Schizophrenia is a mental health condition that is characterized by hallucinations, delusions, and very disorganized thinking.
The condition needs lifelong treatment and often has a significant impact on the person with schizophrenia. Schizophrenia often first appears when a person is in their 20s, but it can occur earlier or later.
One of the first symptoms of schizophrenia can be disruption to your usual sleep pattern. For instance, you might:
- begin staying up all night
- start being unable to sleep for more than an hour or two at a time
- suddenly have trouble falling asleep on schedule
This early sign of schizophrenia is called a circadian rhythm disruption. This symptom often comes before any delusions, hallucinations, or other more noticeable symptoms.
Circadian rhythm disruptions aren’t the only way schizophrenia can affect your sleep. We’ll review the many ways schizophrenia can affect your sleep and how to manage them.
Sleep disturbances and schizophrenia are closely linked. In fact, sleep disturbances are often the first symptom of schizophrenia to appear.
Researchers are still trying to fully understand this link. A scientific review from 2020 suggested that the same gene mutations (changes) might cause schizophrenia and circadian rhythm disruptions.
What is circadian rhythm?
Your circadian rhythm is the pattern of sleeping and waking hours your body sets for every day. People with a disrupted circadian rhythm often can’t get the sleep they need.
People with schizophrenia are also at an increased risk of other sleep disturbances. One 2017 study estimated that
Lack of sleep can cause the symptoms of mental health conditions, including schizophrenia, to increase and become harder to manage — even if you are taking medication. Some of the symptoms which might increase are:
- disorganized thought
- memory difficulties
- difficulty concentrating
- difficulty expressing thoughts
- difficulty paying attention
- anger, sadness, or other emotions that don’t fit the situation
This can weaken the effect of medication and treatment plans that were helping you manage your condition. It can cause a relapse and might cause the need for a new course of treatment.
Additionally, sleep disturbances can impact your physical health. Over time, a lack of sleep can lead to complications such as:
There are several sleep disturbances that people with schizophrenia are likely to experience. Not everyone with schizophrenia will experience all of these conditions, but most experience at least one.
Insomnia is when you have difficulty falling asleep or staying asleep. Most people experience occasional sleepless nights, but people with insomnia cannot sleep at least 3 nights per week.
Sometimes, external factors such as stress, caffeine, or sleeping environment cause insomnia. For people with schizophrenia, insomnia is often the result of overactive dopamine receptors in the brain.
Dopamine is a brain chemical that your body uses to send signals between your nerve cells. It can affect your mood, memory, coordination, and other important functions. Dopamine needs to be at the right level for all of these functions to work correctly.
Both high and low levels of dopamine can impact how your body works.
High dopamine activity is linked to several mental health conditions. Since both insomnia and schizophrenia are linked to high dopamine levels, it can be difficult for people with schizophrenia to manage insomnia and get restful sleep.
Obstructive sleep apnea
Obstructive sleep apnea (OSA) is a condition that occurs when your airways become blocked while you sleep. It causes symptoms such as:
A 2016 review of studies indicated that about
Restless leg syndrome and periodic limb movement disorder
Restless leg syndrome (RLS) is a condition that causes an uncontrollable urge to move your legs. It is typically worse in the evenings and can disrupt your sleep.
Periodic limb movement disorder (PLMD) is a cramping or jerking of your legs while you sleep. It often occurs alongside RLS or other sleep disturbances, but it can also happen on its own.
People with schizophrenia generally have PLMD along with RLS. Schizophrenia and RLS are both linked to high levels of dopamine. This connection is likely why RLS is common among people with schizophrenia.
Circadian rhythm disorders
A circadian rhythm disorder is a condition that makes it difficult for you to sleep on a schedule. This can mean:
- sleeping too much
- sleeping too little
- not being able to sleep for more than a short time
- not being able to maintain a daily sleep and wake routine
According to the
People with schizophrenia are especially likely to have circadian rhythm disorders. They may even be an early sign that a person is developing schizophrenia.
Narcolepsy is a neurological condition that causes you to feel very tired during the day. It can be very difficult to stay awake. People with narcolepsy often have difficulty completing their daily routines because intense urges to sleep can occur during ordinary tasks.
Some research shows an overlap between some of the symptoms of narcolepsy and schizophrenia, such as hallucinations. More research is needed to determine what this link could mean.
Night-eating syndrome (NES) is a condition that causes you to be excessively hungry during the night.
People with this condition wake up feeling very hungry and eat in the middle of the night. As a result, they aren’t hungry during the day.
Researchers haven’t fully studied the link between schizophrenia and NES. This 2021 study suggested that people with schizophrenia might be at a higher risk for NES. People with schizophrenia who are overweight or obese, or who have insomnia, could be at an even higher risk.
If you have schizophrenia and disturbed sleep, you should talk with a healthcare professional right away. To diagnose your sleep disorder, your doctor might:
- ask questions about your sleep or have you fill out a questionnaire
- ask you to keep a sleep diary for several weeks to record your sleep pattern
- study your sleep overnight in a lab setting
- have you wear a device on your wrist to monitor and record your activity
The exact treatment for a sleep disorder will depend on the disorder and on the person with schizophrenia.
As a rule, treatment of your sleep disorder will be part of your overall schizophrenia treatment and management plan. It’s a good idea to talk with your doctor, psychiatrist, or other medical professional as soon as you notice a disturbance in your sleep.
Treating your sleep disorder can help keep it from making your schizophrenia symptoms worse. Treatment options might include:
- Cognitive behavioral therapy (CBT). CBT has proven to be very helpful for people with schizophrenia who are managing sleep disruptions. CBT can give you the tools you need to reduce stress around sleep and break habits that can contribute to poor sleep.
- Antipsychotic medications. Medications used to treat schizophrenia can also help you sleep. Your doctor might change the dose or time of day you take your medication to reduce the symptoms of a sleep disorder.
- Nonstimulant sleeping medications. Your doctor may prescribe you sleeping medications that are usually prescribed for insomnia or other sleep disorders. This isn’t always an option, but it can help in certain cases. Your doctor will ensure that they won’t interfere with the medication you take for schizophrenia.
Your doctor might recommend changes to your lifestyle that can help you sleep. These may include:
- limiting caffeine and alcohol
- making your bedroom darker and more comfortable
- ensuring your bed is only used for sleep and sexual activity
Sleep disorders usually have a negative impact on the people they affect. Even in the short term, a sleep disorder might:
- leave you feeling tired during your waking hours
- cause a headache
- cause eye pain
- make it difficult for you to concentrate
Over time, sleep disorders can lead to complications such as high blood pressure and diabetes.
For people with schizophrenia, the impacts of sleep disorders can be even more severe. Sleep disorders can cause an increase in symptoms such as:
- mood disruptions
- memory trouble
- disorganized thought
People with schizophrenia are at higher risk for multiple sleep disorders. Treatment can help both schizophrenia and the sleep disorder, and is an important part of managing schizophrenia.