Sleep disturbance

What is sleep disturbance in schizophrenia?

Typically, sleep follows a characteristic pattern of four stages, where stage 1 is a state of drowsiness and early sleep, stage 2 comprises the largest component of the sleep cycle and is the first complete loss of awareness of the external environment, stage 3 is a deep slow-wave sleep, and the fourth stage is rapid eye movement (REM) sleep where muscle paralysis and memorable dreaming occurs.

Sleep disturbances include changes in sleep time, sleep latency (the length of time it takes from full wakefulness to sleep) and sleep efficiency (the amount of time spent asleep while in bed). Parasomnias may also be apparent, including sleep walking, night terrors, nightmares, sleep paralysis, and dream enactment behaviours.

What is the evidence for sleep disturbance in people with schizophrenia?

Moderate quality evidence finds people with schizophrenia show large effects of shorter total sleep time, more awake time, longer sleep onset latency, and lower sleep efficiency. There were medium-sized effects of increased stage 1 sleep, decreased stage 4 sleep, decreased slow wave sleep, and decreased REM latency. There were small effects of decreased stage 3 sleep and increased REM duration.

Moderator analyses found medication-naïve patients had shorter total sleep time, longer sleep onset latency, decreased sleep efficacy, and longer awake time. Patients recently withdrawn from antipsychotics had shorter total sleep time, longer sleep onset latency, decreased sleep efficacy, longer awake time, increased stage 1 sleep, decreased stage 2, 3, and 4 sleep, decreased slow wave sleep and shorter REM latency. Patients on antipsychotics had significantly longer sleep onset latency, increased stage 2 sleep, and decreased total REM sleep.

Moderate to low quality evidence finds weekly nightmares were reported in 9 to 55% of people with schizophrenia. Around 15% reported sleep paralysis and 17% reported sleep-related eating disorders.

September 2020

Image: ©Yanyong Kanokshoti –

Last updated at: 1:35 am, 17th October 2021
To view documentation related to this topic download the files below
Fact Sheet Technical Commentary

NeuRA Libraries

Title Colour Legend:
Green - Topic summary is available.
Orange - Topic summary is being compiled.
Red - Topic summary has no current systematic review available.