'I realised that sleep affected all the things I had been studying'

How did you come to be at the University of Birmingham?

I'm from Spain and was educated there, but when I was doing my PhD, I had a fellowship which included a year abroad. I went to California first and then after my PhD I moved to the University of Helsinki in Finland for my postdoc studies and focused on mental health research. I met my husband in Finland and stayed there, moving to the Finnish Institute for Health and Welfare, which is where I started focusing on the research that I'm doing now.

Although Finland is a very small country, the population is very well prepared to participate in any kind of cohort study, so they have everybody participate in everything and they have a lot of data available. I continued looking at risk factors for mental health but I'm now focusing on sleep as a risk factor.

In 2018, I moved to the UK because my husband got a postdoc position in Birmingham, where we're now based. I got quite a prestigious fellowship – similar to the British Academy they have the Finnish Academy, and that was a four-year fellowship with a salary. Because I was working with data that had already been collected in Finland, I could move to the UK and continue my fellowship and work remotely. I joined the University of Birmingham in May 2018 with an honorary contract at the Institute for Mental Health, and then in June 2022, I was appointed Assistant Professor at the School of Psychology, at the University of Birmingham.

How did you become interested in studying sleep?

It was out of personal interest really. When I was doing my postdoc, everything I looked at was about cognitive functioning in mental health problems – I never considered sleep as one of the factors. When I started my second postdoc in Finland, I started to realise how the lack of light can affect sleep and my supervisor's main research area was in Seasonal Affective Disorder. 

I started to see all these different factors that have an impact on our mental health. Finland is supposed to be the happiest country in the world, but it has very high rates of alcoholism. I come from Spain, and we have a different lifestyle. When I experienced the difference in light between countries and the effect that can have, it made us wonder how sleep was affecting Finnish people.

I'm from a culture which is kind of the opposite of Finland. My colleagues in Finland really care about their sleep patterns, people tend to go to bed at 8pm and wake up early, whereas I come from a culture which has an attitude of 'the less sleep the better'! I realised that sleep affected all the things I had been studying – such as attention in patients with psychosis. If you have poor sleep, you don't perform well in attention tasks.

I know you try to embed co-production in many of your studies: could you tell me more about that?

Yes, we have an advisory group which is part of the Institute for Mental Health (IMH). It's made up of young people aged 18 to 25 with either lived experience or a strong interest in mental health. They work with us on different activities and give us feedback on our project funding applications. It's so important to get input from young people with lived experience and embed that input throughout your project. 

Before submission, I always have at least one meeting with three or four members of the Youth Advisory Group and explain my project to them and get feedback. I may want to ask them specific questions, for example, about measuring sleep and whether they would be okay to wear a sleep watch. They can help with aspects of stability in projects and discuss how the lived experience will be involved across the different stages of the project.

Some members of the advisory group attended a conference in Copenhagen about early intervention in young people and presented results from a project that was done at the IMH. I also got some funding from the Wellcome Trust for a project to study risk factors for depression in young people using existing datasets. 

My current research is mainly using existing data sets, and I specifically use the ALSPAC (Avon Longitudinal Study of Parents and Children) cohort study data. This is a lateral longitudinal cohort study run by the University of Bristol. They recruited around 14,000 mums during pregnancy in the 90s and are still following up with the parents and their children. It is a huge, amazing resource. Now those children are in their 30s so their children are also in the study. A large aspect of the study is about mental health, so I use this study to explore risk factors for mental health including sleep.

As part of this project, I got funding from The Wellcome Trust, which highlights lived experience endorsement. The Youth Advisory Group was very involved in co-production. I also hired a person with lived experience from the Youth Advisory Group as a research assistant. She was part of the team, she was at the meetings, she developed the website of our study, wrote updates from our project and also created a resource of risk factors for depression for young people. She also helped in interpreting the results and helped with how to do the data analysis.

Have you done any other co-production work?

Yes, I became interested in perinatal health when I had my daughter. I was doing sleep research, so I was quite careful with all the sleep issues that come with being a parent! When you're pregnant you are very aware of all the things that could happen. I realised how important sleep was in the perinatal period. People say it as a joke, like 'You can say goodbye to sleep from now on until your kid is 20 years old!', and I heard that so much it made me wonder whether people feel that sleep during pregnancy and after is bad by default. If people think like that, they're not going to do anything to try and improve their sleep.

That made me think about people who potentially might be more vulnerable to mental health conditions. It's a super critical period to address these risk factors and that's what got me interested in sleep and how important it is in the perinatal period. 

Postpartum psychosis affects a very small percentage of the population but it has one of the most devastating consequences in terms of perinatal mental health conditions. There is very little research on sleep and postpartum psychosis so I got some funding to hire a research assistant and I did a pilot study with ten mums who had postpartum psychosis who were so insightful. 

It is very rare, and obviously, these mums joined the study because they felt sleep was a relevant issue for them… out of that group all of them highlighted how important sleep was. It was interesting to hear about their different experiences of sleep. 

Some had been in a mother and baby unit and actually managed to sleep and once their sleep was addressed, they started to feel better. We published a narrative review recently on the status of sleep and postpartum psychosis and focus groups with the mums where we gathered qualitative data and found some themes from that.

What burning questions would you like to answer in the future?

I want to continue focusing on sleep and perinatal mental health, to try and understand in more detail how sleep is related to mothers with mental health conditions or how it might lead to perinatal mental health conditions. In one project, we want to focus on mums from under-represented ethnic minorities. A lot of research is on a very homogeneous group of people – even in the cohort study I use, it's 97 per cent white. We know mental health problems might be more frequent in mums from minority ethnic groups, but we don't know whether sleep is a higher risk factor. This is one aspect we want to address.

I work with existing data sets but I would like to create a data set myself – in a lot of the data there's a lack of information on sleep. I'm hoping to create a cohort study to follow mums and their children when they're born and measure sleep and mental health in detail. We'll have more detailed sleep questionnaires and actigraphy – that will help me to answer some more of my questions.