What is Schizophrenia?
Schizophrenia is a mental illness. About 1 in 100 people have it. It affects thoughts, behaviour, per-ceptions and emotions. It tends to start in the late teens or early 20s. People with schizophrenia can suffer from 'psychosis' when unwell. This means a loss of contact with reality. It includes problems such as:
- delusions (fixed, false beliefs inconsistent with their social or cultural background).
- hallucinations (e.g. hearing voices when no one is there).
- strange actions (e.g. abnormal posturing).
- trouble putting thoughts together to make sense and expressing ideas.
What sleep problems are common in people with psychosis?
Sleep hours tend to be less regular. Sleep may occur at any time of the day or night rather than for 7-8 hours overnight like most people.
Sleep hours may be too few or too many. Sometimes this can be due to the drugs used to treat the psychosis. It can also be due to the lack of a regular daytime routine. Such a routine helps our bodies know when to sleep and when to wake up.
It can be hard to get to sleep or stay asleep because of psychotic symptoms that cause fear or anxiety.
The patterns of sleep can change. There may be less deep sleep and more shallow sleep. This can make sleep less refreshing so that there is increased tiredness during the day.
A change in sleep patterns can be the first sign of the start of psychosis. Or it can mean that psy-chosis is coming back again after a period of being well. In other words, it can be a warning sign.
People with psychosis have a higher risk of Obstructive Sleep Apnoea (OSA) or Sleep Disordered Breathing. This is especially so if they have put on extra weight. OSA can worsen other health problems (both physical and mental).
Why do you need to get help for sleep problems in schizophrenia?
- If you are already at risk of psychosis, sleep problems can increase this risk.
- Sleep problems may be the first sign of onset or relapse of illness.
- Sleep problems make it harder to get better.
- Sleep problems cause other health issues.
How are sleep problems diagnosed?
Your doctor or health worker will ask questions about your sleep. They will ask about your mental health too. They may ask you to fill out some questionnaires. This is to help to work out the prob-lem.
They might ask you to keep a sleep diary. This is to keep track of your sleep. It tends to be done over two or more weeks.
They might refer you for a sleep study if they suspect something. This is done for one night.
They might ask you to wear an actigraph watch. This helps to monitor when you are active and sleeping all through the day and night.
How might the sleep problem be treated?
Tell your doctor about your sleep problem. They can't fix a problem if they don't know about it. Once they understand the cause of your poor sleep they will be able to help you.
Often sleep can improve with changes in sleep habits. See our link Understanding and helping poor sleep.
Short term use of sedatives (sleeping tablets or sedative antipsychotics) can help when you are very unwell and your symptoms stop you from sleeping. Melatonin and bright light can help reset your body clock.
Changing the type, dosage or timing of your psychosis medication may help your sleep problems (e.g. some schizophrenia medications tend to make you sleepy). Be sure to discuss possible changes with your doctor first. If you are too groggy in the morning, you might need to take it earli-er at night. Or you can change when you do things each day so that you do not have important things to do in the mornings.
Where can I find out more about schizophrenia and sleep?