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Open Access Publications from the University of California

Scholarly Works (7 results)

  • Thesis
  • Peer Reviewed
UC Berkeley Electronic Theses and Dissertations (2013)

Context: Hypersomnia is poorly defined, though evidence suggests it is associated with a range of negative health outcomes, poorer quality of life, and increased new-onset and recurrence of psychiatric illness. Lack of definition impedes generalizability across research studies.

Objective: To clarify hypersomnia diagnoses by exploring the possibility of subgroups, along with their relationship to prospective sleep data and relapse into psychiatric illness, in a sample of individuals with bipolar disorder.

Design: Prospective longitudinal analysis of a community psychiatric sample

Participants: The final sample included 159 adults (ages 18-70) with bipolar spectrum disorder diagnoses (I, II and NOS) who were euthymic at study entry.

Main Outcome Measures: Self-reports and clinician-administered interviews were used to determine features of hypersomnia, including habitual sleep duration, extent of excessive sleepiness, and napping. Participants completed sleep diaries and wore wrist actigraphy at home to obtain prospective sleep data in the home environment. Follow-up interviews were completed approximately seven months later and psychiatric status was assessed using the Structured Clinical Interview for the DSM-IV (SCID).

Results: Factor analyses confirmed two separate subtypes of hypersomnia - a group characterized by long sleep time and a group characterized by excessive daytime sleepiness - that were uncorrelated (r=-0.09). Latent profile analyses suggested a four-class solution best characterized the data, with long sleep and excessive sleepiness representing two separate classes. Prospective sleep data suggested that the sleep of `long sleepers' is characterized by long time in bed, not long sleep duration. Finally, longitudinal assessment of psychiatric illness suggested that excessive sleepiness at baseline predicted mania/hypomania relapse at follow-up.

Conclusions: This study is the largest investigation of hypersomnia to include objective measurement of sleep, and refines our understanding of classification, characterization and associated morbidity. Hypersomnia appears to be comprised of two separate subgroups, long sleep and excessive sleepiness. Long sleep is characterized primarily by long bedrest duration. Excessive sleepiness is not associated with longer sleep or bedrest, but predicts relapse to mania/hypomania. Understanding these entities has important research and treatment implications.

    Cover page: Hypersomnia in Bipolar Disorder: Clarifying a Diagnostic Dilemma
    • Article
    • Peer Reviewed
    UC Berkeley Previously Published Works (2015)
    Bipolar disorder is a severe and chronic disorder, ranked in the top 10 leading causes of disability worldwide. Sleep disturbances are strongly coupled with interepisode dysfunction and symptom worsening in bipolar disorder. Experimental studies suggest that sleep deprivation can trigger manic relapse. There is evidence that sleep deprivation can have an adverse impact on emotion regulation the following day. The clinical management of the sleep disturbances experienced by bipolar patients, including insomnia, hypersomnia delayed sleep phase, and irregular sleep-wake schedule, may include medication approaches, psychological interventions, light therapies and sleep deprivation.
      Cover page: Interventions for Sleep Disturbance in Bipolar Disorder.
      • Article
      • Peer Reviewed
      UC Berkeley Previously Published Works (2013)
      In psychiatric illness, there is a growing body of evidence indicating that sleep disturbances exert a detrimental influence on the course of these disorders and contribute to impaired function. Even when psychiatric disorders are successfully treated or stabilized, insomnia and other sleep disturbances often fail to remit. The present review focuses on sleep in two severe mental illnesses, namely bipolar disorder and schizophrenia. This article discusses the role of sleep disturbances and altered sleep architecture in relation to symptom status, functional impairment, quality of life, and the course of these disorders. Current evidence regarding pharmacological and psychological treatment approaches for insomnia in these populations is presented. This review also notes considerations for adapting Cognitive Behavioral Therapy for insomnia (CBT-I) procedures for severe mental illness and proposes directions for future research.
        Cover page: Insomnia comorbid to severe psychiatric illness.
        • Article
        • Peer Reviewed
        UC Berkeley Previously Published Works (2014)

        Background

        The aim was to examine the prevalence and consequences of co-occurring insomnia and hypersomnia symptoms in depressed adults drawn from a representative sample of the U.S. population.

        Method

        Data from 687 National Comorbidity Survey Replication (NCS-R) respondents meeting criteria for a major depressive episode (MDE) in the past year were included. Respondents completed clinical interviews that assessed 12-month DSM-IV disorders, impairment, mental health treatment, and depressive symptom severity. Outcomes were compared between respondents who experienced insomnia symptoms-only (N=404), hypersomnia symptoms-only (N=44), both insomnia and hypersomnia symptoms (N=184) and no sleep problems (N=55) during an MDE.

        Results

        Insomnia and hypersomnia symptoms co-occurred in 27.7% of respondents with past-year MDEs, most frequently in bipolar spectrum disorders and major depressive disorder with dysthymia. Similar to the insomnia-only group, respondents with co-occurring sleep disturbances had more severe depression, and higher rates of past-year impulse control disorders and suicide planning. Similar to the hypersomnia-only group, respondents with co-occurring sleep disturbances had higher rates of past-year drug use disorders and suicide attempts. Compared to the insomnia-only and no sleep problem groups, respondents with both sleep disturbances were more frequently in mental health treatment, seeing a general practitioner, and taking antidepressants.

