Sleep Disturbances in Patients with Persistent Delusions: Prevalence, Clinical Associations, and Therapeutic Strategies

Abstract

Sleep disturbances accompany almost all mental illnesses, either because sound sleep and mental well-being share similar requisites, or because mental problems lead to sleep problems, or vice versa. The aim of this narrative review was to examine sleep in patients with delusions, particularly in those diagnosed with delusional disorder. We did this in sequence, first for psychiatric illness in general, then for psychotic illnesses where delusions are prevalent symptoms, and then for delusional disorder. The review also looked at the effect on sleep parameters of individual symptoms commonly seen in delusional disorder (paranoia, cognitive distortions, suicidal thoughts) and searched the evidence base for indications of antipsychotic drug effects on sleep. It subsequently evaluated the influence of sleep therapies on psychotic symptoms, particularly delusions. The review’s findings are clinically important. Delusional symptoms and sleep quality influence one another reciprocally. Effective treatment of sleep problems is of potential benefit to patients with persistent delusions, but may be difficult to implement in the absence of an established therapeutic relationship and an appropriate pharmacologic regimen. As one symptom can aggravate another, comorbidities in patients with serious mental illness all need to be treated, a task that requires close liaison among medical specialties.

Collaboration between Psychiatrists and Other Allied Medical Specialists for the Treatment of Delusional Disorders

“…Sleep disorders have been frequently reported in patients with psychosis, including DD [ 79 , 80 ]. Distressing delusional beliefs often haunt patients at night, either preventing sleep or populating nightmares.…”

“…Insomnia is the most frequent sleep disorder found in patients with DD [ 79 ], and it is associated with an aggravation of paranoid and cognitive symptoms, as well as suicidal ideation. Insomnia and other sleep problems are difficult to address and often require the expertise of sleep specialists.…”

“…Basu and collaborators [ 82 ] reported the case of a 38-year-old woman suffering from DD and RLS who had been treated with olanzapine and whose RLS improved after treatment with risperidone. RLS is significantly more common in women than in men [ 83 ], but no consistent difference in sex prevalence has been found in DD [ 79 ].…”

Exercise improves sleep quality in older adults: a protocol for a systematic review and meta-analysis

“… 5 6 Studies have shown that sleep disturbance is a potential risk factor for major health problems. 7 8 Sleep disturbances may be related to several mental and cognitive disorders including persistent delusions, 9 depression, anxiety and dementia 10 and often coexist with major medical conditions, such as hypertension, 11 12 diabetes 13 and cancer, 14 which may increase pain and even increase the risk of mortality. 15 16 Therefore, sleep disturbance is an important therapeutic target for healthcare.…”

The Bidirectional Associations Between Insomnia and Psychotic-Like Experiences Before and During the COVID-19 Pandemic

“…A great volume of literature has robustly supported the co-occurrence of insomnia and psychosis, including in clinical populations, those at ultra-high-risk for psychosis, and the general population. [1][2][3][4] While research in clinical populations (patients with schizophrenia or other psychotic disorders) aims to explore the interaction between insomnia and psychosis in predicting clinical symptomatology, functions and treatment, 5,6 studies in non-clinical populations are essential to understanding their potential relationship in the absence of antipsychotic medication and institutionalisation effects, 7 which also provides information on prevention at an early stage.…”