Biyolojik Ritimler, Uyku Bozuklukları ve Kadın Ruh Sağlığı: Bir Psikiyatri Yatan Hasta Ünitesinden Bulgular

Year 2025, Volume: 17 Issue: 2, 150 - 158, 17.06.2025

Aslı Enzel Koç , Kader Semra Karataş , Çiçek Hocaoğlu

Abstract

Amaç: Uyku ve sirkadiyen ritim bozuklukları, nöropsikiyatrik hastalıklarda yaygın olarak görülmekte ve semptom şiddeti, nüks oranları ve tedaviye yanıtsızlık ile ilişkilendirilmektedir. Kadınlar, biyolojik, sosyal ve psikolojik faktörler nedeniyle erkeklere kıyasla daha yüksek oranda uyku bozuklukları yaşamaktadır. Ancak, hastaneye yatırılan kadın psikiyatri hastalarında uyku sorunlarına ilişkin veriler sınırlıdır. Bu çalışma, kadın psikiyatri hastalarının yatış ve taburculuk sırasındaki uyku örüntülerini değerlendirmeyi ve uyku kalitesindeki değişimleri etkileyen faktörleri belirlemeyi amaçlamıştır.
Yöntemler: Doksan kadın psikiyatri hastası, yatış ve taburculuk dönemlerinde Pittsburgh Uyku Kalitesi İndeksi, Epworth Uykululuk Ölçeği, İnsomni Şiddeti İndeksi ve Nöropsikiyatride Biyolojik Ritim Değerlendirme Görüşmesi kullanılarak değerlendirilmiştir. Sosyodemografik veriler, psikiyatrik tanılar ve tedavi detayları yapılandırılmış görüşmeler yoluyla toplanmıştır. Veriler SPSS 22.0 kullanılarak analiz edilmiştir.
Bulgular: Yatış sırasında hastaların %87,8’i kötü uyku kalitesi bildirmiştir, bu oran taburculukta %63,3’e düşmüştür. İyileşmeye rağmen, önemli ölçüde uyku bozuklukları devam etmiştir. Taburculukta kötü uyku kalitesi, yüksek benzodiazepin kullanımı, işsizlik, ailede uyku bozukluğu öyküsü ve sık hastaneye yatış ile ilişkilendirilmiştir. Psikiyatrik tanılar arasında anlamlı bir fark bulunmamıştır. Yaş, uyku ilacı kullanımı ile pozitif korelasyon göstermiştir. Sirkadiyen ritim bozuklukları, kötü uyku kalitesi ve artmış insomni şiddeti ile güçlü bir şekilde ilişkilendirilmiştir.
Sonuç: Kadın psikiyatri hastalarında uyku bozuklukları tedaviye rağmen devam etmekte ve sosyodemografik, klinik ve sirkadiyen ritim faktörlerinden etkilenmektedir. Biyolojik, psikolojik ve sosyal katkıları hedefleyen, cinsiyete özgü müdahaleler, tedavi sonuçlarını iyileştirebilir, hastaneye yatışları azaltabilir ve psikiyatri servislerindeki hasta bakımını güçlendirebilir.

Keywords

Uyku , Sirkadiyen ritim , Kadın , Hastaneye yatış

Biological Rhythms, Sleep Disturbances, and Women’s Mental Health: Findings From a Psychiatric Inpatient Unit

Abstract

Objective: Sleep and circadian rhythm disruptions are common in neuropsychiatric disorders, correlating with symptom severity, relapse rates, and poor treatment response. Women experience higher rates of sleep disturbances than men due to biological, social, and psychological factors. However, data on sleep issues in hospitalized female psychiatric patients remain limited. This study assessed sleep patterns in female psychiatric inpatients at admission and discharge and identified factors influencing changes in sleep quality.
Methods: Ninety female psychiatric inpatients were evaluated using the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Insomnia Severity Index and Biological Rhythm Interview of Assessment in Neuropsychiatry at both admission and discharge. Sociodemographic data, psychiatric diagnoses, and treatment details were collected through structured interviews. Data were analyzed using SPSS 22.0.
Results: At admission, 87.8% of patients reported poor sleep quality, which decreased to 63.3% at discharge. Despite improvement, significant sleep disturbances persisted. Poor sleep quality at discharge was associated with higher benzodiazepine use, unemployment, family history of sleep disorders, and frequent hospitalizations. No significant differences were found across psychiatric diagnoses. Age correlated positively with sleep medication use. Disruptions in circadian rhythms were strongly linked to poorer sleep quality and higher insomnia severity.
Conclusion: Sleep disturbances persist in female psychiatric inpatients despite treatment and are influenced by sociodemographic, clinical, and circadian rhythm factors. Targeted, gender-specific interventions addressing biological, psychological, and social contributors, including circadian irregularities, may improve treatment outcomes, reduce hospitalizations, and enhance patient care in psychiatric settings.

