The nature, consequences, mechanisms, and management of sleep disturbances in individuals at-risk for psychosis

Abstract

There is strong evidence that sleep disturbances are commonly experienced by people with psychosis. Evidence has also shown that sleep disturbances are present since the very early stages of the disease, even during the pre-diagnostic phase. More recently, research involving young individuals at ultra-high risk (UHR) for psychosis documented frequent occurrence of sleep disturbances in this group. The very early onset of sleep disturbances in the course of psychosis has drawn attention to the possible links between sleep parameters and the risk of psychosis. To date, the nature of sleep disturbances characterizing the UHR stage remains unclear, with available studies having yielded mixed findings. In this regard, we performed this review to update the body of literature on the nature of sleep disturbances, their underlying mechanisms, their clinical and functional consequences, the prevention and intervention strategies in the at-risk for psychosis population. Our findings provided further support to the presence of disturbed sleep in UHR individuals as evidenced by subjective and objective sleep measures such as polysomnography, sleep electroencephalograms, and actigraphy. Reviewing the possible mechanisms underlying the relationship between sleep and psychosis emphasized its complex and multifactorial nature which is yet to be determined and understood. Further research is warranted to determine which facets of sleep disturbances are most detrimental to this specific population, and to what extent they can be causal factors or markers of psychosis.

Mediation effect of insomnia symptoms between positive psychotic like experiences and suicidal ideation among Lebanese young adults

“…Insomnia represents one of the most common sleeping disorders worldwide [ 45 ], with a prevalence in the general population of 10–25% [ 46 – 48 ].Based on literature data, we propose the hypothesis that insomnia may represent a mediator underlying the relationship between PLEs and SI. Insomnia is associated with both PLEs [ 49 – 51 ] and SIB [ 52 , 53 ]. As for SIB, it is now well-established that insomnia is linked to SI [ 54 – 56 ], suicide attempts [ 57 , 58 ], and even suicide deaths [ 59 , 60 ] in adolescents and young adults.…”

Validation of the Arabic language version of the shortest form of the Community Assessment of Psychic Experiences (CAPE-9) in a young adult population-based sample

“…While self-report questionnaires measuring PEs in community individuals have recently been made available in the Arabic language [29,50,51], their length may be a barrier to PEs assessment in settings in lower-to-middle income Arab countries, that often operate under severe resources constraints. As such, using short self-report tools could encourage the introduction of wide routine screening for PEs in primary care, educational, and community settings in Arab countries, where the duration of untreated illness remains incredibly high (e.g., up to around 6 years in patients with rst episode psychosis in Tunisia [52]), and where early intervention in psychosis paradigm is still in its infancy or not yet developed [53].…”

The relationship between internet gaming disorder and psychotic experiences: cyberbullying and insomnia severity as mediators

“…In addition, multiple brain functioning modifications due to excessive gaming may trigger an increased dopamine release [42,43], and other neurobiological alterations (such as decreased activation in areas involved in inhibitory control, impaired executive function, cognitive control, and motivation [44][45][46]); which could, in turn, increase psychosis proneness in genetically predisposed individuals. In addition, numerous emotional and behavioral disturbances related to IGD may possibly increase vulnerability to psychosis, such as sleep deprivation [47,48], depression, anxiety, stress, and bullying [4,49]. To summarize, little is known about the underlying mechanisms that may moderate or mediate the relationship between cyberbullying and psychosis.…”

“…On the other hand, insomnia has been demonstrated to increase the risk for developing mental health problems, including psychosis [59]. Insomnia is highly prevalent in individuals with psychotic disorders in different clinical stages of the disease [48,60,61]. Insomnia has been suggested to contribute to persistent or exacerbated psychotic symptoms over time [62][63][64][65], and even lead to emergence of de novo psychotic experiences in healthy individuals [66].…”

“…For instance, a large cross-country study involving 261,547 participants showed that having sleep problems led to increased odds for at least one psychotic symptom, even after adjusting for depression and anxiety [67]. Overall, sleep problems have been identified as a significant vulnerability factor in the development and persistence of young people's psychotic symptoms and experiences [48,68,69].…”