Cognitive and Behavioral Factors Associated With Insomnia in Inpatients With Schizophrenia and Related Psychoses

Abstract

This study examines cognitive and behavioral factors linked to insomnia in individuals with schizophrenia and other psychotic disorders (with and without insomnia) and healthy controls (with and without insomnia). Fifty-five psychiatric inpatients and 66 healthy controls (n = 25 with insomnia in both groups) completed the Insomnia Severity Index, Thought Control Questionnaire for Insomnia-Revised, Dysfunctional Beliefs and Attitudes about Sleep scale, Sleep Hygiene Knowledge scale, and Beliefs about Causes of Sleep Problems questionnaires. Both insomnia groups demonstrated night-time rumination, aggressive suppression as a thought control strategy, and exaggerated views regarding the health consequences of poor sleep. In addition, the psychiatric group with insomnia frequently reported the causes of insomnia to be related to their illness (rather than to their lifestyle factors) and had an incomplete understanding of good sleep habits. Psychological interventions should be more commonly pursued as a first line of treatment for insomnia in schizophrenia and psychosis, and these should be adapted to address the unique knowledge gaps and cognitive style of patients.

Perspectives on Sleep, Sleep Problems, and Their Treatment, in People with Serious Mental Illnesses: A Systematic Review

“…Two quantitative studies showed similar findings regarding the perceived impact of mental health and of worry. Chiu et al [ 53 ], found amongst inpatients with psychotic illnesses the most endorsed causes of sleep problems included ‘your illness’ (76%), worries and negative thoughts (72%), stress (72%), and medications (64%). Compared to community controls with insomnia participants with psychosis were ten times more likely to endorse certain biological causes (medication, illness, ‘problems with the brain’), and they were also less likely to see some lifestyle factors as affecting sleep, especially irregular sleep/wake schedule (p = 0.003).…”

“…Caution should be applied in interpreting Sobieraj et al’s [ 42 ] results as it appears participants were forced to choose a single cause, whilst when given the option participants selected multiple contributing factors [ 53 ]. Collier et al’s qualitative study [ 41 ] also confirms that participants with mixed SMI perceived insomnia as interlinked with multiple other factors.…”

Preferences for different insomnia treatment options in people with schizophrenia and related psychoses: a qualitative study

“…Therefore, studies which seek to understand the perspective and personal experiences of people with lived experience, in their own words, are better able to identify gaps in knowledge and define clinical targets. For instance, our recent work with groups of people with psychosis suggests that night-time rumination, worries, hallucinated voices, external locus of control ( Chiu et al, 2015a ), as well as frequent nightmares, night terrors ( Chiu et al, 2015b ) are key experiences which prevent good sleep from happening. In other words, while better sleep is an objective, targets for treatment should first address factors that get in the way of achieving this objective.…”

“…Negative thoughts at bedtime were commonly brought up as needing coping strategies. Worries and intrusive and ruminative thoughts are a common feature of psychotic disorders ( Morrison and Baker, 2000 ) and are particularly elevated in those with symptoms of insomnia ( Chiu et al, 2015a ). It is thus particularly important that these individuals find strategies that address these psychological issues.…”

“…Individuals with psychosis often have a sedentary lifestyle and a lack of daytime structure ( Hofstetter et al, 2003 ), suggesting that behavioral approaches promoting good sleep, regular sleep routine, and contributors to daytime sleepiness can therefore increase awareness about the need for behavioral changes. We recently demonstrated evidence of knowledge gaps about sleep hygiene in inpatients with psychosis, specifically regarding the importance of regular sleep–wake timings and the wake-promoting effects of nicotine ( Chiu et al, 2015a , in 55 inpatients with psychotic disorders). In addition, these psychiatric individuals demonstrated levels of thought control strategies (rumination and aggressive suppression) and dysfunctional beliefs about sleep (preoccupation about the consequence of poor sleep) that were similar to non-psychiatric controls insomnia, suggesting that interventions combining cognitive and behavioral strategies (such as CBT-I) are likely to be most efficacious for treating insomnia in psychosis.…”