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The effects of improving sleep on mental health (OASIS): a randomised controlled trial with mediation analysis

Daniel Freeman, 18 Co-authors, Mark Blagrove Orcid Logo, 21 Co-authors, Colin A. Espie

The Lancet Psychiatry, Volume: 4, Issue: 10, Pages: 749 - 758

Swansea University Author: Mark Blagrove Orcid Logo

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DOI (Published version): 10.1016/S2215-0366(17)30328-0

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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 d...

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Published in: The Lancet Psychiatry
Published: 2017
URI: https://cronfa.swan.ac.uk/Record/cronfa36004
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fullrecord <?xml version="1.0"?><rfc1807><datestamp>2017-11-07T13:45:05.3694713</datestamp><bib-version>v2</bib-version><id>36004</id><entry>2017-10-10</entry><title>The effects of improving sleep on mental health (OASIS): a randomised controlled trial with mediation analysis</title><swanseaauthors><author><sid>8c78ee008e650b9f0a463bae56a5636c</sid><ORCID>0000-0002-9854-1854</ORCID><firstname>Mark</firstname><surname>Blagrove</surname><name>Mark Blagrove</name><active>true</active><ethesisStudent>false</ethesisStudent></author></swanseaauthors><date>2017-10-10</date><deptcode>HPS</deptcode><abstract>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&#xB7;78, 95% CI 4&#xB7;29 to 5&#xB7;26, Cohen's d=1&#xB7;11; p&lt;0&#xB7;0001), paranoia (&#x2212;2&#xB7;22, &#x2212;2&#xB7;98 to &#x2212;1&#xB7;45, Cohen's d=0&#xB7;19; p&lt;0&#xB7;0001), and hallucinations (&#x2212;1&#xB7;58, &#x2212;1&#xB7;98 to &#x2212;1&#xB7;18, Cohen's d=0&#xB7;24; p&lt;0&#xB7;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.</abstract><type>Journal Article</type><journal>The Lancet Psychiatry</journal><volume>4</volume><journalNumber>10</journalNumber><paginationStart>749</paginationStart><paginationEnd>758</paginationEnd><publisher/><keywords/><publishedDay>1</publishedDay><publishedMonth>10</publishedMonth><publishedYear>2017</publishedYear><publishedDate>2017-10-01</publishedDate><doi>10.1016/S2215-0366(17)30328-0</doi><url/><notes>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</notes><college>COLLEGE NANME</college><department>Psychology</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>HPS</DepartmentCode><institution>Swansea University</institution><apcterm/><lastEdited>2017-11-07T13:45:05.3694713</lastEdited><Created>2017-10-10T17:04:10.3240027</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">School of Psychology</level></path><authors><author><firstname>Daniel</firstname><surname>Freeman</surname><order>1</order></author><author><surname>18 Co-authors</surname><order>2</order></author><author><firstname>Mark</firstname><surname>Blagrove</surname><orcid>0000-0002-9854-1854</orcid><order>3</order></author><author><surname>21 Co-authors</surname><order>4</order></author><author><firstname>Colin A.</firstname><surname>Espie</surname><order>5</order></author></authors><documents><document><filename>0036004-07112017134327.pdf</filename><originalFilename>36004.pdf</originalFilename><uploaded>2017-11-07T13:43:27.8530000</uploaded><type>Output</type><contentLength>222530</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><embargoDate>2017-11-07T00:00:00.0000000</embargoDate><documentNotes>This is an Open Access article under the CC BY 4.0 license.</documentNotes><copyrightCorrect>true</copyrightCorrect><language>eng</language></document></documents><OutputDurs/></rfc1807>
spelling 2017-11-07T13:45:05.3694713 v2 36004 2017-10-10 The effects of improving sleep on mental health (OASIS): a randomised controlled trial with mediation analysis 8c78ee008e650b9f0a463bae56a5636c 0000-0002-9854-1854 Mark Blagrove Mark Blagrove true false 2017-10-10 HPS 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. Journal Article The Lancet Psychiatry 4 10 749 758 1 10 2017 2017-10-01 10.1016/S2215-0366(17)30328-0 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 COLLEGE NANME Psychology COLLEGE CODE HPS Swansea University 2017-11-07T13:45:05.3694713 2017-10-10T17:04:10.3240027 Faculty of Medicine, Health and Life Sciences School of Psychology Daniel Freeman 1 18 Co-authors 2 Mark Blagrove 0000-0002-9854-1854 3 21 Co-authors 4 Colin A. Espie 5 0036004-07112017134327.pdf 36004.pdf 2017-11-07T13:43:27.8530000 Output 222530 application/pdf Version of Record true 2017-11-07T00:00:00.0000000 This is an Open Access article under the CC BY 4.0 license. true eng
title The effects of improving sleep on mental health (OASIS): a randomised controlled trial with mediation analysis
spellingShingle The effects of improving sleep on mental health (OASIS): a randomised controlled trial with mediation analysis
Mark Blagrove
title_short The effects of improving sleep on mental health (OASIS): a randomised controlled trial with mediation analysis
title_full The effects of improving sleep on mental health (OASIS): a randomised controlled trial with mediation analysis
title_fullStr The effects of improving sleep on mental health (OASIS): a randomised controlled trial with mediation analysis
title_full_unstemmed The effects of improving sleep on mental health (OASIS): a randomised controlled trial with mediation analysis
title_sort The effects of improving sleep on mental health (OASIS): a randomised controlled trial with mediation analysis
author_id_str_mv 8c78ee008e650b9f0a463bae56a5636c
author_id_fullname_str_mv 8c78ee008e650b9f0a463bae56a5636c_***_Mark Blagrove
author Mark Blagrove
author2 Daniel Freeman
18 Co-authors
Mark Blagrove
21 Co-authors
Colin A. Espie
format Journal article
container_title The Lancet Psychiatry
container_volume 4
container_issue 10
container_start_page 749
publishDate 2017
institution Swansea University
doi_str_mv 10.1016/S2215-0366(17)30328-0
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str School of Psychology{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}School of Psychology
document_store_str 1
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description 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.
published_date 2017-10-01T03:44:57Z
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