Keywords

sleep , circadian rhythm , women , hospitalization

Ethical Statement

The study was approved by the Ethics Committee of Recep Tayyip Erdoğan University Faculty of Medicine on 24.01.2020, decision number 2020/03. Patients were informed about the study, and their written consent was obtained.

References

• 1. Colten HR, Altevogt BM, editors; Institute of Medicine (US) Committee on Sleep Medicine and Research. Extent and health consequences of chronic sleep loss and sleep disorders. In: Sleep disorders and sleep deprivation: an unmet public health problem. Washington (DC): National Academies Press (US); 2006. Available from: https://www.ncbi.nlm.nih.gov/books/NBK19961/.
• 2. Amerikan Psikiyatri Birligi. Mental Bozuklukların Tanısal ve Sayımsal El Kitabı Beşinci Baskı (DSM 5). Arlington, VA: Amerikan Psikiyatri Birligi; 2013.
• 3. Phillips BA, Collop NA, Drake C, Consens F, Vgontzas AN, Weaver TE. Sleep disorders and medical conditions in women. J Womens Health (Larchmt). 2008 Sep;17(7):1191-9.
• 4. Vgontzas AN, Zoumakis E, Bixler EO, et al. Adverse effects of modest sleep restriction on sleepiness, performance, and inflammatory cytokines. J Clin Endocrinol Metab. 2004;89(5):2119-26.
• 5. Saunders EF, Fernandez-Mendoza J, Kamal M, et al. The effect of poor sleep quality on mood outcome differs between men and women: A longitudinal study of bipolar disorder. J Affect Disord. 2015;180:90-6.
• 6. Randler C, Engelke J. Gender differences in chronotype diminish with age: a meta-analysis based on morningness/chronotype questionnaires. Chronobiol Int. 2019;36:888-905.
• 7. Cappadona R, Di Simone E, De Giorgi A, Zucchi B, Fabbian F, Manfredini R. Biological rhythms, health, and gender-specific differences. Ital J Gender-Specific Med. 2021;7(2):109-15. doi: 10.1723/35471.
• 8. Novak C, Packer E, Paterson A, et al. Feasibility and utility of enhanced sleep management on in-patient psychiatry wards. BJPsych Bull. 2020;44(6):255-60.
• 9. Hartescu I, Gardiner PM, Girardi A, Breen KC, Roychowdhury A, Wallang PM, et al. Sleep quality and adverse incidents in secure mental health settings. J Forens Psychiatry Psychol. 2022;33(4):621–637.
• 10. Gardiner PM, Hartescu I, Breen KC, Kinnafick FE. Sleep quality in secure psychiatric healthcare: Inpatient & staff perspectives. Sleep Med. 2024;124:453-61.
• 11. Klinkenberg WD, Calsyn RJ. Predictors of receipt of aftercare and recidivism among persons with severe mental illness: a review. Psychiatr Serv. 1996;47(5):487-96.
• 12. Haynes PL, Parthasarathy S, Kersh B, Bootzin RR, Howell JW, Quan SF. Examination of insomnia and insomnia treatment in psychiatric inpatients. Int J Ment Health Nurs. 2011;20(2):130-6.
• 13. Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193-213.
• 14. Ağargün MY, Kara H, Anlar O. Pittsburgh uyku kalitesi indeksinin geçerliği ve güvenirliği. Turk Psikiyatri Derg. 1996;7(2):107-15.
• 15. Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14(6):540-5.
• 16. Ağargün MY, Çilli AS, Kara H, et al. Epworth Uykululuk Ölçeği’nin geçerliği ve güvenirliği. Turk Psikiyatri Derg. 1999;10(4):261-7.
• 17. Bastien CH, Vallières A, Morin CM. Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med. 2001;2(4):297-307.
• 18. Boysan M, Güleç M, Besiroglu L, Kalafat O, Durgun O, Aydin A. Uykusuzluk Şiddeti İndeksi’nin Türk örneklemindeki psikometrik özellikleri. Anadolu Psikiyatri Derg. 2010;11(3):248.
