Skip to main content

Sleep Disorders Among People With Schizophrenia: Emerging Research

Abstract

Up to 80 % of individuals with schizophrenia spectrum disorders experience sleep disturbances, which impact physical and mental health, as well as quality of life. In this paper, we review and integrate emerging literature, published between 2012 and 2014, regarding approaches to diagnosis and treatment of major sleep disorders for people with schizophrenia spectrum disorders, including insomnia, obstructive sleep apnea (OSA), circadian rhythm dysfunction, and restless legs syndrome (RLS). We advocate for (1) the need to evaluate the utility of nonpharmacological approaches in people with schizophrenia spectrum disorders; (2) documentation of guidelines to assist providers in clinically tailoring such interventions when their clients experience positive, negative, and/or cognitive symptoms; (3) research on the best ways providers can capitalize on clients’ self-identified needs and motivation to engage in sleep treatments through shared decision making; and (4) the importance of investigating whether and how mental health and sleep treatment services should be better connected to facilitate access for people with schizophrenia spectrum disorders. Assessment and tailored treatment of sleep disorders within mental health treatment settings has the potential to reduce sleep problems and improve functioning, quality of life, and recovery of this population.

This is a preview of subscription content, access via your institution.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Bryant PA, Trinder J, Curtis N. Sick and tired: does sleep have a vital role in the immune system? Nat Rev Immunol. 2004;4(6):457–67.

    CAS  Article  PubMed  Google Scholar 

  2. Dolgin E. Deprivation: a wake-up call. Nature. 2013;497(7450):S6–7.

    CAS  Article  PubMed  Google Scholar 

  3. Hanlon EC, Van Cauter E. Quantification of sleep behavior and of its impact on the cross-talk between the brain and peripheral metabolism. Proc Natl Acad Sci U S A. 2011;108 Suppl 3:15609–16.

    PubMed Central  CAS  Article  PubMed  Google Scholar 

  4. Xie L et al. Sleep drives metabolite clearance from the adult brain. Science. 2013;342(6156):373–7.

    CAS  Article  PubMed  Google Scholar 

  5. Anderson KN, Bradley AJ. Sleep disturbance in mental health problems and neurodegenerative disease. Nat Sci Sleep. 2013;5:61–75.

    PubMed Central  Article  PubMed  Google Scholar 

  6. Monti JM et al. Sleep and circadian rhythm dysregulation in schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry. 2013;43:209–16.

    Article  PubMed  Google Scholar 

  7. Zanini M et al. Do sleep abnormalities and misaligned sleep/circadian rhythm patterns represent early clinical characteristics for developing psychosis in high risk populations? Neurosci Biobehav Rev. 2013;37(10 Pt 2):2631–7.

    Article  PubMed  Google Scholar 

  8. Benson KL. Sleep in schizophrenia. Sleep Med Clin. 2008;3:251–60.

    Article  Google Scholar 

  9. Chouinard S et al. Sleep in untreated patients with schizophrenia: a meta-analysis. Schizophr Bull. 2004;30(4):957–67.

    Article  PubMed  Google Scholar 

  10. Poulin J et al. Sleep habits in middle-aged, non-hospitalized men and women with schizophrenia: a comparison with healthy controls. Psychiatry Res. 2010;179(3):274–8.

    Article  PubMed  Google Scholar 

  11. Brissos S et al. Satisfaction with life of schizophrenia outpatients and their caregivers: differences between patients with and without self-reported sleep complaints. Schizophr Res Treat. 2013;2013:502172.

    Google Scholar 

  12. Xiang YT et al. Prevalence and correlates of insomnia and its impact on quality of life in Chinese schizophrenia patients. Sleep. 2009;32(1):105–9.

    PubMed Central  PubMed  Google Scholar 

  13. Afonso P et al. Schizophrenia patients with predominantly positive symptoms have more disturbed sleep-wake cycles measured by actigraphy. Psychiatry Res. 2011;189(1):62–6.

    Article  PubMed  Google Scholar 

  14. Appelberg B, Katila H, Rimon R. Plasma interleukin-1 beta and sleep architecture in schizophrenia and other nonaffective psychoses. Psychosom Med. 1997;59(5):529–32.

    CAS  Article  PubMed  Google Scholar 

  15. Bromundt V et al. Sleep-wake cycles and cognitive functioning in schizophrenia. Br J Psychiatry. 2011;198(4):269–76.

    Article  PubMed  Google Scholar 

  16. Goder R, et al. Impairment of sleep-related memory consolidation in schizophrenia: relevance of sleep spindles? Sleep Med. 2015.

  17. Manoach DS et al. A failure of sleep-dependent procedural learning in chronic, medicated schizophrenia. Biol Psychiatry. 2004;56(12):951–6.

