Skip to main content Accessibility help

Stabilising sleep for patients admitted at acute crisis to a psychiatric hospital (OWLS): an assessor-blind pilot randomised controlled trial

  • Bryony Sheaves (a1) (a2), Daniel Freeman (a1) (a2), Louise Isham (a1) (a2), Josephine McInerney (a2) (a3), Alecia Nickless (a4), Ly-Mee Yu (a4), Stephanie Rek (a1), Jonathan Bradley (a1), Sarah Reeve (a3), Caroline Attard (a5), Colin A. Espie (a6), Russell Foster (a6), Anna Wirz-Justice (a7), Eleanor Chadwick (a3) and Alvaro Barrera (a8)...



When patients are admitted onto psychiatric wards, sleep problems are highly prevalent. We carried out the first trial testing a psychological sleep treatment at acute admission (Oxford Ward sLeep Solution, OWLS).


This assessor-blind parallel-group pilot trial randomised patients to receive sleep treatment at acute crisis [STAC, plus standard care (SC)], or SC alone (1 : 1). STAC included cognitive–behavioural therapy (CBT) for insomnia, sleep monitoring and light/dark exposure for circadian entrainment, delivered over 2 weeks. Assessments took place at 0, 2, 4 and 12 weeks. Feasibility outcomes assessed recruitment, retention of participants and uptake of the therapy. Primary efficacy outcomes were the Insomnia Severity Index and Warwick–Edinburgh Mental Wellbeing Scale at week 2. Analyses were intention-to-treat, estimating treatment effect with 95% confidence intervals.


Between October 2015 and July 2016, 40 participants were recruited (from 43 assessed eligible). All participants offered STAC completed treatment (mean sessions received = 8.6, s.d. = 1.5). All participants completed the primary end point. Compared with SC, STAC led to large effect size (ES) reductions in insomnia at week 2 (adjusted mean difference −4.6, 95% CI −7.7 to −1.4, ES −0.9), a small improvement in psychological wellbeing (adjusted mean difference 3.7, 95% CI −2.8 to 10.1, ES 0.3) and patients were discharged 8.5 days earlier. One patient in the STAC group had an adverse event, unrelated to participation.


In this challenging environment for research, the trial was feasible. Therapy uptake was high. STAC may be a highly effective treatment for sleep disturbance on wards with potential wider benefits on wellbeing and admission length.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Stabilising sleep for patients admitted at acute crisis to a psychiatric hospital (OWLS): an assessor-blind pilot randomised controlled trial
      Available formats

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Stabilising sleep for patients admitted at acute crisis to a psychiatric hospital (OWLS): an assessor-blind pilot randomised controlled trial
      Available formats

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Stabilising sleep for patients admitted at acute crisis to a psychiatric hospital (OWLS): an assessor-blind pilot randomised controlled trial
      Available formats


This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (, which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

Author for correspondence: Bryony Sheaves, Email:


Hide All
American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders, 5th edn. Arlington, VA: American Psychiatric Association.
Barbini, B, Benedetti, F, Colombo, C, Dotoli, D, Bernasconi, A, Cigala-Fulgosi, M, Florita, M and Smeraldi, E (2005) Dark therapy for mania: a pilot study. Bipolar Disorders 7, 98101.
Bastien, CH, Vallières, A and Morin, CM (2001) Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Medicine 2, 297307.
Beck, AT, Kovacs, M and Weissman, A (1979) Assessment of suicidal intention: the scale for suicide ideation. Journal of Consulting and Clinical Psychology 47, 343352.
Beecham, J and Knapp, M (1992) Costing psychiatric interventions. In Thornicroft, G, Brewin, CR and Wing, JK (eds). Measuring Mental Health Needs. London: Gaskell, pp. 163184.
Boyce, N (2015) I'm only sleeping. The Lancet Psychiatry 2, 949.
Bradley, J, Freeman, D, Chadwick, E, Harvey, A, Mullins, B, Johns, L, Sheaves, B, Lennox, B, Broome, M and Waite, F (in press) Treating sleep problems in young people at ultra-high risk of psychosis: a feasibility case series. Behavioural and Cognitive Psychotherapy.
Breitstein, J, Penix, B, Roth, BJ, Baxter, T and Mysliwiec, V (2014) Intensive sleep deprivation and cognitive behavioral therapy for pharmacotherapy refractory insomnia in a hospitalized patient. Journal of Clinical Sleep Medicine 10, 689690.
Browne, RH (1995) On the use of a pilot sample for sample size determination. Statistics in Medicine 14, 19331940.
Connell, J and Barkham, M (2007) CORE-10 User Manual, Version 1.1. CORE System Trust & CORE Information Management Systems Ltd.
Crisp, N (2015) Improving acute inpatient psychiatric care for adults in England (interim report). The commission to review the provision of acute inpatient psychiatric care for adults.
Crisp, N, Smith, G and Nicholson, K (2016) Old problems, new solutions – improving acute psychiatric care for adults in England. The Commission on Acute Adult Psychiatric Care.
Espie, CA (2010) Overcoming Insomnia and Sleep Problems. London: Constable & Robinson.
Espie, CA, Kyle, S, Williams, C, Ong, J, Douglas, N, Hames, P and Brown, J (2012) A randomized, placebo-controlled trial of online cognitive behavioral therapy for chronic insomnia disorder delivered via an automated media-rich web application. Sleep 35, 769781.
Freeman, D, Sheaves, B, Goodwin, GM, Yu, L-M, Nickless, A, Harrison, PJ, Emsley, R, Luik, AI, Foster, RG, Wadekar, V, Hinds, C, Gumley, A, Jones, R, Lightman, S, Jones, S, Bentall, R, Kinderman, P, Rowse, G, Brugha, T, Blagrove, M, Gregory, AM, Fleming, L, Walklet, E, Glazebrook, C, Davies, EB, Hollis, C, Haddock, G, John, B, Coulson, M, Fowler, D, Pugh, K, Cape, J, Moseley, P, Brown, G, Hughes, C, Obonsawin, M, Coker, S, Watkins, E, Schwannauer, M, MacMahon, K, Siriwardena, AN and Espie, CA (2017) The effects of improving sleep on mental health (OASIS): a randomised controlled trial with mediation analysis. The Lancet Psychiatry 4, 749758.
Freeman, D, Waite, F, Startup, H, Myers, E, Lister, R, McInerney, J, Harvey, AG, Geddes, J, Zaiwalla, Z, Luengo-Fernandez, R, Foster, RG, Clifton, L and Yu, L-M (2015) Efficacy of cognitive behavioural therapy for sleep improvements in patients with persistent delusions and hallucinations (BEST): a prospective, assessor-blind, randomised controlled pilot trial. The Lancet Psychiatry 2, 975983.
Harvey, AG, Soehner, AM, Kaplan, KA, Hein, K, Lee, J, Kanady, J, Li, D, Rabe-hesketh, S, Ketter, TA, Neylan, TC and Buysse, DJ (2015) Treating insomnia improves mood state, sleep, and functioning in bipolar disorder: a pilot randomized controlled trial. Journal of Consulting and Clinical Psychology 83, 564577.
Haynes, PL, Parthasarathy, S, Kersh, B and Bootzin, RR (2011) Examination of insomnia and insomnia treatment in psychiatric inpatients. International Journal of Mental Health Nursing 20, 130136.
IBM Corp (2015) IBM SPSS Statistics for Windows 23.0. Armonk, NY: IBM Corp., Version 23.0.
Irwin, MR, Cole, JC and Nicassio, PM (2006) Comparative meta-analysis of behavioral interventions for insomnia and their efficacy in middle-aged adults and in older adults 55+ years of age. Health Psychology 25, 314.
Kaplan, KA and Harvey, AG (2013) Behavioral treatment of insomnia in bipolar disorder. American Journal of Psychiatry 170, 716720.
Kay, SR, Fiszbein, A and Opler, LA (1987) The Positive and Negative Syndrome Scale for schizophrenia. Schizophrenia Bulletin 13, 261276.
Langsrud, K, Vaaler, AE, Kallestad, H and Morken, G (2016) Sleep patterns as a predictor for length of stay in a psychiatric intensive care unit. Psychiatry Research 237, 252256.
Larsen, DL, Attkisson, CC, Hargreaves, WA and Nguyen, TD (1979) Assessment of client/patient satisfaction: development of a general scale. Evaluation and Program Planning 2, 197207.
Manber, R, Edinger, JD, Gress, JL, San Pedro-Salcedo, MG, Kuo, TF and Kalista, T (2008) Cognitive behavioral therapy for insomnia enhances depression outcome in patients with comorbid major depressive disorder and insomnia. Sleep 31, 489495.
Mental Health Strategies (2012) 2011/12 National Survey of Investment in Mental Health Services, prepared for the Department of Health.
Morin, CM, Kowatch, RA and O'Shanick, G (1990) Sleep restriction for the inpatient treatment of insomnia. Sleep 13, 183186.
National Institute for Health and Care Excellence (2015) Managing long term insomnia (>4 weeks). NICE Clinical Knowledge Summary. Available online at
Qaseem, A, Kansagara, D, Forciea, MA, Cooke, M, Denberg, TD, Barry, MJ, Boyd, C, Chow, RD, Fitterman, N, Harris, RP, Humphrey, LL, Manaker, S, McLean, R, Mir, TP, Schünemann, HJ, Vijan, S and Wilt, T (2016) Management of chronic insomnia disorder in adults: a clinical practice guideline from the American college of physicians. Annals of Internal Medicine 165, 125133.
Rehman, A, Waite, F, Sheaves, B, Biello, S, Freeman, D and Gumley, A (2016) Clinician perceptions of sleep problems, and their treatment, in patients with non-affective psychosis. Psychosis 2439, 111.
Sheaves, B, Isham, L, Bradley, J, Espie, C, Barrera, A, Waite, F, Harvey, A, Attard, C and Freeman, D (in press) Adapted CBT to stabilise sleep on psychiatric wards: a transdiagnostic treatment approach. Behavioural and Cognitive Psychotherapy.
Tennant, R, Hiller, L, Fishwick, R, Platt, S, Joseph, S, Weich, S, Parkinson, J, Secker, J and Stewart-Brown, S (2007) The Warwick–Edinburgh Mental Well-being Scale (WEMWBS): development and UK validation. Health and Quality of Life Outcomes 5, 63.
The EuroQol Group (1990) EuroQol – a new facility for the measurement of health-related quality of life. Health Policy 16, 199208.
Waite, F, Myers, E, Harvey, AG, Espie, CA., Startup, H, Sheaves, B and Freeman, D (2015) Treating sleep problems in patients with schizophrenia. Behavioural and Cognitive Psychotherapy 44, 273287.
Waters, F, Faulkner, D, Naik, N and Rock, D (2012) Effects of polypharmacy on sleep in psychiatric inpatients. Schizophrenia Research 139, 225228.
Wirz-Justice, A, Benedetti, F and Terman, M (2013) Chronotherapeutics for Affective Disorders A Clinician's Manual for Light and Wake Therapy. 2nd revise. Basel, Switzerland: Karger.
World Health Organization Collaborating Centre for Drug Statistics Methodology (2016) Definition and General Considerations (DDD). Available online at
Ye, Y-Y, Zhang, Y-F, Chen, J, Liu, J, Li, X-J, Liu, Y-Z, Lang, Y, Lin, L, Yang, X-J and Jiang, X-J (2015) Internet based cognitive behavioral therapy for insomnia (ICBT-i) improves comorbid anxiety and depression – a meta-analysis of randomized controlled trials. PLoS ONE 10, e0142258.
Young, RC, Biggs, JT, Ziegler, VE and Meyer, DA (1978) A rating scale for mania: reliability, validity and sensitivity. British Journal of Psychiatry 133, 429435.


Type Description Title
Supplementary materials

Sheaves et al supplementary material
Sheaves et al supplementary material

 Word (31 KB)
31 KB


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed