Sleep disturbance—including shorter sleep time and lowered sleep quality—is associated with increased psychotic experiences  Few studies have investigated clinical sleep disorders (eg, insomnia, nightmares, sleep apnea) in psychosis. One study found that comorbid insomnia and nightmares was associated with a significant increased risk of suicide in schizophrenia . So what's new?
• Reeve and colleagues performed a detailed assessment of clinical sleep disorders—including presence, severity, and treatment—in patients with early psychosis • A secondary objective was to investigate the association between sleep disorders, psychiatric symptoms, and wellbeing
• Participants completed a Consensus Sleep Diary for 7 days • Participants also worse a wrist-based activity monitoring device for the same 7 days • A subgroup of 29 subjects completed the self-report Sleep-50, which was used to validate DISP outcomes
• Fatigue was measured via the Multi-Dimensional Fatigue Symptom Inventory • Differences in psychotic experiences, mood, and well-being between those with and without sleep disorders were assessed via independent samples t-tests
• Mean subject age was 24, and 65% of subjects were male • 75% of subjects were referred from early intervention psychosis services • The most common diagnoses were Psychosis NOS (42%) and schizophrenia (28%) • 82% of subjects were prescribed antipsychotics and 40% antidepressants
• 80% of subjects had a positive screen or diagnosis for at least one sleep disorder, most commonly insomnia (50%) and nightmare disorder (48%) • Comorbidity was high, with an average of 3.3 sleep disorders per subject, and 52% of all sleep disorders were rated as severe • Over half of all sleep disorders had been discussed with a medical professional
• 30% of all sleep disorders (57% of those discussed with a professional) had received some form of (typically non-recommended) treatment • Having at least one (versus none) sleep disorder was associated with more severe paranoia, hallucinations, and disorganization, as well as more depression, anxiety, and fatigue, and lower health-related quality of life • There was no difference in antipsychotic dose between subjects with and without insomnia
• The authors concluded that 80% of their sample with early psychosis had comorbid sleep disorder, which was often severe and untreated • Subjects with comorbid sleep disorders had more severe psychopathology and lower quality of life • Study limitations include uncertain generalizability to other patients with non-affective psychosis and the absence of polysomnographic data • Nevertheless, findings have important potential implications for clinicians