        Limitations

        The NCS-R is cross-sectional and did not evaluate sleep disorder diagnoses.

        Conclusions

        Co-occurring insomnia and hypersomnia symptoms were associated with a more severe MDE. Further research is warranted to more fully understand the joint presentation of insomnia and hypersomnia in depression.
          Cover page: Prevalence and clinical correlates of co-occurring insomnia and hypersomnia symptoms in depression
          • Article
          • Peer Reviewed
          UC Berkeley Previously Published Works (2019)
          Hypersomnia is common in psychiatric disorders, yet there are few self-report measures that adequately characterize this sleep disturbance. The objective of this study was to validate the Hypersomnia Severity Index (HSI), a tool designed to measure severity, distress and impairment of hypersomnia in psychiatric populations. Psychometric properties were evaluated in an undergraduate Scale Development sample (N = 381) and two psychiatric Scale Validation samples: euthymic bipolar participants with a range of sleep complaints (N = 89), and unmedicated unipolar depressed participants (N = 21) meeting operational criteria for hypersomnolence disorder. Exploratory factor analysis and confirmatory factor analysis in the Scale Development and Validation samples, respectively, suggested a two-factor structure representing Hypersomnia Symptoms and Distress/Impairment best fit the data. Convergent validity was established by significant associations with the Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), and the Sheehan Disability Scale in both samples. Construct validity was further supported by significant correlations between the Scale Validation sample and two weeks of diary- and actigraphy-determined total sleep time and time in bed. A cutoff score of 10 maximally discriminated between those with hypersomnia and those without. The HSI shows promise as a measure of hypersomnia that is commonly seen in psychiatric disorders, and may be of use to both researchers and clinicians. SUPPORT: This work is supported by grants from the American Sleep Medicine Foundation (76-JF-12), the Brain and Behavior Research Foundation (19193), and NIMHK23MH099234 (DTP); National Science Foundation Graduate Research Fellowship Program and Stanford Child Health Research Institute (KAK); and R34MH080958 and R01MH105513 (AGH).
            Cover page: Development and validation of the Hypersomnia Severity Index (HSI): A measure to assess hypersomnia severity and impairment in psychiatric disorders.
            • Article
            • Peer Reviewed
            UC Berkeley Previously Published Works (2014)
            OBJECTIVE: To evaluate the relative role of psychopathology in the relationship between physical activity and sleep, the present study investigated the day-to-day relationship between physical activity and sleep in individuals without a psychiatric disorder and individuals with bipolar disorder using a longitudinal, naturalistic design. METHOD: Participants in two groups-a healthy group with no psychiatric illness (N=36) and an inter-episode bipolar disorder group (N=32)- were studied over a two-month period. Physical health was assessed by the SF-36. Daily subjective and objective measures of physical activity and sleep were collected. A total of 6,670 physical activity measurements and 6,548 sleep measurements were logged. RESULTS: The bipolar disorder group exhibited poorer physical health on the SF-36 and more sleep disturbance relative to the healthy group. No group differences were found in physical activity, nor in models examining the relationship between physical activity and sleep. Hierarchical linear models indicated that for every standard deviation increase in sleep disturbance (i.e., increased total wake time), there was a three percent decrease in subsequent day physical activity, in both the healthy and bipolar groups. Increased physical activity was associated with improved sleep for participants who reported greater average sleep disturbance. CONCLUSIONS: The results for all participants in the study suggest that reduced physical activity and sleep difficulties may be mutually maintaining processes, particularly for individuals who suffer from poor sleep. Findings also raise the potential importance of targeting physical activity and sleep concurrently in interventions aimed at improving physical and mental health.
              Cover page: Physical activity and sleep: Day-to-day associations among individuals with and without Bipolar Disorder.
              • Article
              • Peer Reviewed
              UC Davis Previously Published Works (2019)
              Adaptive management of marine protected areas (MPAs) requires developing methods to evaluate whether monitoring data indicate that they are performing as expected. Modeling the expected responses of targeted species to an MPA network, with a clear timeline for those expectations, can aid in the development of a monitoring program that efficiently evaluates expectations over appropriate time frames. Here, we describe the expected trajectories in abundance and biomass following MPA implementation for populations of 19 nearshore fishery species in California. To capture the process of filling in the age structure truncated by fishing, we used age-structured population models with stochastic larval recruitment to predict responses to MPA implementation. We implemented both demographically open (high larval immigration) and closed (high self-recruitment) populations to model the range of possible trajectories as they depend on recruitment dynamics. From these simulations, we quantified the time scales over which anticipated increases in abundance and biomass inside MPAs would become statistically detectable. Predicted population biomass responses range from little change, for species with low fishing rates, to increasing by a factor of nearly seven, for species with high fishing rates before MPA establishment. Increases in biomass following MPA implementation are usually greater in both magnitude and statistical detectability than increases in abundance. For most species, increases in abundance would not begin to become detectable for at least 10 years after implementation. Overall, these results inform potential indicator metrics (biomass), potential indicator species (those with a high fishing : natural mortality ratio), and time frame (>10 yr) for MPA monitoring assessment as part of the adaptive management process.
                Cover page: Setting expected timelines of fished population recovery for the adaptive management of a marine protected area network
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