    Article  PubMed  Google Scholar 

  18. Seeck-Hirschner M et al. Effects of daytime naps on procedural and declarative memory in patients with schizophrenia. J Psychiatr Res. 2010;44(1):42–7.

    Article  PubMed  Google Scholar 

  19. Wamsley EJ et al. Reduced sleep spindles and spindle coherence in schizophrenia: mechanisms of impaired memory consolidation? Biol Psychiatry. 2012;71(2):154–61.

    PubMed Central  Article  PubMed  Google Scholar 

  20. Babkoff H et al. Perceptual distortions and hallucinations reported during the course of sleep deprivation. Percept Mot Skills. 1989;68(3 Pt 1):787–98.

    CAS  Article  PubMed  Google Scholar 

  21. West LJ et al. The psychosis of sleep deprivation. Ann N Y Acad Sci. 1962;96:66–70.

    CAS  Article  PubMed  Google Scholar 

  22. Brown LK. Can sleep deprivation studies explain why human adults sleep? Curr Opin Pulm Med. 2012;18(6):541–5.

    Article  PubMed  Google Scholar 

  23. Horne JA. Human sleep, sleep loss and behaviour. Implications for the prefrontal cortex and psychiatric disorder. Br J Psychiatry. 1993;162:413–9.

    CAS  Article  PubMed  Google Scholar 

  24. Killgore WD. Effects of sleep deprivation on cognition. Prog Brain Res. 2010;185:105–29.

    Article  PubMed  Google Scholar 

  25. Thomas M et al. Neural basis of alertness and cognitive performance impairments during sleepiness. I. Effects of 24 h of sleep deprivation on waking human regional brain activity. J Sleep Res. 2000;9(4):335–52.

    CAS  Article  PubMed  Google Scholar 

  26. De Havas JA et al. Sleep deprivation reduces default mode network connectivity and anti-correlation during rest and task performance. Neuroimage. 2012;59(2):1745–51.

    Article  PubMed  Google Scholar 

  27. Mullington JM et al. Sleep loss and inflammation. Best Pract Res Clin Endocrinol Metab. 2010;24(5):775–84.

    PubMed Central  CAS  Article  PubMed  Google Scholar 

  28. Goh VH et al. Effects of one night of sleep deprivation on hormone profiles and performance efficiency. Mil Med. 2001;166(5):427–31.25.

    CAS  PubMed  Google Scholar 

  29. Czeisler CA. Impact of sleepiness and sleep deficiency on public health—utility of biomarkers. J Clin Sleep Med. 2011;7(5 Suppl):S6–8.

    PubMed Central  PubMed  Google Scholar 

  30. Mitchell AJ et al. Prevalence of metabolic syndrome and metabolic abnormalities in schizophrenia and related disorders—a systematic review and meta-analysis. Schizophr Bull. 2013;39(2):306–18.

    PubMed Central  Article  PubMed  Google Scholar 

  31. Soehner A, Kaplan K, Harvey A. Insomnia comorbid to severe psychiatric illness. Sleep Med Clin. 2013;8(3):361–71.

    PubMed Central  Article  PubMed  Google Scholar 

  32. Spiegelhalder K, Regen W, Nanovska S, Baglioni C, Riemann D. Comorbid sleep disorders in neuropsychiatric disorders across the life cycle. Curr Psychiatry Rep. 2013;15(6):364.

    Article  PubMed  Google Scholar 

  33. Baandrup L, Jennum P, Lublin H, Glenthoj B. Treatment options for residual insomnia in schizophrenia. Acta Psychiatr Scand. 2013;127(1):81–2.

    Article  PubMed  Google Scholar 

  34. Horn W, Akerman S, Sateia M. Sleep in schizophrenia and substance use disorders: a review of the literature. J Dual Diagn. 2013;9(3):228–38.

    Article  Google Scholar 

  35. Kalucy M, Grunstein R, Lambert T, Glozier N. Obstructive sleep apnoea and schizophrenia—a research agenda. Sleep Med Rev. 2013;17(5):357–65.

    Article  PubMed  Google Scholar 

  36. Siebern AT, Manber R. New developments in cognitive behavioral therapy as the first-line treatment of insomnia. Psychol Res Behav Manag. 2011; 4.

  37. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington: American Psychiatric Publishing; 2013.

    Google Scholar 

  38. Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M. Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med. 2008;4(5):487–504.

    PubMed Central  PubMed  Google Scholar 

  39. Palmese LB, DeGeorge PC, Ratliff JC, Srihari VH, Wexler BE, Krystal AD, et al. Insomnia is frequent in schizophrenia and associated with night eating and obesity. Schizophr Res. 2011;133(1–3):238–43.

