If you or someone you care for with schizophrenia has trouble sleeping, then read on. In this article, types of sleep problems, such as insomnia, and their possible causes are discussed. The importance of sleep is highlighted together with some ideas on how schizophrenia and sleep problems might be managed.

Sleep is important for the overall health of everyone¹, and it is especially true for those with schizophrenia.² Indeed, it’s well known that sleep is key to normal brain functioning and that both memory and learning can be affected by sleep disturbances.^3,4
 
Moreover, for people with schizophrenia, lack of sleep has been linked to the worsening of symptoms and poor clinical outcomes, including an increased risk for suicide.^2,5 Sleep issues may have started before the first signs of schizophrenia and may be an early warning sign that schizophrenia symptoms are about to get worse.⁶

When you think of a sleep problem, insomnia might be the first to come to mind. Indeed, it’s a common problem that can affect anyone occasionally⁷ and around every second person with schizophrenia² – but what is it exactly? Insomnia is a condition in which the person struggles falling or staying asleep and therefore can feel very tired, irritable, or very drained throughout the day.⁷
 
Insomnia is just one of several types of so-called sleep-wake disorders that may affect people with mental health conditions such as schizophrenia; additional sleep problems can include:^{2, 7–12}
 
1.      sleepwalking or talking (parasomnias)
2.      having regular nightmares or night terrors (nightmare disorder)
3.      falling asleep suddenly and unexpectedly at random times during the day (narcolepsy)
4.      stopping breathing on and off while asleep (obstructive sleep apnoea)
5.      involuntary limb movements (restless legs syndrome)
 
Importantly, more than one sleep disorder may be experienced by the same individual, with one study suggesting that people with early psychosis have an average of three sleep disorders.²
 

Sleep disturbances may occur for a variety of reasons.⁷ Stress, anxiety and depression can have a huge impact on people’s ability to sleep, as can trying to sleep in an uncomfortable or noisy environment.⁷ High caffeine consumption, alcohol use, smoking and illicit drug use  can also affect sleeping.⁷
 
Furthermore, vitamin or mineral deficiencies may also play a role, which is why good diet and nutrition are important¹² – restless legs syndrome, for example, has been linked to an iron deficiency.¹² Moreover, poor diet and lack of exercise can lead to being overweight and eventually, to obesity. Carrying excess weight is disadvantageous as it can also affect the ability to sleep and is linked to the development of sleep apnoea.^6,11 Further risk factors for sleep apnoea include smoking; regular alcohol consumption; and having another family member that suffers from it.¹¹
 
Problems sleeping may also be caused by dysregulated signalling in the brain of people with schizophrenia, causing them to feel more awake and stimulated when they should be asleep.⁶

So, how much sleep does an average adult need? The general advice is to try to sleep around 7 to 9 hours a day, with most people aiming for about 8 hours.⁷ Everyone is different, however, and people tend to need less sleep as they get older.⁷ While lack of sleep can be a problem, oversleeping (sleeping for more than 9 hours) can also be an issue and a sign of a mental health condition such as schizophrenia.¹³
 
It’s not just about the amount of sleep that you get, however, it’s also about the quality.⁸ There are four different phases of sleep.¹⁴ From dropping off to sleep within a few minutes to being in a deep sleep, there is a cyclical pattern that varies from person to person.¹⁴ It’s thought that the last of the four phases – REM sleep – is the most important for normal brain functioning.¹⁴ Not being able to fall sleep or not staying asleep long enough will therefore have an impact of how much quality sleep you can get.¹⁴
 
The timing of going to sleep is also important.^8,15 For most people, our natural 24-hour cycle or internal body clock (circadian rhythm) will be to sleep at night when it is dark and then be awake in the day when it is light.¹⁵ If the actual time you go to bed is out of sync with your internal body clock, then this can lead to sleep problems.¹⁵
 

Sleep problems can often be overlooked in the management of schizophrenia, but it’s becoming increasingly clear that it’s an important part of someone’s care.²
 
While there are some things you can do to improve sleep, such as creating a comfortable, noise-free environment or trying to be consistent with the time you go to bed and wake up, seeking professional help is advised.^7,16
 
A healthcare professional will be able to spot if there is an underlying cause for the sleeplessness other than having schizophrenia and will help you address it. Moreover, they will be there to help and support you should you need help with alcohol or drug use, or general advice on the treatments available to help you sleep better.