Insomnia, nightmares, and chronotype as markers of risk for severe mental illness: results from a student population
Open accessAbstract
To group participants according to markers of risk for severe mental illness based on subsyndromal symptoms reported in early adulthood and evaluate attributes of sleep across these risk categories. An online survey of sleep and psychiatric symptomatology (The Oxford Sleep Survey) was administered to students at one United Kingdom university. 1403 students (undergraduate and postgraduate) completed the survey. The median age was 21 (interquartile range = 20–23) and 55.60% were female. The cross-sectional data were used to cluster participants based on dimensional measures of psychiatric symptoms (hallucinations, paranoia, depression, anxiety, and (hypo)mania). High, medium, and low symptom groups were compared across sleep parameters: insomnia symptoms, nightmares, chronotype, and social jet lag. Insomnia symptoms, nightmares frequency, and nightmare-related distress increased in a dose-response manner with higher reported subsyndromal psychiatric symptoms (low, medium, and high). The high-risk group exhibited a later chronotype (mid sleep point for free days) than the medium- or low-risk group. The majority of participants (71.7%) in the high-risk group screened positive for insomnia and the median nightmare frequency was two per 14 days (moderately severe pathology). Insomnia, nightmares, and circadian phase delay are associated with increased subsyndromal psychiatric symptoms in young people. Each is a treatable sleep disorder and might be a target for early intervention to modify the subsequent progression of psychiatric disorder. Young adulthood corresponds to a developmental stage where the symptoms of severe mental illness (SMI; e.g. paranoid thoughts, hallucinatory experiences and hypomanic mood) begin to emerge and are readily identified. Whilst sleep disruption has been associated with the later development of SMI, a detailed examination of specific sleep disorder symptoms and their association with risk for SMI has not been carried out. This study characterised sleep across three risk categories for SMI. Insomnia and nightmare severity increased in a dose response manner with increased risk for SMI. The impact of treating these sleep disorder symptoms on the subsequent development of SMI is a clear next step for research.
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Delayed sleep onset latency was more prevalent than sleep maintenance problems in those at high risk of a mental health problem in a sample of 1403 students.
“For example, Sheaves et al. [45] reported that delayed sleep onset latency was more prevalent than sleep maintenance problems in those at high risk of a mental health problem in a sample of 1403 students (although onset and maintenance were assessed using only 1 item each).”
From A structural equation model of the relationship between insomnia, negative affect, and paranoid thinking (2017) · cites this paper as [45]
Paranoia and hallucinations have the strongest links with insomnia.
“Paranoia and hallucinations have the strongest links with insomnia.2, 7, 8”
From The effects of improving sleep on mental health (OASIS): a randomised controlled trial with mediation analysis (2017) · cites this paper as [8]
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- Authors
- Sheaves, B., Porcheret, K., Tsanas, A., Espie, C. A., Foster, R. G., Freeman, D., Harrison, P. J., Wulff, K., & Goodwin, G. M.
- Affiliations
- Warneford Hospital (GB)
- University of Oxford (GB)
- Nuffeld Department of Clinical Neurosciences, University of Oxford, Sir William Dunn School of Pathology, South Parks Road, Oxford, UK
- Corresponding author
- Sheaves, Bryony
- ORCID
- Venue
- SLEEP
- Publisher
- Oxford University Press (OUP)
- Published
- 2016-01-01
- Volume
- 39
- Issue
- 1
- Pages
- 173-181
- ISSN
- 0161-8105 (ISSN-L)
- 1550-9109
- PMC
- PMC4678337
- OpenAlex
- W2281709244
- Cited by
- 129
- References
- 55
- Citations by year
- 2026: 7 · 2025: 7 · 2024: 5 · 2023: 14 · 2022: 13 · 2021: 14 · 2020: 17 · 2019: 19 · 2018: 11 · 2017: 13 · 2016: 7 · 2015: 2
- FWCI
- 16.57
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- SLEEP (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Wellcome Trust (098461, 098461/Z/12/Z)
- National Institute for Health and Care Research (NF-SI-0513-10010)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Keywords
- insomnia, nightmares, chronotype, circadian phase delay, social jetlag, early adulthood, young adults, sleep disruption, hallucinations, paranoia, depression, anxiety, hypomania, dose-response relationship, university students
- MeSH terms
- Anxiety, Mental Disorders, Bipolar Disorder, Cross-Sectional Studies, Depression, Depressive Disorder, Disease Susceptibility, Dreams, Female, United Kingdom, Humans, Sleep Initiation and Maintenance Disorders, Male, Paranoid Disorders, Surveys and Questionnaires, Risk, Sleep, Students, Universities, Disease Progression, Jet Lag Syndrome, Young Adult
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