Effects of polypharmacy on sleep in psychiatric inpatients

Waters, Flavie; Faulkner, Debbie; Naik, Neepa; Röck, Daniel

doi:10.1016/j.schres.2012.05.013

Cited by 40 publications

(35 citation statements)

References 7 publications

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“…A recent review confirms improvement in some sleep variables by clozapine, olanzapine and paliperidone (whilst quetiapine further disrupted sleep) [64], however antipsychotics have not been shown to improve sleep variables to normal levels, and authors describe anti-psychotics as an inadequate treatment for the sleep problems present in most people with schizophrenia [65, 66]. For many participants, antipsychotics were viewed as a form of sleep treatment, highlighting that although professionals may mostly view effects on sleep as side effects [67], many participants viewed them as intended effects:…”

Section: Resultsmentioning

confidence: 99%

Experiences, perspectives and priorities of people with schizophrenia spectrum disorders regarding sleep disturbance and its treatment: a qualitative study

Faulkner

Bee

2017

BMC Psychiatry

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BackgroundSleep problems are very common in people with schizophrenia spectrum disorders, and impact negatively on functioning and wellbeing. Research regarding interventions to improve sleep in this population has been lacking. Little is known regarding these patient’s perspectives on sleep problems and their treatment, providing very little foundation on which to develop acceptable and patient-centred treatments.MethodsThis study aims to explore perspectives and priorities of participants with schizophrenia spectrum disorders regarding sleep and sleep disturbance, and their perspectives on existing treatments. An Interpretive Phenomenological Analysis (IPA) study was conducted; data were gathered through in depth interviews with 15 people with schizophrenia spectrum disorders and varying degrees of self-reported sleep disturbance, each case was analysed individually before cross-case comparisons were made.ResultsSleep maintenance and sleep quality were universally valued. Changes to sleep were interpreted as part of a perceived loss of normality relating to diagnosis. Participants differed in the extent of any hopes that sleep would improve. Sleep disturbances were linked to a reduced ability or opportunity to participate in valued activities, and were entangled with self-image due to a wish to be perceived as alert and in control. During difficult times, sleep could be seen as an escape. Concerns were expressed regarding the negative effects of using hypnotics or anti-psychotics to aid sleep, although typically antipsychotics were deemed more acceptable than hypnotics. Concerns regarding barriers to adherence and effectiveness of self-help approaches were common. Non-pharmacological interventions were noted to require a personalised whole-lifestyle approach.ConclusionsThis is the first study to explore sleep perspectives in participants with established schizophrenia spectrum disorders, recruited from a population receiving usual care. Findings re-enforce the importance of considering sleep within recovery focused practice. In developing and adapting interventions routine-based approaches should be considered. Approaches should attempt to make gradual changes more easily perceptible, should support motivation for behaviour change, and should consider the impact of regular psychotropic medications.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-017-1329-8) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Experiences, perspectives and priorities of people with schizophrenia spectrum disorders regarding sleep disturbance and its treatment: a qualitative study

Faulkner

Bee

2017

BMC Psychiatry

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“…In addition, a recent study examined the relationship between the number (and dosage) of antipsychotic medications and sleep in a psychiatric inpatient population including SZ patients. The results showed that increasing antipsychotics dosages were linked to better sleep, although antipsychotic medications only accounted for a relatively small amount of the variance in sleep (6%) [36]. Furthermore, sleep complaints were pervasive in 70% of this medicated clinical sample.…”

Section: Effects Of Medication On Sleepmentioning

confidence: 88%

“…Selective serotonin-reuptake inhibitors (SSRI) and the serotoninnorepinephrine-reuptake inhibitors (SNRI), for example, have alerting effects, and are linked to fragmented sleep, increased SOL and daytime somnolence [33]. However, in an examination of the effect of polypharmacy on sleep in psychiatric inpatients, Waters et al [36] showed that SSRI/SNRI, when taken concurrently with antipsychotic medications, failed to show disruptive effect on sleep pattern or daytime functions. A gradual tolerance of sleep effects of SSRI in chronic treatment remains a possibility was provided as one explanation for this finding [37].…”

Section: Effects Of Medication On Sleepmentioning

confidence: 99%

Sleep dysfunctions in schizophrenia: A practical review

Waters¹,

Manoach²

2012

OJPsych

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“…The fact that sleep deprivation of patients with schizophrenia intensifies symptoms with time (Lehmann and Koranyi, 1954;Koranyi and Lehmann, 1960;West et al, 1962) has profound clinical implications: treating sleep disruption in schizophrenia may be a successful way of mitigating risk of psychosis (Waters et al, 2012). We would undoubtedly benefit from adequately controlled quantitative studies of sleep deprivation in schizophrenics using modern methods.…”

Section: Sleep Deprivation and Its Relationship To Psychotic Behaviormentioning

confidence: 99%

“…In this case, 5HT2 receptor antagonism provided by atypical antipsychotics would promote cortical oscillations and thus promote sleep. However, despite treatment with atypical antipsychotics, 70% of hospitalized patients in one study continued to suffer sleep disturbances (Waters et al, 2012). The reticular nucleus is also strongly modulated by GABA receptor activation and may be associated with reported changes in GABAergic neuron populations in schizophrenia ( Ferrarelli and Tononi, 2011).…”

Section: Atypical Vs Typical Antipsychotic Effectiveness In Treatingmentioning

confidence: 99%

Schizophrenia: the role of sleep and circadian rhythms in regulating dopamine and psychosis

Yates

2016

Reviews in the Neurosciences

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AbstractSchizophrenia has long been associated with abnormalities in circadian rhythms and sleep. Up until now, there have been no thorough reviews of the potential mechanisms behind the myriad of circadian and sleep abnormalities observed in schizophrenia and psychosis. We present evidence of sleep playing an important role in psychosis predominantly mediated by dopaminergic pathways. A synthesis of both human and animal experimental work suggests that the interplay between sleep and dopamine is important in the generation and maintenance of psychosis. In particular, both animal and human data point to sleep disruption increasing dopamine release and sensitivity. Furthermore, elevated dopamine levels disrupt sleep and circadian rhythms. The synthesis of knowledge suggests that circadian rhythms, dopamine dysregulation, and psychosis are intricately linked. This suggests that treatment of circadian disturbance may be a useful target in improving the lives and symptoms of patients with schizophrenia.

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Effects of polypharmacy on sleep in psychiatric inpatients

Cited by 40 publications

References 7 publications

Experiences, perspectives and priorities of people with schizophrenia spectrum disorders regarding sleep disturbance and its treatment: a qualitative study

Experiences, perspectives and priorities of people with schizophrenia spectrum disorders regarding sleep disturbance and its treatment: a qualitative study

Sleep dysfunctions in schizophrenia: A practical review

Schizophrenia: the role of sleep and circadian rhythms in regulating dopamine and psychosis

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