Schizophrenia is a mental illness with several distinctive symptoms. These include delusions and hallucinations, as well as difficulty feeling and processing emotions. Another very common symptom is disordered sleep. The connection between schizophrenia and sleep disorders is an increasing focus for researchers. Research into the link between schizophrenia and sleep is important for several reasons. One is that poor sleep makes you feel miserable. That means it’s a quality of life issue. Another reason is that insomnia is often followed by increased psychotic symptoms. That’s why monitoring and improving sleeping habits might be able to help you or a loved one manage schizophrenia symptoms. For anyone with a mental disorder, the mental health benefits of a good night’s rest are enormous. Research into schizophrenia and sleep may even lead to new treatments.
What Does the Research Say About Schizophrenia and Sleep?
Schizophrenia, sleep and circadian rhythms
Circadian rhythms can influence a person’s sleep-wake cycles, hormones, eating habits, body temperature and other important bodily functions. In a 2012 study at the University of Oxford in Great Britain, researchers found that schizophrenia has a major impact on sleep. In the study, 41 people wore devices that monitored their sleeping habits. Twenty of the people had schizophrenia, while 21 were mentally healthy unemployed people. The results showed that while the mentally healthy people had regular sleep hours, the people with schizophrenia struggled with a variety of sleep abnormalities. Some people with schizophrenia slept more than normal, while others had irregular sleep patterns. Some had extreme insomnia and would often go 24 hours or more without sleeping. These problems existed regardless of mood, mental state or the kind of treatments people received. The research showed disrupted circadian rhythms in people with schizophrenia. The circadian rhythm is a natural process that regulates when people sleep and wake. For most people, this means sleeping at night and being awake during the day. For people with schizophrenia, however, this healthy sleep rhythm is disrupted. Their brain doesn’t distinguish sleeping hours from non-sleeping hours as easily.
Why do people with schizophrenia have trouble sleeping?
The reason why schizophrenia causes sleep problems isn’t well understood. Research points to dysfunction of the dopamine D2 receptor as a possible cause. This dysfunction causes the dopamine receptors to be overactive. This is linked to many of the symptoms of schizophrenia, including sleep disruption. There is also evidence that serotonin dysfunction plays a role in schizophrenia and the sleep disturbances it causes. No single gene is known to be responsible for schizophrenia. Instead, it’s likely that several genetic and other factors contribute to the illness. In studies exploring genetic variations in patients with schizophrenia, a few common genes were identified. These include mutations in genes relating to various kinds of sleep disorders. For instance:
- CLOCK (circadian locomotor output cycles kaput). This gene influences how circadian cycles are regulated.
- BTBD9 and TH. These are genes associated with restless leg syndrome.
- MTNR1A. This gene is associated with melatonin, the hormone that regulates sleep cycles.
- Various other genes involved in regulation of circadian rhythms or neurotransmitters.
Schizophrenia is linked to several types of sleep disturbances
People with schizophrenia have irregular sleep patterns, but also have a higher risk of other sleep problems, too. These include:
- Restless leg syndrome and periodic limb movement disorder. These both cause involuntary movement during sleep. This contributes to reduced sleep quality and quantity.
- Obstructive sleep apnea is more common in people with schizophrenia. This may be because many antipsychotic drugs cause weight gain, as obesity is a risk factor for sleep apnea.
How Can You Improve Sleep Quality?
When you’re schizophrenic, improving your sleep quality and quantity is harder than it is for everyone else. This is because your ability to sleep isn’t just determined by your habits and preferences. To improve your sleep, all the normal sleep hygiene rules still apply. These include:
- Keep to a regular sleep schedule. Go to bed at the same time each night, and try to wake up at the same time each morning.
- As much as possible, use your bed and bedroom only for sleep and sexual activity.
- When you can’t fall sleep, get out of bed and do a quiet activity such as reading or listening to relaxing music. Go back to bed when you feel sleepy.
- Exercise during the day.
- Avoid caffeine as much as possible, especially during the afternoon and before bed.
When you have schizophrenia these kinds of behaviors may not “fix” your insomnia, but they are your first line of defense against sleep disturbances. Still, there are other things you can do to help increase the amount of sleep and rest you get.
Medication can be an effective way to manage sleep problems. There are a couple of downsides, however. One is that some medications are addictive. Another is that many schizophrenics find it hard to take medication regularly. Some options for medication to treat sleep problems include:
- Antipsychotics such as paliperidone and olanzapine. These drugs can reduce insomnia in people with schizophrenia.
- Zopiclone and eszopiclone are effective sleep medications. They are highly addictive, so are often prescribed sparingly.
- Melatonin, a hormone that helps regulate the sleep cycle, may help some schizophrenics. It can improve both quality and quantity of sleep and is non-addictive.
Talk to your doctor about the possibility of treating your sleep problems with medication. They will know the pros and cons of medications and the unique challenges of your situation.
Alternatives to medication
Some schizophrenics develop negative associations about sleep. For instance, worrying about insomnia can make it even harder to get quality sleep. This may mean that medication is less useful, because the negative thoughts they have about sleep lead them to avoid it. If you’re having these kinds of problems, therapy may be a more useful strategy than medication. For instance, cognitive behavioral therapy can help people change how they think about sleep. This means negative thoughts are less likely to contribute to sleep problems.
Address any co-occurring psychiatric disorders
It is very common for a person with schizophrenia to have additional co-occurring disorders. You might be tempted to use alcohol or drugs to fall asleep. However, any substance abuse will ultimately damage your goal of healthy sleep and worsen your symptoms. In addition, post-traumatic stress disorder (PTSD) is more common in individuals with schizophrenia. Most people with PTSD will also struggle with sleeping, due to a hyperarousal state. If you struggle with substance abuse or PTSD, you cannot ignore these issues. Unresolved trauma, drugs and alcohol all cause sleep disturbances. Be honest with your doctor about any additional struggles you experience, so you can get help.
Sleep May Be Harder, But It’s Not Impossible
Most people with schizophrenia have sleep disturbances of one kind or another. The research shows that these two things are strongly linked. If you have schizophrenia, it’s likely you’ll have sleep problems sometimes. There are some treatments that may help. Getting healthy sleep may be harder, but it’s not impossible. It’s worth exploring your options with your doctor to see if there’s any way you can improve the quality of your sleep.