Gina Poe, PhD: How Psychiatric Diseases Impact Sleep Health

The interplay between between sleep health and psychiatric wellbeing is deeply established and practically inevitable in affected patients. But the association is not as simple as stating that those with mental illness sleep worse—or vice versa.

In the first segment of an interview with HCPLive during the American Psychiatric Association (APA) 2022 Annual Meeting in New Orleans last week, Gina Poe, PhD, the Eleanor Leslie Chair for Innovative Brain Research at UCLA, discussed her team’s laboratory work in understanding the association between sleep status and patients with post-traumatic stress disorder (PTSD) or opioid use disorder.

Poe discussed the various processes of sleep progression that are supposed to occur nightly. A highly impacted factor of sleep health among patients with psychiatric conditions is the transition to rapid eye movement (REM) stage, during which sleep spindles occur and the brain is essentially “reformatted and updated with new information.”

“That’s really important to mental health,” Poe explained. “People with schizophrenia, for example, don’t have many sleep spindles, or they’re very small or short.” In fact, she cited research from a Boston lab that showed restoring sleep spindles in such patients could benefit their memory and learning.

Along with cognitive and memory functions, sleep is impactful in the brain’s capability to process previous events before “resetting” for the next day.

“It’s also important for growth and the immune system—there’s so many things that it’s important for,” Poe explained. “And in terms of psychiatric disease, almost every psychiatric disease is accompanied with a sleep disturbance.”

Sleep status is a major complaint among patients with PTSD, Poe explained, as it has been observed that affected patients have over-activation of the locus coeruleus prior to the brain’s process to REM stage similar to patients with anxiety-related insomnia. While people are supposed to have “entirely silent” locus coerulueus prior to REM sleep, patients with PTSD can fall asleep with rapid activity.

“What we think is that REM sleep becomes maladaptive, and instead of us helping us to break apart the emotionality from the facts of what we’ve learned, it in fact melds them together in an abnormal fashion so that whenever we’re remembering that traumatic event, instead of just having the knowledge of the memory…we still feel horrible,” Poe said. “People with PTSD are afraid to go to sleep for a good reason.”

In terms of self-management, Poe stressed the importance of attempting to “calm the coeruleus” prior to sleep: meditation, prayer, mindfulness and deep breathing exercises may help. Patients with PTSD should refrain from overstimulation or emotionally-charged interactions or activities.

And because they possess similar pathology, Poe spoke on the potential benefit of cognitive behavioral therapy for insomnia in patients with PTSD.