    Article  PubMed  Google Scholar 

  40. Freeman D, Pugh K, Vorontsova N, Southgate L. Insomnia and paranoia. Schizophr Res. 2009;108(1–3):280–4.

    PubMed Central  Article  PubMed  Google Scholar 

  41. Morgenthaler T et al. Practice parameters for the psychological and behavioral treatment of insomnia: an update. Sleep. 2006;29(11):1415–9.

    PubMed  Google Scholar 

  42. Tek C et al. The impact of eszopiclone on sleep and cognition in patients with schizophrenia and insomnia: a double-blind, randomized, placebo-controlled trial. Schizophr Res. 2014;160(1-3):180–5. This double-blind, randomized placebo-controlled trial was the first to report the efficacy of eszopiclone on sleep in cognition in people with both schizophrenia and insomnia, finding a possible beneficial short-term effect on working memory.

    Article  PubMed  Google Scholar 

  43. Wamsley E et al. The effects of eszopiclone on sleep spindles and memory consolidation in schizophrenia: a randomized placebo-controlled trial. Sleep. 2013;36(9):1369–76. This double-blind, randomized placebo-controlled trial demonstrated that eszopiclone selectively enhances sleep spindle activity and supported the association between spindle activity and memory processing.

    PubMed Central  PubMed  Google Scholar 

  44. Andrade C, Suresh Kumar PN. Treating residual insomnia in schizophrenia: examining the options. Acta Psychiatr Scand. 2013;127(1):11.

    CAS  Article  PubMed  Google Scholar 

  45. Dixon L et al. The 2009 PORT psychosocial treatment recommendations and summary statement. Schizophr Bull. 2010;36(1):48–70.

    PubMed Central  Article  PubMed  Google Scholar 

  46. Myers E, Startup H, Freeman D. Cognitive behavioural treatment of insomnia in individuals with persistent persecutory delusions: a pilot trial. J Behav Ther Exp Psychiatry. 2011;42:330–6.

    PubMed Central  Article  PubMed  Google Scholar 

  47. Dopke C, Lehner R, Wells A. Cognitive-behavioral group therapy for insomnia in individuals with serious mental illnesses: a preliminary evaluation. Psychiatr Rehabil J. 2004;27(3):235–42.

    Article  PubMed  Google Scholar 

  48. Buysse DJ, Ancoli-Israel S, Edinger JD, Lichstein KL, Morin CM. Recommendations for a standard research assessment of insomnia. Sleep. 2006;29(9):1155–73.

    PubMed  Google Scholar 

  49. Freeman D, Startup H, Myers E, Harvey A, Geddes J, Yu LM, et al. The effects of using cognitive behavioural therapy to improve sleep for patients with delusions and hallucinations (the BEST study): study protocol for a randomized controlled trial. Trials. 2013;14:214.

    PubMed Central  Article  PubMed  Google Scholar 

  50. Epstein LJ et al. Clinical guideline for the evaluation, management, and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009;5(3):263–76.

    PubMed  Google Scholar 

  51. Navqi H, Wang D, Glozier N, Grunstein R. Sleep-disordered breathing and psychiatric disorders. Curr Psychiatry Rep. 2014;16(12):519.

    Article  Google Scholar 

  52. Winkelman J. Schizophrenia, obesity, and obstructive sleep apnea. J Clin Psychiatry. 2001;62:8–11.

    CAS  Article  PubMed  Google Scholar 

  53. Rishi MA, Shetty M, Wolff A, Amoateng-Adjepong Y, Manthous CA. Atypical antipsychotic medications are independently associated with severe obstructive sleep apnea. Clin Neuropharmacol. 2010;33:109–13.

    Article  PubMed  Google Scholar 

  54. Boufidis S, Kosmidis M, Bozikas V, Daskalopoulou-Vlahoyianni E, Pitsavas S, Karavatos A. Treatment outcome of obstructive sleep apnea syndrome in a patient with schizophrenia: Case report. Int J Psychiatry Med. 2003;33(3):305–10.

    Article  PubMed  Google Scholar 

  55. Karanti A, Landén M. Treatment refractory psychosis remitted upon treatment with continuous positive airway pressure: a case report. Psychopharmacol Bull. 2007;40(1):113–7.

    PubMed  Google Scholar 

  56. Allison DB et al. Obesity among those with mental disorders: a National Institute of Mental Health meeting report. Am J Prev Med. 2009;36(4):341–50.

    Article  PubMed  Google Scholar 

  57. Leinum C, Dopp J, Morgan B. Sleep-disordered breathing and obesity: pathophysiology, complications, and treatment. Nutr Clin Pract. 2009;24(6):675–87.

    PubMed Central  Article  PubMed  Google Scholar 

  58. Morgenthaler T et al. Practice parameters for the clinical evaluation and treatment of circadian rhythm sleep disorders. Sleep. 2007;30(11):1445–59.

    PubMed Central  PubMed  Google Scholar 

  59. Wulff K, Dijk D, Middleton B, Foster R, Joyce E. Sleep and circadian rhythm disruption in schizophrenia. Br J Psychiatry. 2012;200(4):308–16.