• 19. Giglio LMF, Magalhães PVS, Andreazza AC, et al. Development and use of a biological rhythm interview. J Affect Disord. 2009;118(1-3):161-5.
• 20. Aydemir Ö, Akkaya C, Altınbaş K, et al. Biyolojik ritim değerlendirme görüşmesinin Türkçe sürümünün güvenilirliği ve geçerliliği. Anadolu Psikiyatri Derg. 2012;13:256-61.
• 21. Aboaja AM, Lindsay HD, Perry AE, et al. Sleep interventions for adults admitted to psychiatric inpatient settings: a systematic scoping review. Sleep Med Rev. 2024;101950.
• 22. Mijnster T, Boersma G, Engberts J, et al. Lying awake in forensic hospitals: a multicenter, cross-sectional study on the prevalence of insomnia and contributing factors in forensic psychiatric patients. J Forensic Psychiatry Psychol. 2022;33(3):335-53.
• 23. Gruber J, Miklowitz DJ, Harvey AG, et al. Sleep matters: sleep functioning and course of illness in bipolar disorder. J Affect Disord. 2011;134(1-3):416-20.
• 24. Zhang B, Wing YK. Sex differences in insomnia: a meta-analysis. Sleep. 2006;29(1):85-93.
• 25. Fernandez-Mendoza J, Calhoun SL, Bixler EO, et al. Sleep misperception and chronic insomnia in the general population: the role of objective sleep duration and psychological profiles. Psychosom Med. 2011;73(1):88-97.
• 26. Najafi A, Mahboobi M, Sadeghniiat Haghighi K, et al. Sleep disturbance, psychiatric issues, and employment status of Iranian people living with HIV. BMC Res Notes. 2021;14(1):1-6. 27. Khurshid KA. Comorbid insomnia and psychiatric disorders: an update. Innov Clin Neurosci. 2018 Apr 1;15(3–4):28–32.
• 28. Brower KJ, Perron BE. Sleep disturbance as a universal risk factor for relapse in addictions to psychoactive substances. Med Hypotheses. 2010;74(5):928-33.
• 29. Manber R, Edinger JD, Gress JL, San Pedro-Salcedo MG, Kuo TF, Kalista T. Cognitive behavioral therapy for insomnia enhances depression outcome in patients with comorbid major depressive disorder and insomnia. Sleep. 2008;31(4):489-95.
• 30. Ter Heege FM, Mijnster T, van Veen MM, Hoenders HR, Dekker J, Aan het Rot M. The clinical relevance of early identification and treatment of sleep disorders in mental health care: protocol of a randomized control trial. BMC Psychiatry. 2020;20(1):1-10.
• 31. Cretu JB, Culver JL, Goffin KC, Shah S, Ketter TA. Sleep, residual mood symptoms, and time to relapse in recovered patients with bipolar disorder. J Affect Disord. 2016;190:162-6.
• 32. Bloom HG, Ahmed I, Alessi CA, Ancoli-Israel S, Buysse DJ, Kryger MH, Phillips BA, Thorpy MJ, Vitiello MV, Zee PC. Evidence-based recommendations for the assessment and management of sleep disorders in older persons. J Am Geriatr Soc. 2009;57(5):761–789.
• 33. Chen L, Bell JS, Visvanathan R, Hilmer SN, Emery T, Robson L, Hughes JM, Tan ECK. The association between benzodiazepine use and sleep quality in residential aged care facilities: a cross-sectional study. BMC Geriatr. 2016;16:196.
• 34. Jaussent I, Dauvilliers Y, Ancelin ML, et al. Insomnia symptoms in older adults: associated factors and gender differences. Am J Geriatr Psychiatry. 2011;19(1):88-97.
• 35. Ohayon MM. Epidemiology of insomnia: what we know and what we still need to learn. Sleep Med Rev. 2002;6(2):97-111.
• 36. Seixas BV. Prevalence and factors associated with use of sleeping pills among older adults in Brazil. Int J Pharm Pract. 2021;29(3):235-44.
• 37. Codoñer-Franch P, Gombert M, Martínez-Raga J, Cenit MC. Circadian disruption and mental health: the chronotherapeutic potential of microbiome-based and dietary strategies. Int J Mol Sci. 2023;24(8):7579.