Author: Professor Jason Ellis, Northumbria University, Department of Psychology
Over the last 12 years at Northumbria Sleep Research we have been studying the pathophysiology of insomnia. In other words, how can two people have the same experiences in life and yet one develops insomnia and the other does not?
As there was no working definition of acute insomnia (the period prior to it being classed as a sleep disorder), prior to us starting this work, the first thing we had to do was create a clinical definition of acute insomnia. We did this in terms of having existing vulnerabilities, how it can start, how long someone should have it to be classified, what symptoms they should experience and how frequently they should experience those symptoms every week.
Using this definition, we then demonstrated how many people in the general population are affected by it at any given time (prevalence = 7.9%) and how many people will be affected by it over the course of a year (annual incidence = 31-36%) in the UK and USA. We then went on to examine what makes people with acute insomnia different from normal sleepers and people with chronic insomnia along several dimensions (genetic, physiological, neuropsychological, psychological, social, behavioural and environmental).
Over the course of our studies, using a variety of techniques (quantitative and qualitative), we have identified which factors increase the likelihood of getting acute insomnia (i.e. insomnia for less than three months) and what factors increase the likelihood that the insomnia will progress from acute to chronic.
These findings include, changes in the timing of the human body clock, differences in brain-wave activity during sleep, how preoccupied we are with our sleep during the day, our levels of depression and how much time we spend in bed awake worrying.
In the final step of this programme of research, we created, and tested, a brief intervention (the ‘one-shot’) which can prevent chronic insomnia in up to 73% of individuals with acute insomnia. We started by testing it in the general population but then went on to determine whether the intervention works for vulnerable groups such as prisoners, adults with chronic illnesses and adolescents with anxiety and depression.
Why is preventing chronic insomnia important in the context of COVID?
We have seen a sharp increase in people reporting acute insomnia over the crisis. This increase has been attributed not only to fears and concerns about the virus itself but worry and anxiety about family and friends. There have also been increases in financial and work-related pressures and lifestyle and routine changes due to the lockdown which can also negatively impact on sleep.
If left untreated, acute insomnia can develop into a chronic insomnia which increases the risk, significantly, for several physical and psychological illnesses (for example Northumbria Sleep Research were the first to demonstrate that untreated acute insomnia significantly increases the risk for a first episode of depression).
Within the context of COVID specifically, there is lots of evidence that good sleep can; i) minimise the chances of contracting a virus, if exposed, ii) increase the recovery rate after contracting a virus and iii) increase the speed at which immunity occurs following vaccination. Together, this underscores the reasons why identifying and preventing chronic insomnia is so important at the moment.
How are staff in the Northumbria Centre for Sleep Research helping?
One of the most important things about doing research, at least in our view, is that it must have implications for practice, policy and/or changes in individual’s behaviour (real-world impact). Based upon the findings from our research and the intervention, we have already contributed to guidelines for managing sleep during COVID for the British Psychological Society, British Sleep Society, Public Health England, NHS England, the European Sleep Research Society and the Society for Behavioral Sleep Medicine in the USA. Additionally, to date, we have trained over two hundred clinicians in the UK, USA, Japan and Holland on how to use our intervention to help students, front-line healthcare workers, carers and vulnerable populations manage their sleep during the crisis.
What we are doing now, through several ongoing studies around the world, is trying to find out whether our brief intervention is actually protective against getting acute insomnia in the context of COVID