Sleep Interventions in the Treatment of Schizophrenia and Bipolar Disorder

Abstract

Due to the effects of sleep on the central nervous system, it is thought that sleep disorders have a special importance in the onset, course and treatment of psychiatric diseases. Although the negative effects of sleep problems on the occurrence, recurrence and clinical course of psychiatric disorders are well known, it is reported that clinicians do not spend enough time for sleep problems in practice. This may be related to the fact that patients underreport their complaints for various reasons, insufficient examination time, and clinicians’ lack of knowledge about the importance of the subject. Pharmacotherapy, psychological and behavioral interventions are options among the therapeutic approaches to sleep problems. But, it seems that clinicians tend to prefer pharmacological approaches for the treatment of sleep problems. However, it is important to choose the appropriate treatment option with considering the method preferred by the patients, who already use many and high doses of pharmacological agents, the nature of the psychiatric disorder and the sleep problem. In this context, chronotherapeutic approaches such as bright light, sleep deprivation, interpersonal relations and social rhythm therapy, and cognitive behavioral therapy techniques adapted for patients with bipolar disorder can be used in the treatment of suitable patients. In this article, the current literature about sleep-related problems observed in patients with schizophrenia and bipolar disorder is reviewed comprehensively with presenting clinical phenotypes and treatment approaches.

Role of adjunctive nonpharmacological strategies for treatment of rapid-cycling bipolar disorder

“…Combining sleep deprivation with antidepressants or mood stabilizers, BLT, or sleep phase-advance treatment also sustains its effects[ 107 , 110 - 112 ]. The treatment might be particularly effective for those with bipolar rather than unipolar depression[ 113 - 117 ]. There is no difference in efficacy between total and partial sleep deprivation[ 106 , 108 , 118 , 119 ].…”

“…Dark therapy involves keeping patients with mania/hypomania in dark rooms for extended periods of rest and sleep[ 84 ]. This treatment can reduce manic symptoms but has not been examined in RCTs[ 84 , 86 , 117 ]. A more practical option is the use of glasses that block blue light.…”

Prescribing and deprescribing trends in schizophrenia: An overview of inpatients in Belgium and in the Canadian province of Québec

“…The benefit–risk ratio for their use as hypno‐sedatives is thus uncertain, and their use is controversial 53,54 . Non‐pharmacological approaches should be prioritized over pharmacological treatment in situations of sleep disorders in schizophrenia 55 . Interestingly, patients on a larger number of hypno‐sedative drugs were less likely to have an antipsychotic deprescribed.…”

“…53,54 Nonpharmacological approaches should be prioritized over pharmacological treatment in situations of sleep disorders in schizophrenia. 55 Interestingly, patients on a larger number of hypno-sedative drugs were less likely to have an antipsychotic deprescribed. As hypno-sedative drugs are often prescribed in situations of agitation, aggressiveness and/or anxiety, prescribing of these drugs may indicate a more complicated clinical context.…”

Sleep health among people with severe mental ill health during the COVID-19 pandemic: Results from a linked UK population cohort study

“…Sleep health is a considerable problem among the people with severe mentally illness (SMI) population, where sleep disorders can have an impact on the onset, course, and treatment of mental ill health ( 5 ). This is due, in part, to sleep's regulatory role in various functions of the central nervous system, including mood and cognitive abilities ( 6 ). Notably, the rate of sleep disturbance (including insomnia, hypersomnia and delayed sleep phase) in schizophrenia and bipolar disorders has been estimated to be 78% and 69%, respectively, compared to 39% in healthy controls ( 5 ).…”