The role of sleep dysfunction in the occurrence of delusions and hallucinations: A systematic review

Background Sleep dysfunction is extremely common in patients with schizophrenia. Recent research indicates that sleep dysfunction may contribute to psychotic experiences such as delusions and hallucinations. Objectives The review aims to evaluate the evidence for a relationship between sleep dysfunction and individual psychotic experiences, make links between the theoretical understanding of each, and highlight areas for future research. Method A systematic search was conducted to identify studies investigating sleep and psychotic experiences across clinical and non-clinical populations. Results 66 papers were identified. This literature robustly supports the co-occurrence of sleep dysfunction and psychotic experiences, particularly insomnia with paranoia. Sleep dysfunction predicting subsequent psychotic experiences receives support from epidemiological surveys, research on the transition to psychosis, and relapse studies. There is also evidence that reducing sleep elicits psychotic experiences in non-clinical individuals, and that improving sleep in individuals with psychosis may lessen psychotic experiences. Anxiety and depression consistently arise as (partial) mediators of the sleep and psychosis relationship. Conclusion Studies are needed that: determine the types of sleep dysfunction linked to individual psychotic experiences; establish a causal connection between sleep and psychotic experiences; and assess treatments for sleep dysfunction in patients with non-affective psychotic disorders such as schizophrenia.
Highlights • The review assesses the link between sleep dysfunction and psychotic experiences, particularly delusions and hallucinations. • A systematic review is undertaken of 66 papers that assessed sleep and individual psychotic experiences. • Sleep dysfunction and psychosis clearly co-occur and sleep dysfunction may predict later psychotic experiences. • The effect of improving sleep on psychotic experiences remains to be tested in an adequately powered trial. • The mechanisms linking sleep dysfunction to psychotic experiences require testing.