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How did you make the link between sleep and mental health?

When I was based at Charing Cross Hospital in London around 2003, I happened to be in a lift with a psychiatrist who said: 鈥淵ou always get sleep disruption in people with mental illness. That鈥檚 because they don鈥檛 have a job, so they go to bed late and get up late.鈥� I felt that made no sense.

So a team of us started working with people with schizophrenia, 80 per cent of whom have reported sleep disturbances broadly termed 鈥�insomnia鈥�. We monitored their sleep-wake cycles over six weeks and compared them to healthy people of the same age and gender who were also unemployed. For those with schizophrenia, regardless of their antipsychotic treatment, sleep patterns weren鈥檛 just disrupted; they were often totally smashed.

What other mental health conditions involve bad sleep?

Everything that鈥檚 been looked at, including bipolar disorder and seasonal affective disorder. We鈥檝e also known for a long time that depression and poor sleep occur together. It was always assumed that depression caused poor sleep, but actually sleep disruption precedes the depression. In addition, neurodegenerative disorders like dementia, Alzheimer鈥檚 and Parkinson鈥檚 disease are also always associated with sleep disruption.

So what might explain the link?

People ask, is it chicken or egg? But I don鈥檛 think that鈥檚 the right way to look at it. Research over the past decade shows that the sleep/wake cycle draws on all the brain鈥檚 neurotransmitters and multiple structures. So if you have got a defect in a pathway that predisposes you to mental illness, it鈥檚 going to have an effect on sleep. Clearly once sleep is affected, that may exacerbate the mental illness.

Should we view disturbed sleep as providing early warning of mental health issues?

That鈥檚 one idea we have been looking at. My colleague has developed a screen to identify young people in their teens and early 20s at high risk of developing bipolar disorder. The results are extraordinary. All the high-risk kids we have looked at so far have a sleep abnormality, but no clinical diagnosis of bipolar. So we can use sleep disruption as a biomarker of potential problems. And that offers the possibility of early intervention.

Has anyone tried using sleep to treat mental illness?

Yes. Researchers here at Oxford have found that if you can partially stabilise sleep using cognitive behavioural therapy in people with schizophrenia, you can . Others have tried to improve sleep in people in nursing homes with mild dementia by introducing big lights during the day and real darkness in the bedrooms at night. .

Could sleep even be used to prevent mental illness?

We are working on this now. If we take those kids at higher risk of bipolar and try to improve their sleep as much as possible, can we delay onset of the condition? Will sleep stabilisation knock the brain into a different developmental trajectory? That鈥檚 what we are trying to find out. We are also developing drugs to activate the light pathways that regulate the body clock. For example, we have discovered drugs that increase the clock鈥檚 sensitivity to light and others that trigger the pathways instead of light. This is all very exciting as currently there are very few options to regulate the body clock.

We answer all the questions keeping you up at night in 鈥淪leep: A user鈥檚 guide鈥�

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This article appeared in print under the headline 鈥淨+A: Sleep well 鈥� your mind could do with it鈥