Sleep dysfunctions in schizophrenia: A practical review

Objective: Sleep dysfunctions are common in schizophrenia, yet few evidence-based guidelines exist for the detection, diagnosis and management of sleep disturbances in this disorder. This critical review paper sought to increase awareness amongst mental health clinicians of sleep problems in schizophrenia, promote better identification of sleep problems, and help clinicians make more informed decisions about integrated treatment plans. Specifically, we examined the following key questions: 1) Which sleep problems occur in schizophrenia? 2) What evidence exists regarding the impact of poor sleep? 3) What are the underlying mechanisms of sleep problems in schizophrenia? 4) How can this information be used by clinicians to design a more complete treatment plan? Data Sources and study selection: We conducted a non-systematic review of studies that have shaped our current understanding of sleep in schizophrenia (n = 65). Data sources included PubMed, Medline, and cross-referencing. Results: Sleep disorders are pervasive and broad-ranging in people with schizophrenia, and are associated with substantial burden. An integrated model is proposed whereby a combination of highly interactive factors comprising genetic and neurobiological vulnerabilities, and behavioural and environmental factors, interact to cause sleep abnormalities. However, prospective and rigorous studies of sleep in schizophrenia are lacking. Conclusion: Patients often do not receive optimal care because sleep problems are rarely diagnosed, and treatments plans are incompletely formulated. A better understanding of sleep problems in schizophrenia will lead to increased treatment options, and a more positive clinical outcome.