Sleep Abnormalities in Schizophrenia Patients

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It’s not uncommon for patients with schizophrenia spectrum disorders (SSDs) to exhibit sleeping issues. In fact, it’s more common for patients to have a sleep problem than not! A whopping 80 percent of people living with SSDs exhibit some kind of sleep abnormality, while large-scale studies have reported up to 78 percent of patients having sleep dysfunction. Depending on the study criteria and definitions of “sleep disorder,” rates of insomnia can occur anywhere between 36 percent and 80 percent in some studies.

These problems might be familiar to you if you live with an SSD. Classic cases are severe, prolonged issues with insomnia, circadian rhythm disorders, and reduced time in stage four (slow wave) or rapid eye movement (REM) sleep, for example.

How exactly does schizophrenia affect sleep? Is it the disorder or the medications that we take?

Sleep, Schizophrenia, and Science

According to a study released in Frontiers in Neuroscience, there are some clear bodily changes that affect our sleep at the molecular level. Mutations in “clock genes,” which are responsible for aligning our circadian rhythms to the natural mornings and nights, are associated with a higher risk of schizophrenia.

Additionally, disruptions in internal body temperature regulation affect our alignment with our circadian rhythm as well. Due to the nature of SSDs as well as the medications that treat SSDs, both might possibly alter the ability of the body to adjust to a rapidly changing temperature, which is why you might feel alright on a cold winter’s day while you walk, but feel suffocated to the point of nausea once you reach an indoor room or subway where the temperature is warm. This inability of the body to regulate temperature may contribute to lasting effects on sleep.

If you’re familiar with the dopamine hypothesis with schizophrenia, perhaps you know that an imbalance in dopamine can incur hallucinations and psychosis. Well, it turns out that dopamine helps regulate the sleep/wake cycle, too, where higher dopamine levels can negatively affect sleep. Dopamine is seen as a critical component in regulating the sleep/wake cycle, and there is some evidence to suggest that this neurotransmitter plays a key role in producing a quality of life.

Cognitive impairments can worsen quickly without adequate sleep, so it’s important to maintain a consistent schedule.

However, there are not many treatments aside from a few therapies and antipsychotics that can heavily sedate patients with SSDs. However, one effective treatment for these sleep disorders is cognitive remediation therapy (CRT). But due to the individualistic responses to therapy, the efficacy rates vary. Novel ways of treating sleep issues cooccurring with SSDs are necessary to help patients with SSDs.

A Personal Story

I first started having sleep abnormalities when I was an adolescent and had the precursor of psychosis, which manifested as depression. I overslept for at least 12 hours beginning when I was 13. I frequently missed school, and my attendance prevented me from achieving high grades or a good record to qualify for the colleges I wanted to attend.

When I was finally diagnosed with schizoaffective disorder by the age of 23, my insomnia was so bad I had to take medications and couldn’t make it to work on time. With each medication, I grew resistant. I would have nightmares even when I did sleep, so my quality of sleep began to deteriorate even more when I began having mania and suicidal urges during a period of medication withdrawal.

Today, my sleep quality is still poor, but I’ve learned how to manage it with medications and good sleep hygiene. Recently, I’ve had times when I only slept between 9 a.m. and 1 p.m. after a night of insomnia. I’ve had times when I’ve slept for 16 hours at the onset of a new medicine. But I’ve had some normal days, too! Instead of guilting myself for being unable to sleep, I try to focus on other activities that contribute to my career or well-being during the late hours. Eventually, I get tired and fall asleep.

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Nevertheless, my battle with sleep is an ongoing, uphill feat, and sometimes I also become anxious and depressed from never knowing when I’m going to be able to snooze peacefully into the night.

All of this makes it difficult to function in a 9 to 5 society, but thankfully, with some creative problem-solving, I was able to figure out a work-life balance that works for me.

Some helpful things I’ve found include NuCalm, a technology combining binaural beats and GABA-releasing chemicals that activate the parasympathetic nervous system. Meditation, exercise, yoga, and a proper diet also help. Being in bed at the same time each night is crucial to maintaining a consistent schedule.

Living in New York City makes it difficult to adhere to a normal sleep schedule since there are many invitations to party until the sun rises or late-night bar hangs most nights, and being in my early 20s made it difficult to adhere to a solid schedule in fear of missing out. But eventually, the right friends will understand that you need to take care of yourself. Having no shame in the fact that your body works differently than others can free you up to find alternative ways for you to integrate your life and goals.