Research Mental Health Professionals Shouldn’t Sleep On

by Denis Storey
April 22, 2024 at 1:12 PM UTC

Studies explore the relationship between poor sleep quality and schizophrenia, how sleep affects mania patients, and new hope for veterans.

Clinical relevance: Studies explore the relationship between poor sleep quality and schizophrenia, how sleep affects mania patients, and new hope for veterans.

  • Poor sleep quality remains prevalent in schizophrenia patients, particularly women, leading to significant daytime functioning disturbances.
  • Mania patients with shorter sleep duration at admission endure longer hospital stays, suggesting the importance of addressing sleep duration as a treatment target.
  • Pimavanserin shows promise in treating PTSD-related insomnia in veterans, with subjective improvements in sleep quality observed during a pilot study.

With apologies to Gillian Flynn, sleep might be like a cat (it only comes when you ignore it), but it’s more like a lion when it comes to our health.

While researchers have known for years about its impact on cardiovascular disease, new research – appearing in the latest Journal of the American Heart Association –  suggests that those with uneven sleep routines bear a “higher coronary artery calcification burden” compared to those who enjoy more regular patterns.

Challenges to a decent night’s slumber also threaten our mental health, as multiple studies have shown. The Journal of Clinical Psychiatry and The Primary Care Companion for CNS Disorders both published papers over the last several months that investigate some of the links between mental health and sleep. We’ve provided summaries and links to them for further review.

Study Confirms High Prevalence of Poor Sleep Quality in Schizophrenia Patients

Most schizophrenia patients have trouble sleeping. To better understand this, researchers in Northern India launched a cross-sectional descriptive study based on 100 schizophrenia patients from a tertiary care center. 

PCC published the study findings in December 2023.

The participants filled out demographic forms, the Pittsburgh Sleep Quality Index (PSQI), and the Insomnia Severity Index (ISI). These questionnaires allowed the research team to assess each participant’s psychosis severity on the Positive and Negative Syndrome Scale (PANSS).

The study revealed that 78% of patients suffered from poor sleep quality.

Other critical findings include:

  • A high prevalence of poor sleep quality, particularly in women.
  • Significant daytime functioning disturbances.

Despite no significant association with psychopathology, researchers uncovered a link between benzodiazepine use and improved sleep quality. The study highlighted the importance of addressing these problems comprehensively in schizophrenia management.

Nevertheless, the study’s authors conceded limitations that include the recruitment of only clinically stable patients from a single center. Additionally, the study’s cross-sectional design precluded causal inference. And, finally, the research team didn’t assess cognitive function’s impact on sleep quality.

In conclusion, the study underscored the destructive effect of poor sleep quality on daytime functioning in schizophrenia patients, highlighting the need for holistic sleep management approaches. The team, however, argued for further research to explore subjective sleep quality determinants and cognitive function’s influence on sleep in schizophrenia patients.

Study Finds Link Between Sleep Duration and Hospital Stays in Mania Patients

Mental health professionals have long tied a lack of sleep in acute mania patients with extended hospital stays.

To dig deeper into this phenomenon, a group of researchers in Minnesota, conducted research that compared sleep duration between patients hospitalized for mania and major depressive disorder (MDD). They also investigated its correlation with the length of hospital stays.

PCC published the retrospective study in February 2024.

The study’s authors assessed sleep duration by looking at nursing observer reports from 2018 to 2021 at an acute care psychiatric unit. The study included 41 patients with mania and 38 with MDD.

While mania patients reported longer hospitalizations and received higher doses of antipsychotics and benzodiazepines, they also experienced fewer hypnotics. Researchers found that sleep duration at admission and discharge didn’t change significantly between the two groups, but the change in sleep duration during hospitalization appeared more significant in the mania group.

Interestingly, in mania patients, shorter sleep duration at admission correlated with longer hospital stays. But sleep duration parameters didn’t correlate with the length of stay in MDD patients.

The authors insist that these findings point to a trend toward greater improvement in sleep duration in patients with mania compared to MDD. Additionally, shorter sleep duration at admission could indicate more severe illness in patients with mania, potentially leading to longer hospitalizations.

While the study’s authors admitted to some shortcomings with the study – such as small sample size and reliance on observer reports – they said that it still highlights the importance of considering sleep duration as a potential treatment target to improve outcomes in mania patients.

Pimavanserin Shows Potential for Treating PTSD-Related Insomnia in Veterans

Veterans struggling with post-traumatic stress disorder (PTSD) mention insomnia as their most common complaint. And strong evidence has emerged that pimavanserin, an FDA-approved Parkinson’s medication, could help with insomnia without the daytime somnolence or addictive potential.

To test this theory, researchers started an open-label pilot study to explore the potential of pimavanserin in alleviating chronic insomnia in veterans with PTSD.

Pimavanserin, approved for Parkinson’s disease psychosis, shows promise due to its unique pharmacological profile and long half-life.

For this study, the researchers recruited half a dozen veterans with active PTSD and chronic insomnia and administered fixed-dose pimavanserin for six weeks.

Participants underwent initial screening, actigraphy monitoring, and polysomnography to ensure eligibility and establish a baseline. Pimavanserin treatment led to subjective improvements in sleep quality, particularly in sleep initiation and maintenance.

Objective measures, such as actigraphy-derived sleep onset latency, also showed marked improvement. The study’s authors, who wrote about their findings in the JCP in November 2023, added that any adverse effects they noted were generally mild, identifying drowsiness as the most common.

Every participant expressed a desire to continue pimavanserin after the study. Two of them even secured approval to stay on it.

The study suggests that the participants tolerated pimavanserin well and enjoyed some relief from PTSD-induced insomnia. But, they admitted that further randomized controlled trials could confirm its efficacy and safety compared to a placebo. They concluded that future research could expose the underlying mechanisms through which pimavanserin influences sleep quality.

Further Reading

Study Casts Colors – And Sleep Rhythms – In A New Light

What Time Are You Reading This?

Testing for Sleep-Disordered Breathing in Psychiatric Practice


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