The vast majority of people with schizophrenia have sleep difficulties, ranging from insomnia to excessive sleepiness.

Schizophrenia is a complex mental health condition that affects your thoughts, feelings, behaviors, and perception of reality.

Though disturbed sleep isn’t included in the diagnostic criteria for schizophrenia, it is still a significant problem that up to 80% of people with the condition experience.

People with schizophrenia may have various sleep problems, including insomnia, excessive sleepiness, and trouble with consistent sleep routines. Effective schizophrenia treatments can help with sleep problems.

Getting a good night’s sleep is vital for your health and well-being. During sleep your body is able to repair itself, your brain can sort information and consolidate memories, and your immune and nervous systems get a chance to rest.

In contrast, sleep irregularities in schizophrenia can significantly reduce the person’s quality of life and lead to a deteriorating clinical condition.

Research from 2020 on people with acute schizophrenia found that 83% have at least one type of sleep difficulty, such as the following:

  • difficulty falling asleep
  • difficulty waking up
  • difficulty maintaining sleep
  • poor sleep quality
  • increased time spent in bed

Common sleep conditions in schizophrenia may include the following:

  • insomnia
  • excessive sleeping
  • sleep apnea
  • sleeping pattern changes
  • restless leg syndrome
  • periodic limb movement disorder

Sleep difficulties in schizophrenia often begin well before the first symptoms of psychosis. In fact, disturbed sleep is the most commonly reported symptom in the prodromal phase (early phase before illness onset).

Disturbed sleep is also a predictive factor in determining which high risk individuals will ultimately go on to develop psychosis.

Research from 2017 suggests that dysfunction of dopamine D2 receptors may influence the positive symptoms of schizophrenia as well as sleep problems.

Specifically, the overactivity of D2 receptors in the brain’s striatum has been linked to the positive symptoms of schizophrenia. This may also cause increased wakefulness, often leading to insomnia.

Disturbed sleep-wake patterns can also occur in schizophrenia, with people sleeping more at night overall but with poorer efficiency (amount of time spent actually sleeping while in bed), according to 2017 research.

Circadian rhythm problems are also common in people with mental health conditions, including schizophrenia. In a 2012 study of 20 people with schizophrenia, researchers found that half had severe circadian misalignment. These participants took longer to fall asleep and also slept longer.

A 2022 study of people with schizophrenia found that their biggest struggles were:

  • poor sleep hygiene (habits and practices conducive to a good night’s sleep)
  • rumination
  • obsessive thoughts keeping them up at night

All participants in the study said they experienced ruminations, regardless of insomnia severity, and these ruminations seemed to cause the participants the most anxiety and distress.

When asked about their sleep difficulties, one participant in the study said “…I want to sleep soundly without waking up and this problem comes to me, what I want is to get it out of my head so I can keep sleeping, I don’t want to think about this problem anymore, I just want to keep sleeping.”

Other features of schizophrenia itself — such as delusions and problems with urinary containment — and comorbid diseases can further worsen insomnia.

Poor sleep directly affects everyday functioning and social activities — two areas already significantly impacted by schizophrenia. Sleep disturbances are also linked to symptom severity.

According to the same 2022 research, people with schizophrenia and sleep problems report experiencing the following daytime difficulties:

  • feeling down with no energy
  • nervous and anxious
  • restlessness
  • lack of motivation
  • difficulties concentrating and performing
  • memory problems
  • bad mood
  • difficulty getting up
  • irritability
  • apathy
  • increased rumination
  • worsening of schizophrenia symptoms

Sleep difficulties can significantly affect a person’s quality of life and limit their ability to perform daily tasks and activities. In fact, one aspect in which virtually all participants agreed is that they want sleep to bring rest — specifically, the feeling of resting physically and mentally.

Research from 2018 shows that treatment with either first- or second-generation antipsychotics is linked to an overall improvement in sleep quality and efficiency in people with schizophrenia.

This is either due to the relief of psychosis or as an effect of the drug’s action on various neurotransmitters such as:

  • dopamine
  • histamine
  • norepinephrine
  • serotonin

But while antipsychotic medications may lessen some of the sleep problems in schizophrenia, they can also trigger or worsen others.

Restless leg syndrome (RLS) and periodic limb movement disorder (PLMD) are sleep movement disorders characterized by a distressing need to move one’s legs or other limbs while sleeping.

RLS and PLMD are linked to low dopamine levels, and since antipsychotics work by blocking D2 receptors, these medications can trigger or worsen these two conditions.

When it comes to excessive sleeping, however, antipsychotic medications have a sedative effect and may thus make you even more tired. These medications can also impair daily functioning and interfere with one’s ability to go back to school or work after starting medication.

In addition, long-term treatment with high doses of antipsychotics may be linked with weaker circadian rhythms in people with schizophrenia.

Abruptly stopping antipsychotic medications can lead to a progressive deterioration of sleep quality.

Among people who still experience insomnia while regularly taking antipsychotics, discontinuing their medications can further worsen insomnia along with worsening psychotic symptoms.

Research shows that if these individuals do discontinue their medications, the severity of their insomnia is strongly linked to the severity of psychotic symptoms.

According to 2022 research certain medications, cognitive behavioral therapy (CBT), and good sleeping habits may help improve sleep in people with schizophrenia.

Benzodiazepines are frequently used to treat insomnia and agitation in schizophrenia. However, research shows that benzodiazepines may impair slow-wave sleep and REM sleep, features which may already be altered in people with schizophrenia.

In contrast, zopiclone, a non-benzodiazepine sleep medication, may be a good alternative to benzodiazepines, as it may enhance slow-wave sleep with minimal effects on REM sleep.

Regarding excessive sleepiness, atypical antipsychotics (second-generation) tend to cause less sedation than first-generation antipsychotics.

In fact, 2018 research shows that switching from a first-generation to second-generation antipsychotic improves subjective sleep quality. And this improvement tends to correlate with an improvement in negative symptoms of schizophrenia as well.

People who switched from first-generation to second-generation antipsychotics found improvements in the following problems:

  • sleep quality
  • sleep latency
  • sleep efficiency
  • sleep disturbances
  • daytime dysfunction

However, sleep duration and use of sleep medication remained unchanged.

The following second-generation antipsychotics were superior to perospirone in their improvement of sleep duration, sleep efficiency, and daytime dysfunction:

  • risperidone
  • olanzapine
  • quetiapine

Research also shows that melatonin therapy may offer positive outcomes for sleep, metabolic profile, and tardive dyskinesia (drug-induced motor dysfunction) in people with schizophrenia.

There are several things we can do to improve sleep:

  • Exposure to natural light cycle. Lighting plays a major role in getting a good night’s sleep. When we get too little light during the day or too much at night, it leads to dysfunction in our body’s sleep-wake cycle.
  • Exercise. Research shows that exercise significantly improves sleep quality in people with mental illness.
  • Keep a regular sleep schedule. Going to bed and waking up at the same time every day is important for keeping a healthy sleep-wake cycle.
  • Limit the use of electronic devices at night. Blue light can also interfere with your body’s sleep-wake cycle.

We spend about one-third of our lives sleeping. A good night’s sleep helps us maintain mental and physical balance, as it refreshes and restores our energy.

Sleep dysfunction is extremely common in people with schizophrenia, affecting up to 80% of people with the disorder. In fact, it often begins well before the first symptoms of psychosis even appear.

When people with schizophrenia have poor sleep quality, it can significantly lower their quality of life and worsen symptoms.

Taking the right medication, exercising, getting enough sunlight, and keeping a regular sleep schedule can help improve sleep quality.