The Role of Psychological Adjustment in the Evolution of Chronic Insomnia
Lead Research Organisation:
University of Glasgow
Department Name: School of Medicine
Abstract
Abstracts are not currently available in GtR for all funded research. This is normally because the abstract was not required at the time of proposal submission, but may be because it included sensitive information such as personal details.
People |
ORCID iD |
| Jason Ellis (Principal Investigator) |
Publications
Ellis J
(2010)
Priming affects poor sleepers but not normal sleepers on an insomnia ambiguity task.
in Journal of sleep research
Ellis J G
(2014)
European Sleep Research Sleep Medicine Textbook
Ellis JG
(2012)
The natural history of insomnia: focus on prevalence and incidence of acute insomnia.
in Journal of psychiatric research
Ellis JG
(2014)
The natural history of insomnia: acute insomnia and first-onset depression.
in Sleep
Ellis JG
(2012)
Acute insomnia: current conceptualizations and future directions.
in Sleep medicine reviews
Holloway PM
(2014)
Complexity analysis of sleep and alterations with insomnia based on non-invasive techniques.
in Journal of the Royal Society, Interface
Jason Ellis (Speaker)
(2008)
Differences in higher cognitive processing between acute and chronic insomniacs
Jason Ellis (Speaker)
(2010)
From acute to chronic insomnia : bridging the gap in assessment, diagnosis, and treatment
Jason Ellis (Speaker)
(2011)
Preventing chronic insomnia : the role of sleep preoccupation in acute sleep disturbance and acute insomnia
Man S
(2013)
Examining the Attention-Intention-Effort pathway in acute insomnia: A preliminary investigation of differences in sleep and life preoccupations
in Sleep Medicine Research
| Description | Based upon the findings from the studies we have: 1) Created a standard diagnostic measure to identify people with acute insomnia in both the community and in primary care 2) Demonstrated the prevalence of acute insomnia in the UK population (7.9%) and in the USA (9.5%) 3) Shown that around a third (between 31.2% and 36.6% depending on how we define acute insomnia) of the UK population will suffer from acute insomnia in one year 4) Demonstrated that over a fifth (21.43%) of those people with acute insomnia will transition to chronic insomnia 5) Shown that significant night-to-night variability exists in the objective sleep of people with acute insomnia compared to those who sleep normally 6) Demonstrated that if your acute insomnia does not remit within three months you are significantly more at risk of developing your first-ever episode of depression (9.26% move likely) compared to if you were a normal sleeper (1.85%) or remitted from acute insomnia within three months (1.85%) 7) Shown that specific characteristics of sleep are altered in people with acute insomnia (they demonstrate much longer periods of light sleep) compared to normal sleepers 8) That people who are likely to transit to chronic insomnia, as opposed to remit, demonstrate a sleep profile (i.e. a shorter than normal onset of REM sleep and reduced amounts of deep sleep) which is also a biological marker of the development of many other psychiatric illnesses (including depression and anxiety disorders) 9) Shown that the main characteristics that predict who will develop chronic insomnia, as opposed to remitting, are increased worry, more preoccupation about sleep, having unrealistic expectations of sleep and using alcohol to sleep or caffeine to keep awake during the day |
| Exploitation Route | From the findings of the studies we have developed a self-help toolkit which comprises of an information leaflet and narrative which aims to circumvent the transition from acute insomnia to chronic insomnia. We have piloted the toolkit and found that it prevents the transition to chronic insomnia in approximately 60% of cases compared to 15%, in a group who did not receive the toolkit. We are now exploring: a) how feasible the toolkit would be to use in primary care b) the impact of the toolkit on levels of psychological adjustment (i.e. stress, anxiety and depression) |
| Sectors | Healthcare,Pharmaceuticals and Medical Biotechnology |
| Description | Our societal impact has followed the same timeline, and trajectory, as our scientific impact. Initially, we identified that there is no existing evidence on the treatment of acute insomnia and conveyed this to clinicians through the policy document (Update on Mental Health in Scotland: A guide to delivering evidence-based psychological therapies in Scotland). One of the cornerstones of our public engagement talks has been outlining the findings that a significant proportion of individuals with acute insomnia will naturally remit (especially if it is their first episode) as opposed to transit to chronic insomnia and that there are cognitive and behavioural interventions that appear to be beneficial in buffering against the transition to chronic insomnia. As such we have outlined the need to explore non-pharmacological self-help interventions to over 1,700 member of the public. Feedback from our professional engagement talks (particularly the CFS/ME Northern Clinical Network, the UCB Talk, and the talk at the Freeman Hospital) suggests that changes in how sleep is assessed and what advice is given have been instigated in at least three clinical services in the North of England that we know of. The success of the extension to the