The AkuSleep Study- Treating Sleep Disturbances in Patients With Psychotic Symptoms in an Acute Ward Setting Using Cognitive Behavioral Treatment Techniques

Sleep disturbances are highly prevalent among patients admitted to any hospital ward, but in particular in psychiatric patients where insomnia and poor sleep quality is a major clinical challenge.

Approximately 950 patients are admitted to The Acute Psychiatric Department at Oslo University each year. The majority of the patients (approximately 450) admitted for more than 48 hours have a severe psychotic disorder and after being evaluated by a psychiatrist upon admittance, they are allocated to one of three similar wards specialized in the treatment of psychosis. A majority of the patients experience sleep difficulties both in terms of insomnia and problems regulating circadian rhythm. Psychiatric wards in general offer several challenges to sleep, including limited access to natural daylight, noisy environment and frequent observations by staff during night for risk management purposes. A part from offering medication which the patient often declines, staff members possess little means as to how to cope with noise and agitation at night time due to frustrated patients unable to find rest.

In September 2019 our department started organizing the treatment for psychotic patients in three similar wards ("psychosis wards") and patients were allocated to a ward according to their date of birth. Nurses are stationed permanently at each ward, while psychiatrist and psychologists make up a "specialist pool" serving all three psychosis wards. One of the main intentions for organizing the department and treatment this way is to ensure that all patients with psychotic disorders receive the same treatment according to recommended guidelines.

The aim of our study is to rethink our day to day psychological interventions and our around the clock milieu therapy for our patients with acute and severe mental illness in light of established knowledge on how sleep is obtained and maintained. After making physical adjustments to the ward environment and training allocated nurses in modified CBT techniques, the AkuSleep intervention will start up in March 2020 and will be carried out for up to six months. All patients admitted one of the psychosis wards will be offered the same customized treatment focusing on sleep, whereas all the patients admitted to the other two psychosis wards will receive treatment as usual (TAU). Upon discharge, all patients admitted to the Department of Acute Psychiatry who are able to give informed consent are asked to give a broad consent allowing us to systemize clinical information from hospital records for research purposes.

The AkuSleep protocol is as follows: