The disturbed sleep pattern of people living with schizophrenia is more likely to be due to exposure to light than intrinsic biological factors.
Application of a physiologically-based mathematical model to light exposure, sleep timing data and biological markers of the circadian clock, has revealed that disturbed sleep timing in people living with schizophrenia is more likely to be related to light exposure than to intrinsic biological factors. Surprisingly enough, the combination of the mathematical model and digital health data suggested that the normalization of disturbed sleep timing is possible by increasing the availability of light and does not require the introduction of altered sleep patterns or sitting in front of light boxes , as recommended in current bright light therapy.
It is well known that the timing of sleep is altered in people living with mental health disorders including those suffering from schizophrenia, and contributes to poor sleep. Poor sleep is linked to anxiety, mental illness and a lower quality of life. In line with other studies, the present review of data previously published found that people living with schizophrenia spend more time in bed, get up later and sleep in an irregular pattern. Some of the participants fell asleep during the 24-hour day, especially in winter.
Whether altered sleep timing patterns are related to changes in biologically-determined characteristics of the body clock that drives sleep timing, or to behaviorally-determined patterns of light exposure which normally synchronize the clock to the 24-hour day, is an active topic of debate.
The multidisciplinary team of a mathematician, a circadian and sleep physiologists and a psychiatrist at the University of Surrey, the University of Umea (Sweden) and King’s College London respectively joined teams to tackle this problem. The unique data was fed through a mathematical model that includes the biological factors that influence sleep timing and how the body clock is affected by environmental factors showed that light exposure is the primary factor that determines.
Despite the fact that light is important, current interventions require people to sit in front of light boxes that emit bright light at specific times of the day. These interventions require that people with schizophrenia are required to get up and then go to bed according to a specific time to reap the most benefits. Mathematical analyses show that this is not required. It is much simpler to modify the pattern of light availability. The mathematical principles that regulate sleep timing through light will also be implemented.
It is important to note that this method is able to be tailored to individual differences and can be implemented by using currently available digital health technology. These interventions could be developed in conjunction with patients and make them easier to stick to. Light interventions are more effective in treating sleep disorders when they are more easily observed and tailored to the specific needs of the patient.
In their paper, the authors describe an approach to the implementation of their approach which could become a template for how data-model fusion techniques could help to reduce sleep disturbances in a variety of disorders, including bipolar disorders, schizophrenia, delayed sleep phase syndrome, and dementia. The current focus of Surrey researchers is on dementia, because of funding from the UK Dementia Research Institute.
Professor Anne Skeldon, University of Surrey’s Department of Mathematics said:
“Our clinical framework suggests a cost effective method to assist people in sleeping more often by implementing “light availability” interventions that are designed and tailored to the individual’s lives. With the help of clinicians and a wearable device that can detect light and the appropriate software, light-related interventions could take into account individual physiological characteristics and preferences.”
Combining digital health technology with mathematical models to examine the effects of light on circadian rhythms, sleep timing, and sleep time is a powerful way to create personalized interventions.
Professor Derk-Jan Dijk, Surrey Sleep Research Centre
Associate Professor Katharina Wulff from Umea University in Sweden said:
“With these technologies, individuals could monitor the response to intense seasonal daylight changes in the Northern part of Sweden and then use mathematical models to design individualized lighting regimes when additional lighting is required.”
Skeldon, A.C., and. (2021) Extracting Circadian and Sleep Parameters from Longitudinal Data in Schizophrenia for the Design of Pragmatic Light Interventions. Schizophrenia Bulletin. doi.org/10.1093/schbul/sbab124.
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