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

Abstract

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.

The experience of sleep problems for adolescents with depression in short-term psychological therapy

“…Experiences of insomnia were characterised by a surge of negative thoughts and feelings at bedtime, caused by a lack of distraction. This is consistent with previous findings suggesting that bedtime rumination causes difficulties falling asleep (Conroy, et al, 2017;Waite, et al, 2018), although a lack of distraction has not previously been highlighted as the potential mechanism.…”

“…A few studies have examined features of treatment that might improve sleep problems in adolescents with mental health difficulties (Conroy et al, 2017;Waite et al, 2018). For example, Waite et al (2018) found that adolescents improved their sleep by learning more about sleep hygiene.…”

Do sleep disturbances contribute to cognitive impairments in schizophrenia spectrum and bipolar disorders?

“…However, further support for the early presence and persistence of sleep disturbances comes from studies in bipolar disorder suggesting sleep disturbances are evident before illness onset ) and persistent over a 5-year study period (Kanady et al, 2015) and from studies in early psychosis in schizophrenia . Also, research investigating the role of sleep disturbance in individuals with an ultra-high risk for development of psychosis is emerging, pointing to the importance of addressing and treating sleep disturbances early on (Lunsford-Avery et al, 2017; F. Waite et al, 2018;Zanini et al, 2015). Still there is an urgent need for more research on sleep disturbances in the early phases of severe mental disorders, and to firmly establish their potential as an early intervention target (Bradley et al, 2018;.…”

Treating sleep problems in young people at ultra-high-risk of psychosis: study protocol for a single-blind parallel group randomised controlled feasibility trial (SleepWell)

“…In qualitative interviews, participants described achieving meaningful change in both sleep and well-being by developing a 'repertoire of skills'. 29 The treatment now requires testing in a randomised trial to determine the effects on psychotic experiences and the potential to prevent the onset of psychosis.…”