Elizabeth Ann Barrett1, Sofie Ragnhild Aminoff1,2, Carmen Simonsen1, Kristin Lie Romm1,2; 1Division of Mental Health and Addiction, Oslo University Hospital Trust, Norway, 2NORMENT, KG Jebsen Centre for Psychosis Research, Oslo University Hospital & University of Oslo, Norway.
Sleep disturbances are prevalent in psychotic disorders and have negative effects on symptoms, cognition, functioning, and well-being. Disturbed sleep may contribute to the onset of psychosis and is thus an important target for early intervention. Patients welcome sleep treatment, but knowledge about the use of evidence-based sleep interventions is lacking. This study aimed to investigate clinicians’ views on sleep disturbances and their use of assessment and treatment approaches in psychotic disorders. An online survey was emailed to clinicians in in- and outpatient mental health clinics. A total of 203 clinicians working with patients with psychotic disorders completed the survey. All clinicians reported sleep problems in this patient group. The most prevalent sleep complaints were insomnia (87%), circadian rhythm disorders (87%) and hypersomnia (48%). A vast majority of clinicians thought that sleep disturbances had negative effects on patients’ mood, symptoms, and functioning, and that sleep disturbances and psychotic symptoms exacerbate each other. As many as 77% of the clinicians assessed sleep problems by informal dialogue, instead of using structured assessment tools. The most prevalent interventions were sleep hygiene (88%) and medications (86%). Antipsychotics (34%) and antihistamines (29%) were most commonly used. However, recommended interventions like light therapy for circadian rhythm disorders (8%) and CBT for insomnia (19%) were rarely used. Recurrent obstacles to improve sleep were patients’ non-adherence to treatment and clinicians’ lack of knowledge about sleep interventions. In conclusion, clinicians acknowledge the importance of sleep in psychotic disorders. However, sleep problems are assessed informally, and evidence-based interventions are used infrequently.
