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

Freeman, D. and Sheaves, B. and Goodwin, G. and Yu, L. and Nickless, A. and Harrison, P. and Emsley, R. and Luik, A. and Foster, R. and Wadekar, V. and Hinds, C. and Gumley, A. and Jones, R. and Lightman, S. and Jones, S. and Bentall, R. and Kinderman, P. and Rowse, G. and Brugha, T. and Blagrove, M. and Gregory, A. and Fleming, L. and Walklet, Elaine and Glazebrook, C. and Davies, B. and Hollis, C. and Haddock, G. and John, B. and Coulson, M. and Fowler, D. and Pugh, K. and Cape, J. and Moseley, P. and Brown, G. and Hughes, C. and Obonsawin, M. and Coker, S. and Watkins, E. and Schwannauer, M. and Macmahon, K. and Siriwardena, N. and Espie, C. (2017) The effects of improving sleep on mental health (OASIS): a randomised controlled trial with mediation analysis. The Lancet Psychiatry, 4 (10). pp. 749-758. ISSN 2215-0366 Online: 2215-0374

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Abstract

Background Sleep 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. Methods We 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. Findings Between 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. Interpretation To 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.

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Uncontrolled Keywords: sleep, mental health, randomised controlled trial, mediation analysis
Subjects: B Philosophy. Psychology. Religion > BF Psychology
Divisions: Academic Departments > Institute of Health and Society
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Depositing User: Elaine Walklet
Date Deposited: 07 Aug 2017 11:14
Last Modified: 06 Nov 2017 11:17
URI: https://eprints.worc.ac.uk/id/eprint/5581

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