existing clinical service at the Royal Victoria Infirmary which aims to address acute insomnia and complex cases is also directly impactful to individuals with insomnia. Although the numbers seen through the service at present are small due to the allotted time (.5 days per week), we have seen significant improvements in terms of the quality of life and a reductions in calls from patients for a prescription for hypnotics. More broadly, we have been informed that the talks to the A Level teachers (National Science Learning Centre) have resulted in sleep being chosen as one of the option choices for the A Level curriculum at three colleges/schools. Findings and Outputs The study findings have been translated into a comprehensive message: the three-Ds (Detect, Distract, Detach). The first D (Detect) works on the premise of our finding that early identification buffers affect against the transition from acute to chronic insomnia and high levels of sleep-related dysfunctional beliefs positively related to the transition from acute to chronic insomnia. As such we suggest an individual identify and acknowledge their sleep problem but reframe it within the context of a 'normal' biological reaction to stress. The second D (Distract) works on the premise that daytime sleep preoccupations and sleep-related effort at night also predict the transition to chronic insomnia. As such we suggest the individual uses cognitive techniques (i.e. a series of distraction techniques similar to those used in Cognitive Behaviour Therapy for Insomnia) during the acute phase. The third, and final, D (Detach) relates to two of our findings a) that those people who reduced the amount of time spent in bed, during the acute phase, were more likely to remit from acute insomnia compared to those who kept their normal routines or increased their Time in Bed, and b) that 'nesting behaviour' (i.e. using the bedroom for activities unrelated to sleep or sex such as watching TV or catching up on e-mail) mediated the relationship between stress and the length of the insomnia. As such we advocate the 15-minute rule (i.e. if you are in bed for more than 15 minutes, not asleep, get out of the bedroom) and remove all non-sleep-related items from the bedroom. This framework has been the basis for the GP leaflet and has also been outlined at all public and professional engagement events. Additionally, as the Newcastle Science Festival and TEDx talks were filmed both will be available for download soon on a dedicated webpage for the Northumbria Centre for Sleep Research and on our Facebook page (the TEDx talk will also be available on their main website and on Youtube). How these impacts were achieved These impacts have been achieved through four public engagement events (From Bench to Bedside: Recent advances in preventative sleep medicine. Newcastle Science Festival (Newcastle, UK); Synchronising your secret sleep switch. Newcastle Science Festival: Newcastle, UK; I can't sleep! Understanding the psychology of insomnia. British Science Festival: Surrey, UK; Sleep Medicine in the 21st Century. TEDx Conference: Stockport, UK), three professional engagement talks (The significance and consequence of insomnia. Taipei, Taiwan: Sponsored by Sanofi Aventis; What's new in insomnia research? York, UK: Sponsored by UCB Pharma; Understanding CBT-I in CFS/ME. Northumberland, UK: Sponsored by NHS Chronic Fatigue Syndrome and ME Northern Clinical Network), one talk to a local sleep service (Understanding insomnia: acute to chronic and beyond. Freeman Hospital: Newcastle), and one consultation document (Update on Mental Health in Scotland: A guide to delivering evidence-based psychological therapies in Scotland 'The Matrix: Subsection: Insomnia; National Education for Scotland). Additionally, we recently extended a local clinical service for people with insomnia, the 'Sleep Well Clinic', at the Royal Victoria Infirmary, Newcastle, to provide an evidence-based service for people with acute insomnia and complex cases and the PI runs that particular side of the service under an Honorary Contract. We have also produced the second iteration of our GP leaflet 'Stressed and Sleeplesswhat to do now!' following our proposed focus groups with GPs and service users. Whom These findings continue to have a significant impact on clinicians, both sleep specialists and non-specialists, from a number of perspectives and approaches (physical and psychological) and across a number of illnesses and conditions (psychiatry, respiratory medicine, ENT, CFS/ME). As the purpose of the National Health Service Education for Scotland 'Matrix' was to provide service developers and commissioners, health-care practitioners, and trainees a guide to delivering evidence-based services psychological across Scotland the inclusion of the insomnia section has the potential to significantly impact at all delivery levels. That said, this is limited by the fact that the only aspect that was reported about acute insomnia was that there was no evidence base. As the programme of work was addressing an issue related to both primary prevention and tertiary care the beneficiaries also include the lay public and those in primary care. Unexpected Impacts There have been three unexpected impacts based on this programme of work. Firstly, we found a high prevalence on individuals who reported having insomnia, did not meet criteria for insomnia, but instead met