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Sleep in Schizophrenia: Exploring Subjective Experiences of Sleep Problems, and Implications for Treatment

Abstract

Sleep dysfunction is a pervasive issue in schizophrenia and psychosis. Current knowledge is drawn almost exclusively from studies using quantitative research methodologies that include measures and tools developed in healthy population groups. Qualitative studies investigating the first-person perspectives of sleep problems are therefore important for designing better assessment and treatment tools to meet consumer needs. Focus groups were conducted to elicit detailed information regarding the personal experience of sleep problems, their antecedents and impact, in 14 individuals with schizophrenia-spectrum disorder who experienced insomnia during their illness. Thematic analysis was applied to examine the data and draw treatment implications for sleep management. Insomnia was ubiquitous and frequently co-occurred with other sleep difficulties (nightmares, sleep walking, acting out dreams, etc.) in this group. Discussions revealed themes common across insomnia populations (role of negative mood states and cognitive intrusions) and also new themes on factors contributing to sleep problems in schizophrenia: (1) beliefs that sleep problems cannot be changed; (2) trauma and adversity; (3) lifestyle choices and lack of motivation; and (4) medication side effects. Sleep problems also had profound impact on daytime dysfunctions and disability. The findings point to novel issues that may benefit from consideration in the treatment of sleep problems in schizophrenia. Unhelpful cognitions and behaviours about sleep can be addressed with psychological interventions, activity scheduling and motivational interviewing techniques. Seeking a first-person perspective is vital for identifying issues that will impact on treatment success and recovery.

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Acknowledgments

Sincere thanks to participants and staff at Lorikeets Centre and Graylands Hospital, Perth WA.

Funding

FW is supported financially by the North Metropolitan Area Health Service-Mental Health (NMHS MH). VC is supported by funding from the School of Psychiatry and Clinical Neurosciences at University of Western Australia, a University Postgraduate Award scholarship, top-up scholarship from NMHS MH, and grant from the Schizophrenia Research Institute’s Daniel Beck Memorial Award.

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Correspondence to Vivian W. Chiu.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Chiu, V.W., Ree, M., Janca, A. et al. Sleep in Schizophrenia: Exploring Subjective Experiences of Sleep Problems, and Implications for Treatment. Psychiatr Q 87, 633–648 (2016). https://doi.org/10.1007/s11126-015-9415-x

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  • DOI: https://doi.org/10.1007/s11126-015-9415-x

Keywords

  • Schizophrenia
  • Sleep problems
  • Insomnia
  • Thematic analysis
  • Cognitive-behavioural therapy (CBT)
  • Consumer-perspective