effective in people with schizophrenia spectrum disorders, as well as examine new directions for pharmacological intervention.…”

“…Indeed, sedative-hypnotic and antipsychotic medications are typically used to treat insomnia among people with psychotic disorders [68]. Given that individuals with mental illness often express preferences in line with taking fewer medications [69] and are interested in behavioral sleep interventions [70], it is imperative that the field also study nonpharmacological approaches and that these are offered by providers. As noted above, our team and others [40,46,71] are developing guidelines for the use of CBT-I with people with psychotic disorders and testing its efficacy on insomnia, psychiatric symptoms, and functional outcomes.…”

Gender Differences in the Relationship Between Sleep Problems and Suicide Attempt in Adolescents

“…There is evidence that cognitive behavioral therapy for insomnia could be used to target suicide risk prevention and intervention (31). Moreover, dysfunctional beliefs and high concern about sleep offer potential targets for psychotherapy of mental health and suicidal behavior (34,48). In any event, further studies are required to determine whether sleep screening/interventions, incorporating global sleep problems or more specific sleep domains, are effective in suicide treatment or prevention.…”

Sleep beliefs and attitudes and the association with insomnia among psychiatric outpatients

“…There has been little research on subjective sleep experiences and beliefs among patients with various psychiatric disorders. To the best of our knowledge, a study by Huthwaite et al (2014) was the only study that explored subjective sleep experiences among patients with a range of psychiatric disorders and looked into dysfunctional sleep beliefs. Therefore to address the gaps in sleep literature, this study aimed to gain insights into dysfunctional sleep beliefs among psychiatric patients by exploring sociodemographic and clinical factors which are associated with dysfunctional sleep beliefs, and examining the associations between these beliefs and insomnia among psychiatric patients.…”