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

Abstract

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.

A phenomenological inquiry into the experience of sleep: Perspectives of US military veterans with insomnia and serious mental illness

“…For instance, those experiencing sleep as a refuge voiced longing and fighting for it. This concept of sleep as an escape has also been reported in two recent qualitative papers focused on the psychosis and insomnia experience (Faulkner & Bee, ; Waite, Evans et al., ); we found this belief among both those with depression, bipolar and schizophrenia disorders, showing it can transcend diagnosis. Another metaphor was that sleep itself was a struggle and a negative experience, and thus other participants feared and fought against sleep.…”

“…Labelling the process of getting to sleep with “fight”, “battle” and other military metaphors may exacerbate bedtime hyperarousal; non‐veterans rarely use similar military terminology (Carey et al., ; Faulkner & Bee, ; Waite, Evans et al., ). Clinicians may want to explore whether such metaphors work against good sleep for some veterans, and help them develop meaningful personal alternatives.…”

The Experience of Sleep Problems and Their Treatment in Young People at Ultra-High Risk of Psychosis: A Thematic Analysis

“…It may be the case that some participants viewed their sleep problems as so intractable as to be untreatable – this attitude has been reported in patients with sleep problems in the context of established psychosis (17). Faulkner and Bee found that patients had pessimistic or neutral views on the likely effectiveness of “talking therapy” as an intervention for sleep problems, although individual components (e.g., stimulus control, increasing daytime activity) were seen as far more likely to be effective.…”

“…Previous qualitative studies have explored sleep problems in the absence of other mental health problems (16), or specifically in patients with sleep disturbance in the context of severe and enduring psychosis (17, 18). However, these accounts do not explore the specific developmental context of adolescence and early adulthood nor the novel target of addressing sleep as a preventative intervention for those at risk of serious mental health problems.…”

Sleep, Nightmares and Schizophrenia

“…In summary, there is evidence that improvement in nightmares can improve well-being and reduce general psychopathology in diverse groups of psychiatric patients, including those with schizophrenia, and that brief psychological interventions that improve sleep are seen as important and very much appreciated by this population [86,87]. Precisely because it is very much appreciated, one can never dismiss the operation of a placebo effect in reports of well-being.…”