Sleep Disorders and Psychiatric Illness: A Complex Clinical Challenge

Sleep dysfunction is very common among patients diagnosed with psychiatric disorders, but treatment can be tricky.

Sleep dysfunction is very common among patients diagnosed with psychiatric disorders, but treatment can be tricky, should be carefully individualized to each patient, and should initially include cognitive behavioral therapy rather than pharmacotherapies alone, according to experts in the field.1,2

“There is a very, very strong relationship between psychiatric disorders in general and sleep issues,” said Raj Dasgupta, MD, a fellow of the American Academy of Sleep Medicine (AASM) and assistant professor of clinical medicine at the Keck School of Medicine at the University of Southern California (USC). 

The relationship between sleep dysfunction and psychiatric illness is complex. One recently-published meta-analysis pooling data from 31 studies found that patients diagnosed with schizophrenia have very disrupted sleep patterns, including “significantly shorter sleep time, longer sleep-onset latency, more wake time after sleep onset, lower sleep efficiency, and decreased stage-4 sleep, slow wave sleep, and duration and latency of rapid eye movement [REM] sleep compared with healthy controls.”1

When treating patients with psychiatric disorders, clinicians should look for insomnia, hypersomnia, obstructive sleep apnea, circadian rhythm dysfunction, and restless legs syndrome, according to Elizabeth A. Klingaman, PhD, a clinical research psychologist at the VA Capitol Health Care Network Mental Illness Research, Education, and Clinical Center at the Baltimore VA Medical Center in Maryland.

Both the underlying psychiatric disease and medication prescribed to treat psychiatric disease can contribute to sleep dysfunctions. Atypical antipsychotics like quetiapine, for example, have been implicated in weight gain, and hence is a risk factor for the development of sleep apnea, Dr. Dasgupta noted.

“Sleep dysfunction and circadian irregularities have been found in both drug-naive and medicated patients, so they are not necessarily induced by pharmacotherapies,” agreed Todd Girard, PhD, associate professor of psychology at Ryerson University in Toronto, Ontario, Canada. “That said, most antipsychotics (both traditional and second-generation medications) have sedating effects. In fact, historically, the sedative effect was considered key to their efficacy in reducing positive symptoms of psychosis and agitation.”

“Biological rhythms may also be thrown off further by patients attempting to counteract sedative effects by consuming a lot of caffeine or using stimulant drugs,” Dr. Girard noted. 

Regardless of the etiology of sleep disruptions for patients with psychiatric illness, the impacts can be profound.