Child Psychiatry & Human Development

, Volume 49, Issue 1, pp 63–72 | Cite as

Sleeping Paranoia Away? An Actigraphy and Experience-Sampling Study with Adolescents

  • Timo HennigEmail author
  • Tania M. Lincoln
Original Article


Paranoid symptoms co-occur with distress and poor functioning and constitute a risk for psychosis and other mental disorders. Poor sleep is known to be associated with paranoid symptoms, but the direction of the effect and the mediating factors have not been studied thoroughly. In an experience-sampling study, 61 adolescents wore an actigraph over eight nights and also rated their sleep, symptoms of paranoia, and potentially mediating factors. Shorter sleep time and more dreaming predicted paranoid symptoms in multilevel regression models. Paranoid symptoms did not significantly predict sleep parameters. Positive and negative affect partially mediated the effect of sleep time on paranoid symptoms. The effects were small, but encourage further research that might then be used to improve the prevention of paranoid symptoms.


Psychosis Schizophrenia Persecutory delusions Daily diary Ambulatory assessment 



We like to thank the participating adolescents, the psychology students who helped with the data collection, and Dr. Jürgen Kempkensteffen for technical support. We declare that no potential conflict of interest is associated with the manuscript.


  1. 1.
    Linscott RJ, van Os J (2013) An updated and conservative systematic review and meta-analysis of epidemiological evidence on psychotic experiences in children and adults: on the pathway from proneness to persistence to dimensional expression across mental disorders. Psychol Med 43(6):1133–1149CrossRefPubMedGoogle Scholar
  2. 2.
    Kelleher I, Connor D, Clarke MC, Devlin N, Harley M, Cannon M (2012) Prevalence of psychotic symptoms in childhood and adolescence: a systematic review and meta-analysis of population-based studies. Psychol Med 42(9):1857–1863CrossRefPubMedGoogle Scholar
  3. 3.
    Taylor MJ, Freeman D, Ronald A (2016) Dimensional psychotic experiences in adolescence: evidence from a taxometric study of a community-based sample. Psychiatry Res 241:35–42CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Yung AR, Nelson B, Baker K, Buckby JA, Baksheev G, Cosgrave EM (2009) Psychotic-like experiences in a community sample of adolescents: implications for the continuum model of psychosis and prediction of schizophrenia. Aust NZ J Psychiatry 43(2):118–128CrossRefGoogle Scholar
  5. 5.
    Ronald A, Sieradzka D, Cardno AG, Haworth CMA, McGuire P, Freeman D (2014) Characterization of psychotic experiences in adolescence using the Specific Psychotic Experiences Questionnaire: findings from a study of 5000 16-year-old twins. Schizophr Bull 40(4):868–877CrossRefPubMedGoogle Scholar
  6. 6.
    Armando M, Nelson B, Yung AR et al (2010) Psychotic-like experiences and correlation with distress and depressive symptoms in a community sample of adolescents and young adults. Schizophr Res 119(1–3):258–265CrossRefPubMedGoogle Scholar
  7. 7.
    Kelleher I, Cederlöf M, Lichtenstein P (2014) Psychotic experiences as a predictor of the natural course of suicidal ideation: a Swedish cohort study. World Psychiatry 13(2):184–188CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Fisher HL, Caspi A, Poulton R et al (2013) Specificity of childhood psychotic symptoms for predicting schizophrenia by 38 years of age: a birth cohort study. Psychol Med 43(10):2077–2086CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Kelleher I, Wigman JT, Harley M et al (2015) Psychotic experiences in the population: association with functioning and mental distress. Schizophr Res 165(1):9–14CrossRefPubMedGoogle Scholar
  10. 10.
