The Management of Sleep Disturbances in Patients with Schizophrenia: A Case Series
Status PubMed-not-MEDLINE Language English Country New Zealand Media electronic-ecollection
Document type Case Reports, Journal Article
PubMed
36544913
PubMed Central
PMC9762406
DOI
10.2147/prbm.s388702
PII: 388702
Knihovny.cz E-resources
- Keywords
- NREM sleep, REM sleep, actigraphy, antipsychotics, cognitive behavioral therapy, hypnotics, polysomnography, schizophrenia, sleep, symptomatology,
- Publication type
- Journal Article MeSH
- Case Reports MeSH
Patients with schizophrenia commonly encounter a variety of sleep disorders. Disturbed sleep can be found in 30-80% of patients, depending on the degree of psychotic symptomatology. Difficulty falling asleep, maintaining, or achieving restful sleep is associated with symptom severity and has been reported as a prodromal symptom of psychotic relapse. Although some sleep disorders improve with antipsychotic treatment, in many cases, even during disease remission, sleep continues to be fragmented, or even different pathophysiological mechanism is causing sleep disruption. Moreover, it may be complicated if the patient needs specific treatment, such as positive airway pressure (PAP) therapy, due to sleep-disordered breathing. The article presents case reports of patients with schizophrenia with sleep disturbances. As presented in our case reports, cognitive behavioral therapy seems effective in treating comorbid insomnia, even in patients with schizophrenia. The second and third case reports emphasise the need for broader clinical considerations, a cross-diagnostic approach, and cooperation in care for patients with severe mental disorders.
See more in PubMed
Cohrs S. Sleep disturbances in patients with schizophrenia: impact and effect of antipsychotics. CNS Drugs. 2008;22(11):939–962. doi:10.2165/00023210-200822110-00004 PubMed DOI
Sheaves B, Freeman D, Isham L, et al. Stabilising sleep for patients admitted at acute crisis to a psychiatric hospital (OWLS): an assessor-blind pilot randomised controlled trial. Psychol Med. 2018;48:1694–1704. doi:10.1017/S0033291717003191 PubMed DOI PMC
Afonso P, Viveiros V, Vinhas de Sousa T. Sleep disturbances in schizophrenia. Acta Med Port. 2011;24(Suppl 4):799–806. PubMed
Harvey A, Murray G, Chandler RA, Soehner A. Sleep disturbance as transdiagnostic consideration of neurobiological mechanisms. Clin Psychol Rev. 2011;31:225–235. doi:10.1016/j.cpr.2010.04.003 PubMed DOI PMC
Wulff K, Gatti S, Wettstein JG, Foster RG. Sleep and circadian rhythm disruption in psychiatric and neurodegenerative disease. Nat Rev Neurosci. 2010;11:589–599. doi:10.1038/nrn2868 PubMed DOI
Freeman D, Brugha T, Meltzer H, Jenkins R, Stahl D, Bebbington P. Persecutory ideation and insomnia: findings from the second British National Survey of Psychiatric Morbidity. J Psychiatr Res. 2010;44:1021–1026. doi:10.1016/j.jpsychires.2010.03.018 PubMed DOI PMC
Freemna D, McManus S, Brugda T, Meltzer H, Jenkins R, Bebbington P. Concomitants of paranoia in the general population. Psychol Med. 2011;41:923–936. doi:10.1017/S0033291710001546 PubMed DOI
Freman D, Stahl D, McManus S, et al. Insomnia, worry, anxiety and depression as predictors of the occurrence and the persistence of persecutory ideation. Soc Psychiatry Psychiatr Epidemiol. 2012;47:1195–1203. doi:10.1007/s00127-011-0433-1 PubMed DOI
Freeman D, Startup H, Myers E, 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 randomised controlled trial. Trials. 2013;14:214. doi:10.1186/1745-6215-14-214 PubMed DOI PMC
Myers E, Startup H, Freeman D. Cognitive behavioral treatment of insomnia in individuals with persistent persecutory delusions. J Behav Ther Exp Psychiatry. 2011;42:330–336. doi:10.1016/j.jbtep.2011.02.004 PubMed DOI PMC
Monti JM, Monti D. Sleep disturbance in schizophrenia. Int Rev Psychiatry. 2005;17:247–253. doi:10.1080/09540260500104516 PubMed DOI
Chan MS, Chung KF, Yung KP, Yeung WF. Sleep in schizophrenia: a systematic review and meta-analysis of polysomnographic findings in case-control studies. Sleep Med Rev. 2017;32:69–84. doi:10.1016/j.smrv.2016.03.001 PubMed DOI
Bian Y, Liang WY, Yue WH, et al. Sleep architecture in drug naive patients with schizophrenia: a meta-analysis. Chinese Ment Heal J. 2017;31:208–214.
