Sleep and Rest-Activity Rhythms in Recovering Patients with Severe Concurrent Mental and Substance Use Disorder: A Pilot Study

Abstract

Objective: Mental health and substance use disorders are commonly associated with disrupted sleep and circadian rest-activity rhythms. How these disorders in combination relate to sleep and circadian organization is not well studied. We provide here the first quantitative assessment of sleep and rest-activity rhythms in inpatients with complex concurrent disorders, taking into account categories of substance use (stimulant vs. stimulant and opioid use) and psychiatric diagnosis (psychotic disorder and mood disorder). We also explore how sleep and rest-activity rhythms relate to psychiatric functioning. Methods: A total of 44 participants (10 female) between the age of 20–60 years (median = 29 years) wore wrist accelerometers over 5–70 days and completed standardized questionnaires assessing chronotype and psychiatric functioning (fatigue, psychiatric symptom severity, and impulsiveness). To examine potential influences from treatment, we computed (1) length of stay; (2) days of abstinence from stimulants and opioids as a measure of withdrawal; and (3) a sedative load based on prescribed medications. Results: Participants exhibited a sustained excessive sleep duration, frequent nighttime awakenings, and advanced rest-activity phase related to sedative load. Sleep disruptions were elevated in participants with a history of opioid use. Patients with a psychotic disorder showed the longest sleep and most fragmented and irregular rest-activity patterns. Non-parametric circadian rhythm analysis revealed a high rhythm amplitude by comparison with population norms, and this was associated with greater psychiatric symptom severity. Psychiatric symptom severity was also associated with greater fatigue and later MCTQ chronotype. Conclusions: This pilot study provides initial information on the prevalence and severity of sleep and circadian rhythm disturbances in individuals with severe concurrent disorders. The results underline the need for further studies to start to understand the role of sleep in the disease and recovery process in this understudied population.

Keywords:

• Circadian rhythms
• sleep
• actigraphy
• concurrent disorder
• mental health
• sedative load
• inpatients
• rest-activity
• substance use
• dual diagnosis

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Acknowledgments

We thank our funders and BCMHA staff, in particular Kathryn Embacher (center Director) and Ariel Gabriel (unit patient care coordinator) for their support and commitment throughout the study. Special thanks also go out to our dedicated research assistants Marelle Reid, Scott Greenwood, Olivier Maguire, Cindy Chang, and Rayan Syeda, and to all our amazing participants.

Disclosure statement

Myriam Juda is a scientific advisory board member and restricted share owner at Fatigue Science, the maker of the ReadiBand. Christian G. Schütz is a practicing psychiatrist at the Red Fish Center for Healing (former Burnaby Center for Mental Health and Addiction), compensated by the Provincial Health Services Authority. Christian G. Schütz has received funding for research from the Canadian Institute of Health Research, Health Canada, the Canadian Center of Substance Use and Addiction, Brain and Behavior Foundation, and Peter Wall Institute. Joana Pater and Ralph Mistlberger declare no conflict of interest. The funders and Fatigue Science had no role in the design of the study or in the collection, analyses, and interpretation of data, or in the decision to publish the results.

Additional information

Funding

This work was supported by Mitacs through the Mitacs Accelerate Program (IT10482) in partnership with BC Hydro.