Ask anyone if they get enough sleep at night and most will say, “No way.” Then ask why not. Full schedules, demanding jobs, social media, television…it all gets in the way of a good night’s sleep.
No matter how often Americans hear that even minor sleep deprivation has been linked to everything from injury to chronic diseases like diabetes, obesity and depression, it’s still a rampant problem in this country. According to the Centers for Disease Control and Prevention, more than a third of American adults sleep less than the recommended minimum of seven hours per night.
Amy Wolfson, Ph.D., a professor of psychology and associate dean for faculty development at the College of the Holy Cross in Worcester, Mass., is a leading expert on sleep who wrote a book on women and sleep, (“The Woman’s Book of Sleep: A Complete Resource Guide”). Wolfson sits on the board of the National Sleep Foundation and is studying adolescent sleep habits using a sleep hygiene program she developed.
Wolfson spoke with New England Psychologist’s Catherine Robertson Souter about her work and about the need for psychology to take sleep issues into account when assessing mental health and when treating mental illness.
Q: First, tell us about your most recent work with middle school students.
A: This was funded by the by National Institute of Child Health and Human Development. It was the largest study funded to an individual faculty member in the history of the college, almost $1.1 million dollars.
The focus of the study was to evaluate the effectiveness of a preventive interventional program for early adolescents on sleep hygiene using a program based on a social learning model. It was not just a didactic program but attempted to get these early adolescents to feel competent to make changes in their sleep hygiene and sleep/wake patterns.
We were also interested in secondary variables like academic performance and general emotional and behavioral well being. And we were in a school district that has a significant number of kids living at or below the poverty line so we had a number of social demographic factors that we assessed.
Q: What were the results?
A: We are still analyzing data but we have two clear findings to date – one is in press and one is a paper that is not in press yet. The first finding looked at the data [collected at start of study]. Almost 30 percent of the students came from families with incomes of $30,000 or less. Not surprisingly, although it has not been shown in the literature, the kids who were living in the lowest income group were getting significantly less sleep than kids in more middle and upper income brackets.
The other finding that will be presented at a national conference in 2012 and will be submitted for publication in the next few weeks has more to do with the impact of the study. We had some impact from our program but not as much as we had hoped. There were changes regarding sleep hygiene on certain scales and we also found striking differences in what we call sleep competence or efficacy. Kids felt that that they had learned something and felt more able to manage their sleep/wake habits.
Q: Besides adolescence, there are other times of life when sleep problems are prevalent such as during pregnancy or post-partum?
A: I am always hesitant to get too focused only on women, although it’s near and dear to my heart. It’s funny, when I first did studies on pregnancy and postpartum issues with sleep, I could not find a single study that was looking at post-partum depression that asked about sleep. If you speak with anyone who has been through that, they will say they were sleep deprived. That has changed, but there is still further to go.
Q: How did you get interested in studying sleep?
A: I was always interested in areas that might lead to the prevention of mental health problems. My doctoral work was a study where we educated first-time parents about infants to help them sleep through night. We were able to not only help the babies in that group develop better sleep/wake habits but we were also able to demonstrate that couples in the treatment group had less stress and were more satisfied with their marriage.
Q: Do you think more people are recognizing the importance of sleep on all areas of physical and mental health? There has been a lot of press about the issue.
A: I certainly think that the field itself has received far more attention over the last 20 years. I am not so convinced that that means we are doing better with our sleep. The National Sleep Foundation does a poll every year and the data shows that the general public in the U.S. are not necessarily getting more sleep. Some of that is a kind of clash of cultures. The 24/7 society we live in is not making it easy for people to focus on and prioritize sleep in their lives.
For example, from the poll last year something like 18 percent of 13-29-year-olds admitted that at least a couple times a week they were either responding to or sending out text messages in the middle of the night. People get treated for disrupted sleep and here you have developing individuals self-creating what we would basically consider a sleep disorder by waking up in the middle of the night to use their cell phone.
Q: But you don’t see the issue getting enough attention in the field of psychology?
A: I think that medical schools are slowly trying to add curriculum regarding sleep but my sense is that most individuals who are going to get their doctorate in clinical psychology did not receive any training regarding sleep disorders or a basic understanding of biology and behavior relating to sleep and circadian rhythms.
I think we need to improve that because there is tremendous overlap and important differential diagnostic questions that need to be asked when you are assessing mental health.
Q: Can you share an example?
A: For example, sleep difficulties can be a symptom of depression and it is unclear sometimes whether the sleep problems triggered the onset of the depression or if it is possibly not even depression. So there can be misdiagnoses.
Also, one of the common treatments for depression, if you are going pharmacologically, is to use SSRIs which can have a side effect of causing insomnia. If you treat depression with an SSRI, you might exacerbate the sleep problems.
There is also growing research showing that it is possible that insomnia may be a precursor or even an explanation for a return to substance abuse post treatment. Not understanding that might mean putting someone at risk for returning to substance abuse. You need to treat the sleep problems even if there is a dual diagnosis. You are not going to take care of sleep problems by only treating the substance abuse or only treating the depression.
By Catherine Robertson Souter