    Kaymaz N, Drukker M, Lieb R et al (2012) Do subthreshold psychotic experiences predict clinical outcomes in unselected non-help-seeking population-based samples? A systematic review and meta-analysis, enriched with new results. Psychol Med 42(11):2239–2253CrossRefPubMedGoogle Scholar
  11. 11.
    Zammit S, Kounali D, Cannon M et al (2013) Psychotic experiences and psychotic disorders at age 18 in relation to psychotic experiences at age 12 in a longitudinal population-based cohort study. Am J Psychiatry 170(7):742–750CrossRefPubMedGoogle Scholar
  12. 12.
    Dolphin L, Dooley B, Fitzgerald A (2015) Prevalence and correlates of psychotic like experiences in a nationally representative community sample of adolescents in Ireland. Schizophr Res 169(1–3):241–247CrossRefPubMedGoogle Scholar
  13. 13.
    Waters F, Manoach DS (2012) Sleep dysfunctions in schizophrenia: a practical review. Open J Psychiatry 2:384–392CrossRefGoogle Scholar
  14. 14.
    Cohrs S (2008) Sleep disturbances in patients with schizophrenia: impact and effect of antipsychotics. CNS Drugs 22(11):939–962CrossRefPubMedGoogle Scholar
  15. 15.
    Kamath J, Virdi S, Winokur A (2015) Sleep disturbances in schizophrenia. Psychiatr Clin North Am 38(4):777–792CrossRefPubMedGoogle Scholar
  16. 16.
    Klingaman EA, Palmer-Bacon J, Bennett ME, Rowland LM (2015) Sleep disorders among people with schizophrenia: emerging research. Curr Psychiatry Rep 17(10):8CrossRefGoogle Scholar
  17. 17.
    Spiegelhalder K, Regen W, Nanovska S, Baglioni C, Riemann D (2013) Comorbid sleep disorders in neuropsychiatric disorders across the life cycle. Curr Psychiatry Rep 15(6):6CrossRefGoogle Scholar
  18. 18.
    Lunsford-Avery JR, Mittal VA (2013) Sleep dysfunction prior to the onset of schizophrenia: a review and neurodevelopmental diathesis-stress conceptualization. Clin Psychol Sci Pract 20(3):291–320CrossRefGoogle Scholar
  19. 19.
    Reeve S, Sheaves B, Freeman D (2015) The role of sleep dysfunction in the occurrence of delusions and hallucinations: a systematic review. Clin Psychol Rev 42:96–115CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Lunsford-Avery JR, LeBourgeois MK, Gupta T, Mittal VA (2015) Actigraphic-measured sleep disturbance predicts increased positive symptoms in adolescents at ultra high-risk for psychosis: a longitudinal study. Schizophr Res 164(1–3):15–20CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Lee YJ, Cho SJ, Cho IH, Jang JH, Kim SJ (2012) The relationship between psychotic-like experiences and sleep disturbances in adolescents. Sleep Med 13(8):1021–1027CrossRefPubMedGoogle Scholar
  22. 22.
    Oshima N, Nishida A, Fukushima M et al (2010) Psychotic-like experiences (PLEs) and mental health status in twin and singleton Japanese high school students. Early Interv Psychiatry 4(3):206–213CrossRefPubMedGoogle Scholar
  23. 23.
    Jeppesen P, Clemmensen L, Munkholm A et al (2015) Psychotic experiences co-occur with sleep problems, negative affect and mental disorders in preadolescence. J Child Psychol Psychiatry 56(5):558–565CrossRefPubMedGoogle Scholar
  24. 24.
    Taylor MJ, Gregory AM, Freeman D, Ronald A (2015) Do sleep disturbances and psychotic-like experiences in adolescence share genetic and environmental influences? J Abnorm Psychol 124(3):674–684CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Thompson A, Lereya ST, Lewis G, Zammit S, Fisher HL, Wolke D (2015) Childhood sleep disturbance and risk of psychotic experiences at 18: UK birth cohort. Br J Psychiatry 207(1):23–29CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Freeman D, Pugh K, Vorontsova N, Southgate L (2009) Insomnia and paranoia. Schizophr Res 108(1–3):280–284CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Myers E, Startup H, Freeman D (2011) Cognitive behavioural treatment of