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The effects of improving sleep on mental health (OASIS): a randomised controlled trial with mediation analysis
The Lancet Psychiatry, Volume: 4, Issue: 10, Pages: 749 - 758
Swansea University Author: Mark Blagrove
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DOI (Published version): 10.1016/S2215-0366(17)30328-0
SummaryBackgroundSleep difficulties might be a contributory causal factor in the occurrence of mental health problems. If this is true, improving sleep should benefit psychological health. We aimed to determine whether treating insomnia leads to a reduction in paranoia and hallucinations.MethodsWe d...
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SummaryBackgroundSleep difficulties might be a contributory causal factor in the occurrence of mental health problems. If this is true, improving sleep should benefit psychological health. We aimed to determine whether treating insomnia leads to a reduction in paranoia and hallucinations.MethodsWe did this single-blind, randomised controlled trial (OASIS) at 26 UK universities. University students with insomnia were randomly assigned (1:1) with simple randomisation to receive digital cognitive behavioural therapy (CBT) for insomnia or usual care, and the research team were masked to the treatment. Online assessments took place at weeks 0, 3, 10 (end of therapy), and 22. The primary outcome measures were for insomnia, paranoia, and hallucinatory experiences. We did intention-to-treat analyses. The trial is registered with the ISRCTN registry, number ISRCTN61272251.FindingsBetween March 5, 2015, and Feb 17, 2016, we randomly assigned 3755 participants to receive digital CBT for insomnia (n=1891) or usual practice (n=1864). Compared with usual practice, the sleep intervention at 10 weeks reduced insomnia (adjusted difference 4·78, 95% CI 4·29 to 5·26, Cohen's d=1·11; p<0·0001), paranoia (−2·22, −2·98 to −1·45, Cohen's d=0·19; p<0·0001), and hallucinations (−1·58, −1·98 to −1·18, Cohen's d=0·24; p<0·0001). Insomnia was a mediator of change in paranoia and hallucinations. No adverse events were reported.InterpretationTo our knowledge, this is the largest randomised controlled trial of a psychological intervention for a mental health problem. It provides strong evidence that insomnia is a causal factor in the occurrence of psychotic experiences and other mental health problems. Whether the results generalise beyond a student population requires testing. The treatment of disrupted sleep might require a higher priority in mental health provision.FundingFunded by The Wellcome Trust.
Full author list: Prof Daniel Freeman, PhD, Bryony Sheaves, DClinPsy, Prof Guy M Goodwin, FMedSci, Ly-Mee Yu, DPhil, Alecia Nickless, MSc, Prof Paul J Harrison, DM Oxon, Prof Richard Emsley, PhD, Annemarie I Luik, PhD, Prof Russell G Foster, PhD, Vanashree Wadekar, MSc, Christopher Hinds, DPhil, Prof Andrew Gumley, PhD, Prof Ray Jones, PhD, Prof Stafford Lightman, PhD, Prof Steve Jones, PhD, Prof Richard Bentall, PhD, Prof Peter Kinderman, PhD, Georgina Rowse, DClinPsy, Prof Traolach Brugha, MD, Prof Mark Blagrove, PhD, Prof Alice M Gregory, PhD, Leanne Fleming, PhD, Elaine Walklet, MSc, Prof Cris Glazebrook, PhD, E Bethan Davies, PhD, Prof Chris Hollis, PhD, Prof Gillian Haddock, PhD, Prof Bev John, PhD, Mark Coulson, PhD, Prof David Fowler, MSc, Katherine Pugh, DClinPsy, John Cape, PhD, Peter Moseley, PhD, Gary Brown, PhD, Prof Claire Hughes, PhD, Marc Obonsawin, PhD, Prof Sian Coker, DPhil, Prof Edward Watkins, PhD, Prof Matthias Schwannauer, PhD, Kenneth MacMahon, PhD, Prof A Niroshan Siriwardena, PhD, Prof Colin A Espie, PhD
Faculty of Medicine, Health and Life Sciences