Psychosis is a condition that affects the mind, causing people to perceive or interpret things differently from reality. Psychosis involves disrupted thoughts and perceptions, and some common symptoms include hallucinations, delusions, confused thinking, and reduced insight.
Sleep disturbances are common in people with psychosis. Many studies have found that people with psychosis tend to sleep more or less than the average person without the condition. However, psychosis is complex, and sleep patterns can vary greatly between individuals. Some key factors that influence sleep in psychosis include:
- Psychotic symptoms like hallucinations and delusions
- Medication side effects
- Anxiety and depression
- Disrupted circadian rhythms
While some people with psychosis struggle with too little sleep, others report sleeping excessively. On average, it seems people with psychosis tend to sleep more than the general population. But there is no simple answer, as sleep can be impacted both by the disorder itself and its treatment.
Psychotic Symptoms and Sleep
Hallucinations, delusions, and thought disorders associated with psychosis often disrupt normal sleep patterns. Difficulty sleeping is sometimes an early warning sign of psychosis. During acute psychotic episodes, people frequently experience severely fragmented sleep.
Auditory hallucinations like hearing voices can make falling asleep difficult. Visual hallucinations may also interfere with sleep. Bizarre or frightening delusions can further disrupt sleep by causing fear and anxiety.
In addition, the confused thinking that accompanies psychosis can make it challenging to maintain a regular sleep-wake cycle. Disorganized thinking patterns lead to chaotic sleep habits for some.
Medication Effects on Sleep
Medications used to treat psychosis like antipsychotics also influence sleep patterns. Some common side effects of antipsychotics include:
- Drowsiness
- Sedation
- Fatigue
These side effects can cause excessive sleepiness and longer sleep times. However, antipsychotics can also have the paradoxical effect of worsening sleep in some cases. Other potential side effects like restless movements can disrupt sleep.
The sedating effects tend to be most pronounced with first-generation or typical antipsychotics. Newer atypical antipsychotics may be less likely to cause daytime drowsiness. But medications affect each person differently – some people take antipsychotics without sleep-related side effects.
Anxiety, Depression and Sleep
Many people with psychosis also live with co-occurring anxiety or depression. These conditions are associated with high rates of sleep disturbances:
- Anxiety – Difficulty falling/staying asleep, restless sleep
- Depression – Early morning wakening, daytime sleepiness, insomnia
Both excessive sleeping and insomnia are common symptoms of depression. Anxiety around psychotic symptoms or medication side effects can also harm sleep quality and make it harder to fall asleep.
Circadian Rhythm Abnormalities
Circadian rhythms are the body’s internal clock that regulates sleep-wake cycles. Emerging research shows circadian disruptions may contribute to mental health conditions like psychosis:
- Irregular sleep-wake patterns are linked to more severe psychotic symptoms
- People with psychosis are more likely to have abnormal melatonin levels, a hormone that controls circadian rhythms
- Disrupted circadian gene expression is seen in schizophrenia
These circadian disruptions may interact with other factors to destabilize sleep. Genetic abnormalities in circadian genes may also predispose some people to developing psychosis.
Do People with Psychosis Sleep More on Average?
Studies consistently show people with psychotic disorders tend to sleep longer than the general population. However, there is significant variability between individuals.
In one study of 288 patients hospitalized for psychosis, researchers found:
- Patients slept an average of 8.8 hours per night
- 10.4% slept less than 6 hours a night on average
- 20.1% slept 9 hours or more per night on average
The recommended sleep duration for healthy adults is 7-9 hours. So while patients tended to sleep longer overall, many still experienced abnormal sleep durations.
Another study compared the sleep of schizophrenia patients to healthy controls using actigraphy devices to objectively measure sleep. They found:
| Group | Total sleep time | Sleep efficiency |
|---|---|---|
| Schizophrenia patients | 8.2 hours | 81% |
| Healthy controls | 6.8 hours | 88% |
Patients with schizophrenia slept nearly 1.5 hours more on average than controls. However, their sleep efficiency – the percentage of time in bed spent asleep – was lower, indicating more disturbed sleep.
Factors Influencing Excessive Sleep in Psychosis
There are several reasons people with psychosis may struggle with too much sleep on average:
- Medication side effects – Sedating antipsychotics promote daytime sleepiness
- Depression – A psychosis comorbidity linked to hypersomnia and fatigue
- Social isolation – Having less daily responsibilities or activities leads to more time spent asleep
- Disrupted circadian rhythms – Makes it harder to stay awake during the day
However, psychiatrists caution against assuming excessive sleep is solely due to antipsychotics. The disorder itself also clearly disrupts normal sleep-wake patterns.
Does Sleep Improve When Psychosis Is Treated?
For many patients, sleep disturbances tend to improve along with other psychotic symptoms when treated with antipsychotics and psychosocial interventions. One study tracked sleep duration in first-episode psychosis patients over 16 months:
- At baseline, patients slept an average of 10 hours per night
- After 4 months treatment, average sleep duration reduced to 8.8 hours
- After 16 months, patients slept an average of 8.2 hours
Their sleep duration declined to more normal levels in tandem with improvements in symptoms like depression and mania. This suggests that as psychotic symptoms stabilize with treatment, associated sleep disturbances often partially resolve.
Treating Sleep Problems in Psychosis
If psychosis patients continue experiencing excessive or inadequate sleep despite treatment, additional interventions may help. Potential treatment options include:
- Switching antipsychotics
- Adding a stimulant for daytime sleepiness
- Cognitive-behavioral therapy for insomnia (CBT-I)
- Light therapy to stabilize circadian rhythms
- Sleep hygiene education
- Treating co-occurring depression and anxiety
Good sleep hygiene like avoiding screens before bedtime, limiting naps, and exercising regularly can also improve sleep quality. Addressing factors disrupting sleep such as pain or sleep apnea may help.
The Bottom Line
On average, people with psychotic disorders like schizophrenia tend to sleep longer than the typical population. However, this varies significantly between patients – some struggle with insomnia while others deal with excessive sleepiness.
Although antipsychotic medications contribute to increased sleep time, multiple factors related to psychosis itself disrupt normal sleep-wake cycles. As psychotic symptoms improve, sleep often partially normalizes but disturbances may persist.
There is no consensus on the ideal sleep duration for people with psychosis. The key is to identify and treat any factors impairing sleep quality or daytime functioning, while also allowing adequate rest to aid recovery.