criteria for Restless Legs Syndrome (RLS). To that end we have obtained funding (UCB Pharma, £48k) to further explore this concept of 'masked Restless legs Syndrome' (mRLS) and create an algorithm for scientists, practitioners, and the public to help differentiate insomnia from RLS to determine the best care pathway. This has also resulted in the PI being appointed as an Expert Scientific Advisor Panel Member for UCB Pharma and a systematic review of the literature (in progress). The second unexpected impact came in two forms; firstly from an invited workshop to the CFS/ME Northern Clinical Network about acute insomnia and secondly from a radio interview / phone-in about the findings of the research with the PI. In both cases members of the audience (clinicians and a parent) asked for guidance on what can be done for sleep problems in children with Chronic Fatigue Syndrome/ME. This stimulated a literature search, and based on the paucity of evidence, the creation of a working group of clinicians, parents, and researchers, led by the PI, to bid for and obtain funding (Action for ME, £11k) for a study to explore the role of sleep, both qualitatively and quantitatively, in individuals with Chronic Fatigue Syndrome. The final unexpected impact has developed from the finding that the main polysomnographic predictors of the transition from acute insomnia to chronic insomnia (namely reduced latency to Rapid Eye Movement sleep and reduced Slow Wave Sleep) are also observed during the five weeks prior to and during an episode of Major Depression. We have written this finding up for publication and will be submitting the manuscript within the next month to Archives of General Psychiatry. Future Impacts We currently have four manuscripts in progress (Does personality influence the experience of insomnia?; Precipitating factors in insomnia: an update and extension of Bastien et al; Differences in psychological adjustment between normal sleepers and people with acute insomnia; The role of psychological adjustment in the natural evolution of insomnia) and several others planned. Additionally, the PI will be filming and hosting a two-part BBC One documentary 'Goodnight Britain' (May 2012 - June 2012) on the identification, assessment, and treatment of sleep disorders (including discussing the three D's for insomnia) in the community, which will be aired in the autumn of 2012. Additionally, at present we have still not analysed the sleep diary data from the longitudinal survey (n = 21,000 diary nights of data). As such we expect this will also deliver additional findings and associated impact. Our GP/Public leaflet is in its second iteration after piloting it with a series of service users and health-care professionals in the North East of the UK. We aim to have this in production and distributed nationally by the end of the year. To this end we will be tracking the uptake of the leaflet to determine impact levels for the leaflet as well as the number of hits to the websites for the public engagement films. Additionally, as we have engaged a great deal with the scientific community, clinicians and other health-care practitioners, and with the public at local, regional, and national levels, this has been concentrated more recently. As such, we will not be able to determine the full extent and influence of our impact activities for some time. |
| First Year Of Impact | 2013 |
| Sector | Education,Healthcare,Pharmaceuticals and Medical Biotechnology |
| Impact Types | Cultural,Societal |
| Description | Mental Health in Scotland: A guide to delivering evidence-based psychological therapies in Scotland 'The Matrix: Subsection: Insomnia' (National Education for Scotland) |
| Geographic Reach | National |
| Policy Influence Type | Influenced training of practitioners or researchers |
| Impact | This is the first document to provide details for the stepped care management of mental health issues based upon evidence. |
| Description | A case controlled study exploring the qualitative experience of sleep, the roles of sleep architecture, and diurnal patterns of salivary cortisol in ME/CFS |
| Amount | £11,550 (GBP) |
| Organisation | Action for M.E. |
| Sector | Charity/Non Profit |
| Country | United Kingdom |
| Start | 10/2012 |
| End | 09/2013 |
| Description | An evaluation of 'one shot' CBT-I adjunct to CPAP in individuals with insomnia co-morbid with OSA: A pilot investigation |
| Amount | £12,000 (GBP) |
| Organisation | UCB Pharma |
| Sector | Private |
| Country | United Kingdom |
| Start | 01/2015 |
| End | 01/2016 |
| Description | Developing an evidence-based algorithm for masked restless legs syndrome |
| Amount | £48,232 (GBP) |
| Organisation | UCB Pharma |
| Sector | Private |
| Country | United Kingdom |
| Start | 09/2011 |
| End | 08/2012 |
| Description | Development of a sleep intervention for people with ME/CFS |
| Amount | £15,000 (GBP) |
| Organisation | ME Association |
| Sector | Charity/Non Profit |
| Country | United Kingdom |
| Start | 06/2013 |
| End | 05/2014 |
| Description | Understanding the role of acute insomnia in primary care |
| Amount | £5,000 (GBP) |
| Organisation | NHS Greater Glasgow and Clyde (NHSGGC) |
| Sector | Public |
| Country | United Kingdom |
| Start | 10/2008 |
| End | 01/2009 |
| Description | Supervision team for a PhD student :PhD thesis : understanding the devlopment of insomnia subtypes |
| Organisation | University of Cape Town |