insomnia in individuals with persistent persecutory delusions: a pilot trial. J Behav Ther Exp Psychiatry 42(3):330–336CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Freeman D, Waite F, Startup H et al (2015) Efficacy of cognitive behavioural therapy for sleep improvement in patients with persistent delusions and hallucinations (BEST): a prospective, assessor-blind, randomised controlled pilot trial. Lancet Psychiatry 2(11):975–983CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Freeman D, Garety PA, Kuipers E, Fowler D, Bebbington PE (2002) A cognitive model of persecutory delusions. Br J Clin Psychol 41:331–347CrossRefPubMedGoogle Scholar
  30. 30.
    Garety PA, Kuipers E, Fowler D, Freeman D, Bebbington PE (2001) A cognitive model of the positive symptoms of psychosis. Psychol Med 31(2):189–195CrossRefPubMedGoogle Scholar
  31. 31.
    Koyanagi A, Stickley A (2015) The association between sleep problems and psychotic symptoms in the general population: a global perspective. Sleep 38(12):1875–1885CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Baron RM, Kenny DA (1986) The moderator-mediator varible distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol 51(6):1173–1182CrossRefPubMedGoogle Scholar
  33. 33.
    Mulligan LD, Haddock G, Emsley R, Neil ST, Kyle SD (2016) High resolution examination of the role of sleep disturbance in predicting functioning and psychotic symptoms in schizophrenia: A novel experience sampling study. J Abnorm Psychol 125(6):788CrossRefPubMedGoogle Scholar
  34. 34.
    Koffel E, Watson D (2009) Unusual sleep experiences, dissociation, and schizotypy: evidence for a common domain. Clin Psychol Rev 29(6):548–559CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Hartmann E (1996) Outline for a theory on the nature and functions of dreaming. Dreaming 6(2):147–170CrossRefGoogle Scholar
  36. 36.
    Beebe DW (2011) Cognitive, behavioral, and functional consequences of inadequate sleep in children and adolescents. Pediatr Clin North Am 58(3):649–665CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Kim SJ, Lee YJ, Jang JH, Lim W, Cho IH, Cho SJ (2012) The relationship between psychotic-like experiences and attention deficits in adolescents. J Psychiatr Res 46(10):1354–1358CrossRefPubMedGoogle Scholar
  38. 38.
    Trull TJ, Ebner-Priemer U (2013) Ambulatory assessment. Annu Rev Clin Psychol 9:151–176CrossRefPubMedGoogle Scholar
  39. 39.
    Meltzer LJ, Montgomery-Downs HE, Insana SP, Walsh CM (2012) Use of actigraphy for assessment in pediatric sleep research. Sleep Med Rev 16(5):463–475CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Sadeh A (2011) The role and validity of actigraphy in sleep medicine: an update. Sleep Med Rev 15(4):259–267CrossRefPubMedGoogle Scholar
  41. 41.
    Ancoli-Israel S, Martin JL, Blackwell T et al (2015) The SBSM guide to actigraphy monitoring: clinical and research applications. Behav Sleep Med 13:S4–S38CrossRefPubMedGoogle Scholar
  42. 42.
    Meltzer LJ, Walsh CM, Traylor J, Westin AML (2012) Direct comparison of two new actigraphs and polysomnography in children and adolescents. Sleep 35(1):159–166PubMedPubMedCentralGoogle Scholar
  43. 43.
    Hoffmann RM, Müller T, Hajak G, Cassel W (1997) Abend-Morgenprotokolle in Schlafforschung und Schlafmedizin: Ein Standardinstrument für den deutschsprachigen Raum (Sleep logs in sleep research and sleep medicine). Somnologie 1(3):103–109CrossRefGoogle Scholar
  44. 44.
    Stefanis NC, Hanssen M, Smirnis NK et al (2002) Evidence that three dimensions of psychosis have a distribution in the general population. Psychol Med 32(2):347–358CrossRefPubMedGoogle Scholar
  45. 45.
