In a special episode of our In Conversation series, we hear from Dr. Faith Orchard about her recent paper, co-author by Prof. Alice M. Gregory, Prof. Michael Gradisar, and Dr. Shirley Reynolds, titled Self-Reported Sleep Patterns and Quality amongst Adolescents, Cross-Sectional and Prospective Associations with Anxiety and Depression.
The paper is part of the October 2020 Journal of Child Psychology and Psychiatry Special Issue on Sleep ‘Waking Up to the Importance of Sleep for Child & Adolescent Mental Health & Disorders’. Watch the video abstract on this paper and read the Research Digest.
This paper will be discussed at our new FREE online journal club CAMHS around the Campfire, see here for more details and to sign up.
Interviewer: Hello, welcome to a different type of In Conversation podcast from the Association for Child and Adolescent Mental Health ACAMH, where we will look at one paper from the October 2020 Journal of Child Psychology and Psychiatry, the JCPP, which is a special issue on sleep. I’m Jo Carlowe, a freelance journalist for the specialism in Psychology, and I have Dr. Faith Orchard with me, lecturer in clinical psychology at the University of Reading and co-author of the paper Self-Reported Sleep Patterns and Quality amongst Adolescents, Cross-Sectional and Prospective Associations with Anxiety and Depression. If you’re a fan of our In Conversation series, please subscribe on iTunes or your preferred streaming platform. Let us know how we did with a rating or review and do share with friends and colleagues. Hi Faith, thank you for joining me. Can you briefly introduce yourself?
Dr. Faith Orchard: Hi Jo, thanks very much for having me. My name is Faith Orchard. I’m a lecturer at the University of Reading and my main research interests really are in adolescent sleep, depression and anxiety. And I’m particularly interested in trying to understand the relationship between sleep and mental health.
Interviewer: As mentioned in the intro, you’ve just had a paper published in the JCPP which looks at sleep patterns and quality amongst adolescents and prospective associations with anxiety and depression. Before going into more detail, can you give an explanation of what is meant by sleep patterns and by sleep quality?
Dr. Faith Orchard: Sleep patterns refer to the timing of the sleep. So what time we fall asleep, what time we wake up and how many hours, minutes of sleep we actually got. Whereas the sleep quality refers to, I suppose, our experience of sleep and how good or how bad it was. So this might include things like: Did it take us a long time to fall asleep? Did we wake up in the night? And if we did, how many times or for how long? How tired do we feel in the day? So it covers quite a wide range of variables to start to understand how good our sleep actually is.
Interviewer: Sleep problems are common in adolescents and frequently there is comorbidity with anxiety and depression, as far as I understand. What was the aim of this paper? And can you give a brief overview of how you went about exploring this?
Dr. Faith Orchard: Yes as you highlight there is strong growing evidence already of the relationship between sleep and anxiety and depression. But we really wanted to start to understand which sleep problems in particular were related to anxiety and depression and whether young people with anxiety or depression would differ in the types of sleep problems that they had. So to date, most of the research really broadly just looks at the concept of sleep problems as a whole rather than the specific. To do this what we did was we looked at a large cohort study called ALSPAC, which stands for the Avon Longitudinal Study of Parents and Children, where they collected data on mothers and infants back in the early 1990s, and they’ve been following them up ever since. And we look specifically at data on adolescence and early adulthood where they collected measures of sleep and mental health.
Interviewer: In your paper, you state that a range of sleep variables at age 15 predicted the severity of anxiety and depression symptoms and diagnoses of anxiety and depression disorders at age 17, 21 and 24 years. What were the sleep variables that elevated risk of greater depression and anxiety, and how greatly were these variables associated with later psychopathology?
Dr. Faith Orchard: So there were a few variables that came up as having that elevated risk of later psychopathology. These included things like total sleep time, particularly on school nights, and how long it took to fall asleep on those school nights. But also other quality factors as well, so how tired teenagers were in the day and whether they were kind of waking up in the night. And a particularly key one that was quite strong was the perception of the sleep, whether or not young people thought they were getting enough sleep. In terms of how strong the variables were, the effect sizes were actually still quite small, but I guess we would expect that for a number of reasons. So firstly, we were controlling for baseline symptoms of anxiety and depression. So in terms of the variance of the data we were already taking into account a lot of symptomatology at baseline. But also, although this paper highlights that sleep is an important factor and we do need to consider it going forwards, there will also be so many other variables involved in the development of mental health problems, and this is going to be one of many things that we need to be considering. So although we do find these significant effects and are they’re important for us in terms of treatment and early intervention, having a sleep problem at age 15 doesn’t mean you’re definitely going to develop future psychopathology.
Interviewer: What mechanisms are likely to be at work that link sleep anxiety and depression in young people?
Dr. Faith Orchard: Yeah this is a really great question and actually we still don’t know very much about this. The research is very much in its infancy, but there are quite a few contenders, so we have different kind of areas I suppose. So there’s the biological mechanisms, which might be things like dysregulation and hormones. We have more social mechanisms, so things like parenting behaviours, family stress. And then the psychological ones, which we see quite a lot of cognitive mechanisms in particular. So things like worry, rumination, dysfunctional beliefs about sleep, so actually what we think about sleep. And at the moment the research really suggests that many of these mechanisms are likely to be at play and what’s happening is they’re probably interacting with each other.
