Lecture 14 - Insomnia, Sleep, and Mental Health

Question 1

What percentage of australians experience insomnia?

Answer 1

10%

Question 2

Is insomnia higher in adolescence or later adulthood?

Answer 2

Later adulthood.

Question 3

Is there a bidirectional relationship between mental health and sleep?

Answer 3

Yes, those with insomnia are more likely to develop mood disorders.

There is high comorbidity for insomnia and psychiatric disorders.

Question 4

What are the DSM-5 criteria for insomnia disorder?

Answer 4

Difficulty falling asleep.
Difficulty staying asleep.
Waking too early.

Occurs 3 plus nights a week for 3 plus months.

Question 5

What is the hyperarousal hypothesis of insomnia?

Answer 5

People are unable to sleep due to having higher than normal levels of arousal.

Question 6

What differences are seen in those with insomnia in their cortical and physiological arousal?

Answer 6

Cortical arousal:
Subjective experience of a ‘busy mind that won’t shut off’.
Increased sensory perception when going to sleep, such as hearing every little noise in the house.
Increased arousal levels as measured by EEG.

Physiological arousal:
Increased heart rate during pre-sleep and sleep.
Increased sympathetic and decreased parasympathetic activity at night.
Less heart rate variability during the day.
Higher metabolic rate for the whole body.
Increased body temp for elderly people.
Increased night time cortisol levels.

Question 7

What are some of the treatments for insomnia?

Answer 7

Most people who speak with their GP about insomnia get prescribed medication. However, most medication for insomnia is not recommended for use over 4 weeks.

CBTi is the first form of treatment by psychologists and sleep specialists.

Question 8

Is CBTi as effective as sleep medication in the short term?

Answer 8

Yes.
CBTi is as effective as medication in the treatment of insomnia in the short term, but much more effective as a treatment than medication in the long term.

Question 9

Is sleep hygiene a key component of CBTi?

Answer 9

Sleep hygiene one component of CBTi, however, it is not the key component.

Question 10

What are some of the key components of CBTi?

Answer 10

Control stimulus - the bedroom and bed is only for sleep and sex. If you cannot sleep leave the bed/bedroom.

Restricting sleep to when you sleep - only staying in bed when you are sleeping. Reducing amount of time in bed awake and increasing percentage of time in bed asleep.

Relaxation - finding ways, such as mediation, to relax mind and body.

Cognitive - restructuring undesired thinking patterns, such as worrying about you are going to cope the following day.

Question 11

Is it true that CBTi can bring people from sever insomnia to subthreshold levels within 6 sessions?

Answer 11

Yes.

Question 12

Is REM thought to be key for emotional processing?

Answer 12

Yes. Those who are deprived of REM show reduce emotional regulation.

Question 13

What change in sleep architecture is depression often associated with?

Answer 13

Reduced TST (total sleep time).
Reduced SE (Sleep efficiency).
Reduced Slow wave sleep (SWS).

Increased sleep onset latency (SOL).
Increased percentage of time spent in REM. People often report experiencing vivid and intense dreams. (I can relate to this).

Reduced REM latency (go into REM sooner than normal).

Question 14

In a study that looked at those with major depressive disorder and comorbid insomnia, what did they find with regards to remission when people were treated with an anti-depressant and CBTi or no CBTi?

Answer 14

Those who took an antidepressant and engaged in CBTi had almost double the remission rates from MDD as those who did not engage in CBTi.

Question 15

Another study found that those with comorbid depression and insomnia who JUST did CBTi had the same improvements in their depression symptoms as those who took an antidepressant.

Answer 15

True.

Question 16

Do SSRIs reduce REM?

Answer 16

Yes.

Question 17

What effect does acute sleep deprivation have on depression symptoms?

What effect does chronic sleep deprivation have on depression symptoms?

Answer 17

Acute sleep deprivation (one night of reduced sleep) seems to reduce symptoms of depression.
This may be due to body’s increased cortisol levels.

Chronic sleep deprivation increases depressive symptoms.

Question 18

How does sleep impact Bipolar or how does BD impact sleep?

Answer 18

Those with Bipolar often report sleep disturbances.

Prior to and during manic episodes there is a reduced need for sleep.

During depressive episodes there is often insomnia or hypersomnia.

Question 19

What can trigger a manic episode in those with Bipolar?

Answer 19

Periods of sleep deprivation, such as child birth, international travel, or partying.

Question 20

What is the relationship between Schizophrenia and sleep?

Answer 20

Nearly half of those with schizophrenia also have insomnia.

Often have reduced TST, and SE. Increased SOL.

They often show reduced sleep spindles during stage 2 sleep.

Question 21

Do sleep disturbances often predispose psychosis episodes in those with schizophrenia?

Answer 21

Yes.

Question 22

Has CBTi been shown to decrease symptoms of delusions?

Answer 22

Yes. Highlighting the impact of sleep on symptoms of schizophrenia, such as delusions.

Question 23

Are disturbances in circadian rhythms seen in those with schizophrenia?

Why might this be?

Answer 23

Yes.

This could be due to medications taken, lack of imposed schedules that would aid in maintaining circadian rhythms, such as work or light exposure. Or, it could be that this lack of regulation is a driver of the schizophrenic symptoms.

Question 24

What is the relationship between sleep and PTSD?

Answer 24

Bidirectional, but lack of research.

WASO (wake after sleep onset) appears to increase, especially in women.

Question 25

Adolescence are at higher risk of depression symptoms. How does changes to their sleep during this time potentially cause this increased risk of developing depression?

Answer 25

Circadian rhythms change during adolescence, as well as many other things. Adolescence naturally want to sleep later and wake up later, however, as they are required to get up for school or made to get up they often end up being sleep deprived. This increases their risk of developing depression.