Palmese LB, DeGeorge PC, Ratliff JC, et al. Insomnia is frequent in schizophrenia and associated with night eating and obesity. Schizophr Res. 2011;133(1–3):238–243. doi:10.1016/j.schres.2011.07.030 PubMed DOI PMC
Kirlioglu SS, Balcioglu YH. Chronobiology revisited in psychiatric disorders: from a translational perspective. Psychiatry Investig. 2020;17(8):725–743. doi:10.30773/pi.2020.0129 PubMed DOI PMC
Kivelä L, Papadopoulos MR, Antypa N. Chronotype and psychiatric disorders. Curr Sleep Med Rep. 2018;4(2):94–103. doi:10.1007/s40675-018-0113-8 PubMed DOI PMC
Balcioglu SSK, Balcioglu YH, Devrim Balaban O. The association between chronotype and sleep quality, and cardiometabolic markers in patients with schizophrenia. Chronobiol Int. 2022;39(1):77–88. doi:10.1080/07420528.2021 PubMed DOI
Suttajit S, Pilakanta S. Prevalence of metabolic syndrome and its association with depression in patients with schizophrenia. Neuropsychiatr Dis Treat. 2013;9:941–946. doi:10.2147/NDT.S47450 PubMed DOI PMC
Perlis ML, Smith LJ, Lyness JM, et al. Insomnia as a risk factor for onset of depression in the elderly. Behav Sleep Med. 2006;4(2):104–113. doi:10.1207/s15402010bsm0402_3 PubMed DOI
Björnsdóttir E, Janson C, Gíslason T, et al. Insomnia in untreated sleep apnea patients compared to controls. J Sleep Res. 2012;21(2):131–138. doi:10.1111/j.1365-2869.2011.00972.x PubMed DOI PMC
Ban HJ, Kim SC, Seo J, Kang HB, Choi JK. Genetic and metabolic characterisation of insomnia. PLoS One. 2011;6(4):e18455. doi:10.1371/journal.pone.0018455 PubMed DOI PMC
Bak M, Fransen A, Janssen J, van Os J, Drukker M. Almost all antipsychotics result in weight gain: a meta-analysis. PLoS One. 2014;9(4):e94112. doi:10.1371/journal.pone.0094112 PubMed DOI PMC
Lee JH, Cho J. Sleep and obesity. Sleep Med Clin. 2022;17(1):111–116. doi:10.1016/j.jsmc.2021.10.009 PubMed DOI
Rodrigues GD, Fiorelli EM, Furlan L, Montano N, Tobaldini E. Obesity and sleep disturbances: the “chicken or the egg” question. Eur J Intern Med. 2021;92:11–16. doi:10.1016/j.ejim.2021.04.017 PubMed DOI
Okada I, Miyata S, Iwamoto K, Fujishiro H, Noda A, Ozaki N. Prevalence of obstructive sleep apnea as assessed by polysomnography in psychiatric patients with sleep-related problems. Sleep Breath. 2022;26:1983–1991. PMID: 35029795. doi:10.1007/s11325-022-02566-6 PubMed DOI
Hermes ED, Sernyak M, Rosenheck R. Use of second-generation antipsychotic agents for sleep and sedation: a provider survey. Sleep. 2013;36(4):597–600. doi:10.5665/sleep.2554 PubMed DOI PMC
Batool-Anwar S, Goodwin JL, Kushida CA, et al. Impact of continuous positive airway pressure (CPAP) on quality of life in patients with obstructive sleep apnea (OSA). J Sleep Res. 2016;25(6):731–738. doi:10.1111/jsr.12430 PubMed DOI PMC
