REPORT: lack of sleep causes mental health issues (details)

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Researchers at the University of Oxford have uncovered evidence that a lack of sleep contributes to mental health issues, rather than vice versa.

The Guardian reports that subjects who underwent a course of cognitive behavioral therapy (CBT) meant to treat insomnia also saw improvement in symptoms of depression, anxiety, and psychotic experiences.

“The dominant view is that sleep [problems are] either a symptom of several mental health problems or it is a secondary consequence,” said Daniel Freeman, co-author of the research from the University of Oxford. “Really, sleep is one of the contributing causes.”

In a study published in Lancet Psychiatry, researchers utilized online surveys to hammer out a sample for their study, choosing students across 26 universities who were found to have insomnia after answering a web-based questionnaire.

More than 3,700 students were chosen for the study in total, with half serving as a control group and the others receiving a treatment of six 20-minute CBT courses designed to help insomnia. Both groups were monitored with online assessments after three weeks, 10 weeks, and 22 weeks.

After analyzing the control group to account for effects unrelated to the treatment, the difference in results between the two groups was stark. The group given the treatment saw instances of insomnia drop by half after 10 weeks, with depression and anxiety dropping by a fifth, and hallucinations and paranoia dropping 35 percent and 25 percent, respectively.

“Having insomnia doubles your chances of developing depression and we now know that if you treat the insomnia it reduces depression,” said Freeman.

The study wasn’t without flaws, as 50 percent of those receiving the CBT treatment failed to access all six courses. But Freeman says the pattern still holds, nonetheless. If the mental health conditions improved in those who did a few of the sessions, and just not as much as those who did, the conclusion still holds. If mental health worsened in those who dropped out of treatment, the conclusion holds once again.

“It is very clear that even despite there being a lot of drop-out, you can still see the pattern emerge,” said Freeman, adding that the study also underlined the link between sleep and mental health was two-way, with psychotic experiences affecting sleep — albeit to a smaller degree.

Outside of generic anxiety and depression, researchers say insomnia can lead to severe psychotic episodes, characterized by hallucinations and paranoia.

“The realistic view of mental health problems is that there is a spectrum of severity and all the evidence we have is that the causes and the treatments are similar across the spectrum,” said Freeman.

The positive finding is that treating one issue, such as insomnia, can now lead to the improvement across the whole spectrum.

“There is good news here: [insomnia] is something that can be treated, and not only does the distressing sleep problem itself improve, but there are knock-on benefits to a number of areas of your psychological health,” said Freeman, adding that insomnia is easier for young people to talk about than mental health issues.

Still, as in all studies that rely on self-reported data, conclusions are far from concrete.

Ian Hamilton, a lecturer on mental health at York University, who was not involved in the study, cautioned that onlookers must note the self-reported nature of the data and that the sample pool was purely students.

But he also saw positives in the results, adding: “The important message from this research is that there is a real opportunity to help young people with insomnia and reduce their chances of developing psychotic experiences,” he said. “The challenge will be for mental health workers and services who may routinely ask [individuals] about sleep but are not usually equipped or skilled in tackling sleep issues.”

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