Faculty Bibliography

Sleep disturbances have been linked to suicidal ideation and behaviors in adolescents. Specifically, insomnia and nightmares are associated with current suicide risk and predict future ideation. Associations between hypersomnia, sleep apnea, and suicide remain inconclusive. Potential biological mechanisms underlying these relationships include executive functioning deficits and hyperarousal. Related psychological factors may include thwarted belongingness, perceived burdensomeness, and negative appraisals. Assessing suicide risk in patients with sleep disturbances, and vice versa, is needed. Therapeutic interventions such as cognitive behavior therapy for insomnia and imagery rehearsal treatment, as well as pharmacologic treatments, show promise in treating sleep disorders and suicidal behavior.

Maggie is a 16-year-old girl who came to see me because she wanted help with her longstanding difficulties falling asleep at night and waking up in the morning. She goes to bed between midnight and 3 am and usually lies awake worrying until falling asleep at 3 to 4 am. She often video-calls or texts her boyfriend before sleep. Her wakeup time is 8 am; she typically wakes exhausted, having slept 4 to 5 hours. Although a good student, she is often late for classes. On weekends, she wakes around noon. She is tired, anxious, and demoralized. She cannot concentrate as well as she did prior to the onset of her sleep symptoms at age 10 to 11 years. Her psychiatric history includes a diagnosis of anxiety and depression, both in remission, treated with fluoxetine 30 mg daily for several years. Difficulties falling asleep and waking in the morning are common complaints among adolescents and young adults. Before my additional year of training in sleep medicine, I would have misdiagnosed Maggie as having insomnia rather than delayed sleep phase disorder (DSPD), a circadian rhythm disorder.

OBJECTIVE: To examine the impact of a sleep course on sleep-related behaviors, mood, and anxiety in college students. PARTICIPANTS: Participants were 145 students enrolled in either the sleep course (n = 70) or a psychology course (n = 75); data were collected in September 2014, November 2014, and February 2015. METHODS: Sleep characteristics and symptoms of depression and anxiety were assessed using validated questionnaires and sleep logs. Linear, logistic and proportional odds regression models were used to test course effects. RESULTS: In November, sleep course students reported significant differences in sleep hygiene (SHI; p<0.001), perceived sleep latency (PSQI; p<0.05), and circadian sleep phase (MEQ; p<0.05), compared to controls. In February, the sleep course students maintained most of the aforementioned gains and reported fewer symptoms of depression (CES-D; p = 0.05) and anxiety (BAI; p<0.05). CONCLUSIONS: These positive preliminary results indicate that focused education has potential to improve sleep among college students.