Giles JJ, Ling I, McArdle N, et al. Obstructive sleep apnea is treatable with continuous positive airway pressure in people with schizophrenia and other psychotic disorders. Schizophr Bull. 2022;48(2):437–446. doi:10.1093/schbul/sbab100 PubMed DOI PMC
Freeman D, Dunn G, Startup H, et al. Effects of cognitive behaviour therapy for worry on persecutory delusions in patients with psychosis (WIT): a parallel, single-blind, randomised controlled trial with a mediation analysis. Lancet Psychiatry. 2015;2(4):305–313. doi:10.1016/S2215-0366(15)00039-5 PubMed DOI PMC
Espie CA, MacMahoon KMA, Kelly H, et al. Randomized clinical effectiveness trial of nurse-administered small-group cognitive behaviour therapy for persistent insomnia in general practice. Sleep. 2006;30:574–584. doi:10.1093/sleep/30.5.574 PubMed DOI
Sánchez AI, Martínez P, Miró E, Bardwell WA, Buela-Casal G. CPAP and behavioral therapies in patients with obstructive sleep apnea: effects on daytime sleepiness, mood, and cognitive function. Sleep Med Rev. 2009;13(3):223–233. doi:10.1016/j.smrv.2008.07.002 PubMed DOI
Richards D, Bartlett DJ, Wong K, Malouff J, Grunstein RR. Increased adherence to CPAP with a group cognitive behavioral treatment intervention: a randomised trial. Sleep. 2007;30(5):635–640. doi:10.1093/sleep/30.5.635 PubMed DOI
Hwang DK, Nam M, Lee YJG. The effect of cognitive behavioral therapy for insomnia in schizophrenia patients with sleep disturbance: a non-randomized, assessor-blind trial. Psychiatry Res. 2019;274:182–188. doi:10.1016/j.psychres.2019.02.002 PubMed DOI
Waters F, Chiu VW, Dragovic M, Ree M. Different patterns of treatment response to Cognitive-Behavioural Therapy for Insomnia (CBT-I) in psychosis. Schizophr Res. 2020;221:57–62. doi:10.1016/j.schres.2020.03.054 PubMed DOI
Vanek J, Prasko J, Genzor S, et al. Obstructive sleep apnea, depression and cognitive impairment. Sleep Med. 2020;72:50–58. doi:10.1016/j.sleep.2020.03.017 PubMed DOI
Paykel ES. Partial remission, residual symptoms, and relapse in depression. Dialogues Clin Neurosci. 2008;10(4):431–437. doi:10.31887/DCNS.2008.10.4/espaykel PubMed DOI PMC
Braitman DV. Screening for sleep apnea in psychiatry. Am J Psychiatry Resid J. 2018;13(5):5–7. doi:10.1176/appi.ajp-rj.2018.130502 DOI
Redenius R, Murphy C, O’Neill E, Al-Hamwi M, Zallek SN. Does CPAP lead to change in BMI? J Clin Sleep Med. 2008;4(3):205–209. doi:10.5664/jcsm.27181 PubMed DOI PMC
Drager LF, Brunoni AR, Jenner R, Lorenzi-Filho G, Benseñor IM, Lotufo PA. Effects of CPAP on body weight in patients with obstructive sleep apnoea: a meta-analysis of randomised trials. Thorax. 2015;70(3):258–264. doi:10.1136/thoraxjnl-2014-205361 PubMed DOI