Stabilising sleep for patients admitted at acute crisis to a psychiatric hospital (OWLS): an assessor-blind pilot randomised controlled trial

Abstract

BackgroundWhen patients are admitted onto psychiatric wards, sleep problems are highly prevalent. We carried out the first trial testing a psychological sleep treatment at acute admission (Oxford Ward sLeep Solution, OWLS).MethodsThis assessor-blind parallel-group pilot trial randomised patients to receive sleep treatment at acute crisis [STAC, plus standard care (SC)], or SC alone (1 : 1). STAC included cognitive–behavioural therapy (CBT) for insomnia, sleep monitoring and light/dark exposure for circadian entrainment, delivered over 2 weeks. Assessments took place at 0, 2, 4 and 12 weeks. Feasibility outcomes assessed recruitment, retention of participants and uptake of the therapy. Primary efficacy outcomes were the Insomnia Severity Index and Warwick–Edinburgh Mental Wellbeing Scale at week 2. Analyses were intention-to-treat, estimating treatment effect with 95% confidence intervals.ResultsBetween October 2015 and July 2016, 40 participants were recruited (from 43 assessed eligible). All participants offered STAC completed treatment (mean sessions received = 8.6, s.d. = 1.5). All participants completed the primary end point. Compared with SC, STAC led to large effect size (ES) reductions in insomnia at week 2 (adjusted mean difference −4.6, 95% CI −7.7 to −1.4, ES −0.9), a small improvement in psychological wellbeing (adjusted mean difference 3.7, 95% CI −2.8 to 10.1, ES 0.3) and patients were discharged 8.5 days earlier. One patient in the STAC group had an adverse event, unrelated to participation.ConclusionsIn this challenging environment for research, the trial was feasible. Therapy uptake was high. STAC may be a highly effective treatment for sleep disturbance on wards with potential wider benefits on wellbeing and admission length.

The role of psychology in a multidisciplinary psychiatric inpatient setting: Perspective from the multidisciplinary team

“…Collectively, this demonstrates the importance of psychology having clear guidelines for inpatient teams about the full remit of psychology and what can be delivered, particularly for those experiencing psychosis, and developing a better dialogue with their multidisciplinary colleagues. This could include the promotion of adapted psychological therapies, which have been shown to be feasible and acceptable with this population (Sheaves et al ., ; Wood, Byrne, Enache, & Morrison, ).…”

Perspectives in affective disorders: Clocks and sleep

“…Here, we can use light, and/or melatonin, regular exercise and mealtimes, sleep stabilisation (in other words, increase zeitgeber strength). Cognitive behavioural therapy (CBT) for insomnia has entered psychiatric practice as a useful tool to emphasise the importance of sleep hygiene (e.g., (Sheaves et al., ). Such a CBT programme focused on sleep or sleep education could be a straightforward adjunct to other therapies.…”

The Experience of Sleep Problems and Their Treatment in Young People at Ultra-High Risk of Psychosis: A Thematic Analysis

“…Importantly, improving sleep has been shown to result in additional benefits on mental health outcomes including anxiety, depression, psychotic experiences, and psychological wellbeing (12–14). However, CBTi has not been adequately tested in young people, either for its effects on sleep disturbance or potential wider effects on mental health outcomes.…”