    Schlier B, Jaya ES, Moritz S, Lincoln TM (2015) The community assessment of psychic experiences measures nine clusters of psychosis-like experiences: a validation of the German version of the CAPE. Schizophr Res 169(1–3):274–279CrossRefPubMedGoogle Scholar
  46. 46.
    Stemmler G, Heldmann M, Pauls CA, Scherer T (2001) Constraints for emotion specificity in fear and anger: the context counts. Psychophysiology 38(2):275–291CrossRefPubMedGoogle Scholar
  47. 47.
    Wilhelm P, Schoebi D (2007) Assessing mood in daily life: structural validity, sensitivity to change, and reliability of a short-scale to measure three basic dimensions of mood. Eur J Psychol Assess 23(4):258–267CrossRefGoogle Scholar
  48. 48.
    Weinstein SM, Mermelstein RJ, Hankin BL, Hedeker D, Flay BR (2007) Longitudinal patterns of daily affect and global mood during adolescence. J Res Adolesc 17(3):587–599CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Armstrong JG, Putnam FW, Carlson EB, Libero DZ, Smith SR (1997) Development and validation of a measure of adolescent dissociation: the adolescent dissociative experiences scale. J Nerv Ment Dis 185(8):491–497CrossRefPubMedGoogle Scholar
  50. 50.
    American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders DSM-5. American Psychiatric Association, Washington, DCCrossRefGoogle Scholar
  51. 51.
    Enders CK, Tofighi D (2007) Centering predictor variables in cross-sectional multilevel models: a new look at an old issue. Psychol Methods 12(2):121–138CrossRefPubMedGoogle Scholar
  52. 52.
    Doane LD, Thurston EC (2014) Associations among sleep, daily experiences, and loneliness in adolescence: evidence of moderating and bidirectional pathways. J Adolesc 37(2):145–154CrossRefPubMedGoogle Scholar
  53. 53.
    Cousins JC, Whalen DJ, Dahl RE et al (2011) The bidirectional association between daytime affect and nighttime sleep in youth with anxiety and depression. J Pediatr Psychol 36(9):969–979CrossRefPubMedPubMedCentralGoogle Scholar
  54. 54.
    Kouros CD, El-Sheikh M (2015) Daily mood and sleep: reciprocal relations and links with adjustment problems. J Sleep Res 24(1):24–31CrossRefPubMedGoogle Scholar
  55. 55.
    van Zundert RMP, van Roekel E, Engels R, Scholte RHJ (2015) Reciprocal associations between adolescents’ night-time sleep and daytime affect and the role of gender and depressive symptoms. J Youth Adolesc 44(2):556–569CrossRefPubMedGoogle Scholar
  56. 56.
    Hartmann E, Rosen R, Rand W (1998) Personality and dreaming: boundary structure and dream content. Dreaming 8(1):31–39CrossRefGoogle Scholar
  57. 57.
    Revonsuo A (2000) The reinterpretation of dreams: an evolutionary hypothesis of the function of dreaming. Behav Brain Sci 23(6):877–901CrossRefPubMedGoogle Scholar
  58. 58.
    Wichers MC, Myin-Germeys I, Jacobs N et al (2007) Evidence that moment-to-moment variation in positive emotions buffer genetic risk for depression: a momentary assessment twin study. Acta Psychiatr Scand 115(6):451–457CrossRefPubMedGoogle Scholar
  59. 59.
    Varese F, Barkus E, Bentall RP (2012) Dissociation mediates the relationship between childhood trauma and hallucination-proneness. Psychol Med 42(5):1025–1036CrossRefPubMedGoogle Scholar
  60. 60.
    Petrovsky N, Ettinger U, Hill A et al (2014) Sleep deprivation disrupts prepulse inhibition and induces psychosis-like symptoms in healthy humans. J Neurosci 34(27):9134–9140CrossRefPubMedGoogle Scholar
  61. 61.
    Johnson NL, Kirchner HL, Rosen CL et al (2007) Sleep estimation using wrist actigraphy in adolescents with and without sleep disordered breathing: a comparison of three data modes. Sleep 30(7):899–905CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  1. 1.Faculty of Psychology and Human Movement Science, Clinical Psychology and Psychotherapy, Institute of PsychologyUniversität HamburgHamburgGermany

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