![]() Treatments are increasingly beginning to be adapted and tested in some SMI populations with some early signals of success, but these are not yet routinely implemented and their acceptability is not well established. In many cases, however, these studies excluded people with SMI either purposefully through study exclusion criteria, or as a result of recruitment contexts. Thus evidence based treatment recommendations and best practice guidance now exist. A range of treatments for insomnia have been evaluated clinical trials support the efficacy of Cognitive Behavioural Therapy for Insomnia (CBT-i) and related approaches. Insomnia without significant co-morbidity has been relatively well studied to date, both through objective means including polysomnography, and through qualitative exploration of patient’s perspectives and experiences. It is therefore important that relevant research is identified to support this clinical area. Contemporary illness classifications have removed this primary/secondary distinction, emphasising the need for independent clinical attention to sleep disturbance irrespective of co-morbidity. Epidemiological evidence suggests sleep disturbances in fact more often pre-date, than are a by-product of, other symptoms. The utility and reality of this distinction has been questioned, as has the assumption that sleep disturbances will automatically resolve with treatment of other symptoms. This may be partly attributable to long-standing conceptualisations distinguishing ‘primary’ sleep disturbances, from sleep disturbances ‘secondary’ to mental health conditions. Despite its known impact, sleep disturbance remains poorly understood and neglected in people with SMI, and is thought to be underdiagnosed in this population. Serious Mental Illness (SMI) is often considered to include diagnoses which most commonly require treatment from specialised services (secondary care), such as psychotic illnesses and bipolar affective disorder. Importantly, it is well established that co-morbid sleep problems impact negatively on the course of psychiatric illness, and on recovery and quality of life. These interactions offer to explain this frequent co-occurrence of sleep problems with mental illnesses. Researchers are just beginning to understand the complex interconnections between the neurobiological mechanisms underlying various psychiatric diagnoses, and the mechanisms of sleep. Sleep disturbances are a core biological symptom of depression, a relapse indicator in bipolar, and are present in up to 80% of those with psychotic illnesses, often persisting after other symptoms have been treated. The prevalence of sleep disturbances is substantially higher in people with mental illnesses. Sleep disturbances are the most commonly reported psychiatric symptom in the general population, with rates of insomnia ranging from 6% to 30% depending upon the definition adopted. Qualitative studies exploring the experience of sleep disturbance in particular diagnostic groups and contexts are urgently required, as are patient perspectives on sleep interventions. More rigorous research is needed to support adaptation and development of interventions and outcome measures for use in specialist mental health settings. Some evidence suggested patient priorities and conceptualisations regarding sleep may diverge from those of validated screening tools developed in general population and sleep medicine samples. ![]() ![]() Evaluations of treatments varied, however perceived efficacy and personalisation of treatments were valued. ![]() ![]() The limited findings suggested sleep was seen as highly interlinked with mental health. Of the 2,067 hits, only 22 met review inclusion criteria, and high quality evidence was sparse. Qualitative and quantitative studies were included if they explored or measured patient perspectives on sleep, sleep problems or sleep treatments in people with serious mental illness. A systematic literature review was conducted using Medline, AMED, PsychInfo, Embase and CINAHL. To understand the development of sleep problems, their maintenance, and their treatment, an in depth understanding of patient perspectives is crucial. Sleep problems are common in people with serious mental illness, and impact negatively on functioning and wellbeing. ![]()
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