| Country | South Africa |
| Sector | Academic/University |
| PI Contribution | I have been asked to join the supervision team for a PhD student (Michelle Baker) at the University of Capetown. The aim of this project will be to replicate the survey aspect of my study and extend this to examine whether acute insomnia is represented by different subtypes and how these develop over the course of insomnia. |
| Start Year | 2012 |
| Title | 3 D's Brief Intervention for Insomnia |
| Description | A brief behavioural intervention based upon the principles of CBT. It has been piloted in a community sample and we are in the process of seeking funding from the NIHR to determine its feasibility and acceptability in primary care and with patients with acute insomnia co-morbid with psychiatric conditions. |
| Type | Therapeutic Intervention - Psychological/Behavioural |
| Current Stage Of Development | Early clinical assessment |
| Year Development Stage Completed | 2014 |
| Development Status | Actively seeking support |
| Clinical Trial? | Yes |
| Impact | None as yet |
| URL | http://www.isrctn.com/ISRCTN05891695 |
| Description | Contemporary psychology 2 : the pathophysiology of insomnia |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | This was a second invited talk to stimulate interest in contemporary areas of psychology to A Level teachers throughout the UK. My talk was about the latest developments in sleep research with a focus on my study on acute insomnia. We had several A level teachers report changing from stress to sleep as their choice for teaching the psychophysiology module of the A Level syllabus. |
| Year(s) Of Engagement Activity | 2012 |
| Description | Contemporary psychology : sleep & acute insomnia |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | This was an invited talk to stimulate interest in contemporary areas of psychology to A Level teachers throughout the UK. My talk was about the latest developments in sleep research with a focus on my study on acute insomnia. Reported change from studying stress to studying sleep for the biopsychology part of the A level course. |
| Year(s) Of Engagement Activity | 2011 |
| Description | Coping with Stress-related Sleep Loss |
| Form Of Engagement Activity | A magazine, newsletter or online publication |
| Part Of Official Scheme? | Yes |
| Geographic Reach | Local |
| Primary Audience | Public/other audiences |
| Results and Impact | The prototype of the accompanying information leaflet being used in Primary Care This leaflet was launched at an Impact Event organised by myself for our local CCGs and members of NHS England for qualitative feedback and useability This leaflet was launched at an Impact Event organised by myself for our local CCGs and members of NHS England for qualitative feedback and useability |
| Year(s) Of Engagement Activity | 2013 |
| Description | Determining a sleep-stress switch point in the transition to chronic insomnia |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Professional Practitioners |
| Results and Impact | This was an invited talk to the Psychology Department at the University of Stirling to discuss my early findings from the ESRC study on acute insomnia. None |
| Year(s) Of Engagement Activity | 2009 |
| Description | From bench to bedside : recent advances in preventative sleep medicine |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | Yes |
| Geographic Reach | Regional |
| Primary Audience | Public/other audiences |
| Results and Impact | This was a public engagement lecture as part of the Newcastle Science Fesitval 2012 and this stimulated lots of requests from health care practitioners to discuss how to manage sleep problems in primary care. Following I was invited to talk to four GP practices in the North East of England. |
| Year(s) Of Engagement Activity | 2012 |
| URL | http://www.newcastlesciencefest.com/ScienceFest2012.pdf |
| Description | From normal sleep to clinically defined insomnia : understanding the biopsychosocial process to insomnia |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Professional Practitioners |
| Results and Impact | This was an invited talk to the psychology department at the HELP University in Kuala Lumpur. None |
| Year(s) Of Engagement Activity | 2010 |
| Description | I can't sleep! : understanding the psychology of insomnia |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | Yes |
| Geographic Reach | National |
| Primary Audience | Public/other audiences |
| Results and Impact | Public Engagement Talk We saw a notable upsurge in our recruitment for the study that was detailed in the talk. |
| Year(s) Of Engagement Activity | 2009 |
| URL | http://www.surrey.ac.uk/festivalofscience/ |
| Description | Insomnia research : what's new? (acute insomnia : conceptualisations and future directions) |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Professional Practitioners |
| Results and Impact | Talk to neurology and psychiatry consultants in the north east of the UK about recent developments in insomnia, focusing on the definition and management of acute insomnia. Reported decrease in pharmacological prescribing practice by consultants. |
| Year(s) Of Engagement Activity | 2011 |
| Description | Is acute insomnia a slow wave sleep disorder |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Local |
| Primary Audience | Professional Practitioners |
