Sleep: Insomnia

Insomnia involves difficulty falling asleep, staying asleep or obtaining satisfactory sleep despite an opportunity to do so. The person may feel tired, frustrated or unable to function well during the day. In schizophrenia, worry, voices, irregular routines, substances and treatment effects can all contribute.

Sleep supports attention, emotional regulation and physical health. People with schizophrenia can experience insomnia, irregular sleep timing or excessive sleepiness, with several possible causes. Sleep disturbance is not simply an inevitable feature of the diagnosis, and a long period in bed does not necessarily mean that sleep is restorative or appropriately timed.

Assessment explores the actual pattern rather than assuming one cause. A sleep diary may help identify timing, awakenings and daytime consequences. Cognitive behavioural approaches adapted to the person’s needs can be useful, while possible medical sleep disorders also require consideration. Medicines intended to help sleep have their own benefits and harms. Persistent insomnia deserves attention even when psychotic symptoms are otherwise stable. The aim is better sleep and usable daytime functioning, not merely spending more hours in bed or becoming more sedated during the evening.

Insomnia treatment examines factors that perpetuate poor sleep, including worry about sleep and habits that develop in response to it. Adaptations may be needed for psychosis, physical health and the person’s living situation. The approach should be explained clearly and reviewed. A sleep complaint deserves an individual formulation rather than assuming that general sleep-hygiene advice will address every maintaining factor.

Further reading: National Institute of Mental Health; Research record 26363701.