    PubMed Central  Article  PubMed  Google Scholar 

  60. Frank E, Swartz HA, Boland E. Interpersonal and social rhythm therapy: an intervention addressing rhythm dysregulation in bipolar disorder. Dialogues Clin Neurosci. 2007;9(3):325–32.

    PubMed Central  PubMed  Google Scholar 

  61. Kushida CA. Practice parameters for the indications for polysomnography and related procedures: an update for 2005. Sleep. 2005;28(4):499–521.

    PubMed  Google Scholar 

  62. Walters AS. Toward a better definition of the restless legs syndrome The International Restless Legs Syndrome Study Group. Mov Disord. 1995;10(5):634–42.

    CAS  Article  PubMed  Google Scholar 

  63. Allen RP et al. Restless legs syndrome: diagnostic criteria, special considerations, and epidemiology. A report from the restless legs syndrome diagnosis and epidemiology workshop at the National Institutes of Health. Sleep Med. 2003;4:101–19.

    Article  PubMed  Google Scholar 

  64. Kang S et al. Characteristics and clinical correlates of restless legs syndrome in schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry. 2007;31(5):1078–83.

    Article  PubMed  Google Scholar 

  65. Allen RP, Barker PB, Horska A, Earley CJ. Thalamic glutamate/glutamine in restless legs syndrome: increased and related to disturbed sleep. Neurology. 2013;80(22):2028–34. This neuroimaging study demonstrated a strong relation between Glx/Cr and wake time during sleep period, and total PSG and subjective sleep time during sleep period, but no relation with periodic limb movements per hour. These results provide some evidence for the glutamatergic system involvement in RLS and suggest that drugs targeting the glutamatergic system may be effective for sleep loss in RLS.

    PubMed Central  CAS  Article  PubMed  Google Scholar 

  66. Oertel WH et al. Rotigotine transdermal patch in moderate to severe idiopathic restless legs syndrome: a randomized, placebo-controlled polysomnographic study. Sleep Med. 2010;11:848–56.

    Article  PubMed  Google Scholar 

  67. Harvey AG, Murray G, Chandler RA, Soehner A. Sleep disturbance as transdiagnostic: consideration of neurobiological mechanisms. Clin Psychol Rev. 2011;31(2):225–35.

    PubMed Central  Article  PubMed  Google Scholar 

  68. Kantrowitz J, Citrome L, Javitt D. GABAB receptors, schizophrenia and sleep dysfunction: a review of the relationship and its potential clinical and therapeutic implications. CNS Drugs. 2009;23(8):681–91.

    CAS  Article  PubMed  Google Scholar 

  69. Peacey J, Miller H, Huthwaite M, Romans S. Sleep medication in acute psychiatric illness: patient's knowledge and prescription patterns in New Zealand. J Nerv Ment Dis. 2012;200(1):83–7.

    Article  PubMed  Google Scholar 

  70. Huthwaite M, Miller H, McCartney J, Romans S. Dysfunctional cognitions about sleep in psychiatric patients. J Psychiatr Pract. 2014;20(3):188–95.

    Article  PubMed  Google Scholar 

  71. Klingaman EA. CBT-I for Veterans with Psychosis. Poster presented at: The 2015 Penn Sleep-Chronobiology Research Retreat; 2015; Philadelphia, PA.

  72. Klingaman EA, et al. Consumer satisfaction with psychiatric services: The role of shared decision making and the therapeutic relationship. Psychiatr Rehabil J. 2015. [Epub ahead of print].

  73. Park S, Derman M, Kreyenbuhl J, et al. Factors associated with shared decision-making preferences among veterans with serious mental illness. Psychiatr Serv. 2014;65(12):1409–13.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This research is supported by the Department of Veterans Affairs Office of Academic Affiliations Advanced Fellowship Program in Mental Illness Research and Treatment. It is the result of work supported with resources and the use of facilities at the VA Capitol Health Care Network (VISN 5) MIRECC. The authors specially thank Alicia Lucksted for her helpful input to this project.

Compliance with Ethics Guidelines

Conflict of Interest

Elizabeth A. Klingaman, Jessica Palmer-Bacon, Melanie E. Bennett, and Laura M. Rowland declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Elizabeth A. Klingaman.

Additional information

This article is part of the Topical Collection on Sleep Disorders

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Klingaman, E.A., Palmer-Bacon, J., Bennett, M.E. et al. Sleep Disorders Among People With Schizophrenia: Emerging Research. Curr Psychiatry Rep 17, 79 (2015). https://doi.org/10.1007/s11920-015-0616-7

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11920-015-0616-7

Keywords

  • Sleep
  • Schizophrenia
  • Psychosis
  • Insomnia
  • CBT-I