| Results and Impact | This was an invited talk to the psychology department at Queen Margaret University in Edinburgh to talk about the biophysiology of acute insomnia. None |
| Year(s) Of Engagement Activity | 2010 |
| Description | Preventative sleep medicine in the 21st century |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | Yes |
| Geographic Reach | National |
| Primary Audience | Schools |
| Results and Impact | This was a talk to A/AS Level Psychology students and staff about my research on 18th April 2012 http://www.ted.com/tedx/events/4594 The talk was filmed and is avaliable on the main TEDx website and on youtube http://www.ted.com/tedx Increases in referrals for sleep services and for more information on how to participate. Several schools have contacted since to request a visit to my sleep laboratory in Northumbria. |
| Year(s) Of Engagement Activity | 2012 |
| URL | http://www.ted.com/tedx |
| Description | Psychology A level students visit to sleep laboratory |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Schools |
| Results and Impact | I organised an event for a group of A Level students from Richard Rose Sixth Form and their teachers to come to visit our sleep laboratory and as part of their visit I gave them a talk about sleep medicine, based upon my research. Lots of requests from other schools to do the same visit. |
| Year(s) Of Engagement Activity | 2012 |
| Description | Recent advances in sleep medicine |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Local |
| Primary Audience | Professional Practitioners |
| Results and Impact | This was an invited lecture to the MSc Health Psychology students which specifically focused on the application of research (in this case acute insomnia) to the forthcoming DSM-V Requests for internships in my laboratory. |
| Year(s) Of Engagement Activity | 2012 |
| Description | Sleep workshop : examining acute insomnia in CFS/ME |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Participants in your research and patient groups |
| Results and Impact | This was a workshop for the Chronic Fatigue Syndrome and ME Northern Clinical Network on how to identify, assess, and treat sleep problems in patients with CFS/ME. We were asked to apply for funding to look at treating individuals with sleep problems and CFS/ME by two of the main CFS/ME research charities. |
| Year(s) Of Engagement Activity | 2012 |
| Description | Social jet-lag: synchronising your secret sleep switch |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | Yes |
| Geographic Reach | Regional |
| Primary Audience | Public/other audiences |
| Results and Impact | This was a workshop for the public, based upon my research, to help people determine their levels of acute insomnia. http://www.northumbria.ac.uk/sd/central/rbs/nsf2012/sleepswitch/?view=Standard One further publication stemmed from the workshop: Barclay, N.L. & Ellis, J.G. (2013) Sleep-related attentional bias in poor vs. good sleepers is independent of affective valence. Journal of Sleep Research; 22: 414-412 - doi: 10.1111/jsr.12035 Plus, significant increase in public wanting to enroll in our sleep studies at the Northumbria Centre for Sleep Research |
| Year(s) Of Engagement Activity | 2012 |
| Description | Transient insomnia : what we know and what we need to learn |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Local |
| Primary Audience | Professional Practitioners |
| Results and Impact | This was an invited lab talk by Dr. Sean Drummond of the UCSD Sleep Medicine Centre on the relationship between acute insomnia and sleep deprivation. Further invitations from several international laboratories to discuss thsi programme of research. |
| Year(s) Of Engagement Activity | 2009 |
| Description | Understanding daytime dysfunction in insomnia |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Professional Practitioners |
| Results and Impact | This was an invited lab talk to the sleep centre at the Lu Tung hospital in Taipei on the daytime effects of acute insomnia. Stimulated a cross-collaboration between researchers in UK and Taiwan |
| Year(s) Of Engagement Activity | 2009 |
| Description | Understanding insomnia : acute to chronic and beyond |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | Local |
| Primary Audience | Professional Practitioners |
| Results and Impact | Talk to consultants in the sleep and respiratory group at the Freeman Hospital in Newcastle. Reported reduction in pharmacology prescriptions for sleep problems. |
| Year(s) Of Engagement Activity | 2010,2011 |
| Description | Understanding the pathogenesis of insomnia |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Professional Practitioners |
| Results and Impact | This was an invited lecture given to the Psychophysiology and Epidemiology and Public Health groups at UCL and resulted in lots of discussion. Requests from academics and students about research opportunities to work in my lab. |
| Year(s) Of Engagement Activity | 2012 |
| Description | Understanding transitions in sleep : focusing on sleep continuity |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Professional Practitioners |
| Results and Impact | This was an invited talk to the psychology department at the Management Development Institute of Singapore Increased number of applications to study postgraduate psychology at Northumbria Univesity. |
| Year(s) Of Engagement Activity | 2010 |