Chronotherapy
Chronotherapy
Sleep problems are ubiquitous in hospital settings, especially in mental health care. We have developed a hospital infrastructure with an aim to improve the observation of patients at night and improve treatment outcomes using knowledge about the human circadian system. At St. Olavs Hospital, research is integrated in the clinic.
The project
Individuals with mental disorders are admitted to acute inpatient care for three main reasons: acute distress associated with risk of suicide, significant increase in illness severity, or major impairment in day-to-day functioning arising from mental or behavioral dysregulation. Hospitalization allows detailed clinical assessment and monitoring of progress, and intensive treatments, to be provided in a safe and structured environment.
Although the quality and fabric of inpatient facilities have improved over recent decades with more attention to providing a homely environment and better quality accommodation, little attention has been given to how to use the environment of the unit to optimize treatment and improve the mental state and social functioning of the patients. There has been a lack of innovation in treatments, observation techniques or environments over the last 50 years. This project specifically focuses on the development of an innovative program to enhance the environment within an acute inpatient unit to try to reduce time to stabilization of mental state, improve observation at night, and to enable patients to achieve earlier discharge back to their home and community.
Background
This project is based on two important empirical findings
- First, poor sleep quality and circadian dysrhythmia are significantly associated with relapse or worsening of major mental disorders (e.g. psychotic, bipolar and major depressive disorders) and with increased suicidality; whilst improvement in sleep and circadian rhythmicity are associated with early improvement in mental state. Thus, an important target for all acute psychiatric treatment is stabilization of the sleep-wake cycle.
- Second, recent findings from basic physiology and treatment research has elucidated how light at specific frequencies can have a profound impact on arousal, sleep, circadian disruption. Moreover, blocking these specific light frequencies can be a highly effective treatment for severe mental disorders, leading to early improvement in symptoms and functioning. This is a potential breakthrough in our understanding of how severe mental disorders are maintained and offers the opportunity for the development of innovative non-pharmacological interventions.
Based on these findings, we have incorporated new light and radar technologies into a ‘new-build’ psychiatric inpatient unit to create a hospital environment and infrastructure that we hypothesize will: decrease arousal, promote sleep-wake cycle and circadian stability, and lead to a shortening of the average length of admissions. Also, it may allow a reduction in the number or dosages of medications used to achieve improvements in mental state and functioning.
Further, the new technologies employed allow improve non-invasive observation of the patients at night, allowing more accurate monitoring of sleep and symptomatic improvement. There is a critical need to evaluate all aspects of the approach to determine the benefits (and to identify if there are any drawbacks or adverse effects).
Aims
The specific aims of this project are to test these hypotheses in four research avenues:
- A randomized cross-over study to test the positive impacts and any side-effects or adverse effects of the new hospital light environment on physiological and psychological factors (e.g. related to levels of arousal and circadian rhythmicity), and to determine its acceptability to the participants.
- Validation studies on a novel contact-free, ultra-wide band radar technology which can be used for real-time assessment of sleep, movement, and respiration.
- A randomized controlled treatment trial of 400+ patients admitted to the new hospital. The trial will test the effects on duration of admissions, medication use, sleep and circadian stability, and potential side-effects, of this environment compared to patients admitted to an inpatient environment that lacks the new lighting technology.
- Studies on how the hospital staff experience working in the new light environment.
Articles on the project
- The evening light environment in hospitals can be designed to produce less disruptive effects on the circadian system and improve sleep
- Evening light environments can be designed to consolidate and increase the duration of REM-sleep
- Sleep and work functioning in nurses undertaking inpatient shifts in a blue-depleted light environment
- A more detailed description of the unit and background (pdf)
- Søvn 1. utgave 2019
- The chronotherapeutic treatment of bipolar disorders: A systematic review and practice recommendations from the ISBD task force on chronotherapy and chronobiology
- A pragmatic effectiveness randomized controlled trial of the duration of psychiatric hospitalization in a trans-diagnostic sample of patients with acute mental illness admitted to a ward with either blue-depleted evening lighting or normal lighting conditions
Insomnia interventions
Research theme
We have conducted extensive trials of digital adaptations of Cognitive Behavior Therapy for Insomnia (dCBT-I), in which participants can receive treatment for their insomnia from the comfort of their own homes. These digital treatments have yielded positive effects in both the general population and in outpatient care settings.
Sleep-wake assessment
Research theme
Our research implement new technologies to assess and understand sleep and wakefulness. We investigate the potential of an impulse radio ultra-wideband (IR-UWB) radar as tool for contact-free objective sleep assessment and monitoring.
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