Everyone knows that not getting enough sleep, or having their sleep disturbed, can have many different affects. Irritability, difficulty concentrating, drowsiness, and memory issues are all common side effects of low-quality, insufficient sleep.
In a previous blog post, we looked at the connection between insomnia and depression. However, a lack of sleep has also been linked to psychosis, a mental condition that involves loss of contact with reality. Psychosis may include delusions, hallucinations, and incoherent speech, and is often seen in schizophrenia.
Numerous studies show that people with schizophrenia and other serious mental disorders are more likely to have some kind of sleep disorder. These disorders include insomnia, nightmare disorder, and obstructive sleep apnea (in which breathing is interrupted during sleep).
Sleep disorders are common in severe mental illnesses.
One study looked at 60 individuals, aged 18 to 30, with nonaffective psychosis, which includes schizophrenia. The researchers assessed these participants’ sleep through interviews, sleep diaries, and monitoring. Eighty percent of the patients had at least one sleep disorder, most of them rated as “severe.” Insomnia and nightmare disorder were the most common.
Unfortunately, the majority of patients had not been treated for their sleep disorder, although many of the sleep disorders had been discussed with a clinician. The sleep disorders were significantly associated with increased psychotic experiences, fatigue, and lower quality of life.
The study authors suggested that clinicians place a greater priority on sleep, if their results apply to the wider population of patients with psychosis. They also note that DSM-5 recommends assessment and treatment of sleep problems regardless of other psychiatric comorbidities.
Sleep deprivation psychosis is real.
This connection between disordered sleep and mental illness prompts the question: which came first? Not all individuals with psychiatric disorders experience sleep problems. At the same time, many people experience sleep deprivation without a diagnosis of severe mental illness. Are they at risk of psychosis?
Turns out, sleep deprivation can still increase the risk of psychosis in otherwise healthy people with no history of psychiatric illness. A 2018 study, published in Frontiers in Psychiatry, looked at this connection among patients who were sleep deprived for a range of 24 hours to 11 nights.
The study authors found that the longer a person was sleep deprived, the greater their risk of experiencing symptoms of psychosis. These symptoms ranged from simple visual misperceptions (like briefly misjudging a reflection in a glass) to hallucinations and delusions. Fortunately, restoring sleep is likely to resolve these symptoms.
We don’t fully understand yet how sleep helps our brains, so researchers are not sure exactly why sleep deprivation can lead to psychosis. It does seem that a lack of sleep can interfere with how the brain processes sensory information, manages emotions, and restores itself after a rough day. It may also have something to do with how our brains “rewire” themselves to cope with insufficient sleep.
When you treat clients with schizophrenia, it is important to track their quality of life, including sleep. The right tools can help you accomplish this, observing your clients over time to help you make better treatment decisions.