Interviewer: And what is a dysfunctional belief about sleep?
Dr. Faith Orchard: So this is, I suppose, it will be quite varied, but it’ll include things like how much we think it’s really important that we fall asleep quickly or how much we’ll be affected if we don’t get sleep. And the problem with the beliefs about sleep is that they can make us worry even more. If we’re particularly concerned that we’re not falling asleep, and we’ve got a test next week and we really need to get sleep because that’s going to be really important for performing well, then we become even more concerned about the fact that we’re not sleeping, and that makes it then harder to fall asleep.
Interviewer: Faith, your research reveals that adolescents with depression experience difficulties with both sleep patterns and sleep quality, whereas adolescents with anxiety only report problems with sleep quality. Why is that? What did you find?
Dr. Faith Orchard: Yes, we felt this is a really interesting finding for us, and again, this is an area that the literature is still very early and kind of emerging. So there is some suggestion from the anxiety literature in particular that what might be going on is that individuals with anxiety view their sleep as worse than it actually is. So going back to those cognitive mechanisms that I mentioned before, that we might have biases in how we perceive our sleep. So what’s possible, is that both groups are describing problems with a subjective quality, so how they view their sleep, but that the actual pattern or the timing is only really a problem in the depressed young people rather than in the anxious young people. That is, however, very speculative and we’d obviously need a lot more work to be sure if that was the case. But there’s early indication that that could be what’s going on.
Interviewer: Faith, from your findings, what do you recommend in terms of treatment of sleep difficulties in young people and prevention of future anxiety or depression?
Dr. Faith Orchard: Our study obviously didn’t directly address treating sleep and the impact. I think what we do show is that sleep problems in adolescents are potentially risk factors, and I think what this might suggest is that intervening with sleep problems before we’re seeing other mental health difficulties like anxiety and depression might potentially help with preventing those future problems.
Interviewer: How do you go about translating findings then, of this sort, into clinical practice?
Dr. Faith Orchard: This study really is about laying the groundwork for understanding a bit more about how sleep problems present in anxiety and depression and how they might reflect this risk factor. So really, I think in terms of clinical practice, this work is more about triggering the next steps of intervention research by hopefully raising awareness with clinicians about what types of sleep problems young people with anxiety and depression might be experiencing.
Interviewer: Faith, what else is in the pipeline? Are you planning some follow up research that you can reveal to us?
Dr. Faith Orchard: Yeah, of course. We’re always planning the follow up work, and actually we’ve touched really nicely on quite a few of those things today. So I’m really keen to do a bit more work on understanding the mechanisms. I think that’s really important for us to understand how and when to intervene with sleep problems. But also the obvious step really is to start doing some early intervention work. So looking at if we deliver sleep interventions to young people, does that help to reduce or prevent later mental health problems?
Interviewer: Faith, are there any particular resources that you can recommend that are useful if people are worrying about their children’s sleep?
Dr. Faith Orchard: Yeah, so there’s a few different things people can look at, depending on exactly what they’re trying to seek out. So there is actually an ACAMH topic guide, which I co-wrote with Alice Gregory. And actually Alice has a really nice book that you could also have a look at, which is a bit more of a kind of a pop science book. So it’s very accessible, very easy to read. And that’s called Nodding Off. And that one provides a bit more of kind of a general background to understanding sleep and how sleep problems develop. But if people want a little bit more clinical support with helping sleep problems, there’s a really nice self-help guide called Helping Your Child with Sleep Problems. And that’s written by Rachel Hiller and Michael Gradisar. And that’s a bit more of a kind of an intervention-focused book.
Interviewer: And finally Faith, what’s your takeaway message for those listening to our conversation?
Dr. Faith Orchard: I mean, I think we’re all very aware that having a poor night’s sleep has an impact on us and that teenagers in particular are much more vulnerable to having difficult sleep. But for me, I think the takeaway message is that although it’s normal for sleep to change during adolescent years, if young people are struggling and aren’t getting enough sleep to function day to day, this is really important to get help because not only would it help them kind of in the moment with their day to day functioning, but it also might help to support them in future life and in later adolescence and adulthood.
Interviewer: Faith, thank you ever so much. That was great. Lovely to speak to you again. For more details on Dr. Faith Orchard, please visit the ACAMH website www.acamh.org and Twitter a ACAMH. ACAMH is spelt A-C-A-M-H. And don’t forget to follow us on iTunes or your preferred streaming platform. Let us know if you enjoyed the podcast with a rating or review and do share with friends and colleagues.
Faith Orchard has recently moved to the University of Sussex following a position based at the Anxiety and Depression in Young People (AnDY) Research Clinic at the University of Reading. Faith’s research interests span the causal and maintaining mechanisms in child and adolescent mental health, and subsequent implications for intervention. As part of this work, Faith is interested in the role of sleep disturbance in the development of depression, and is conducting research examining the effectiveness of brief CBT-I on symptoms of sleep, mood, and anxiety in community and clinical samples of young people.