title: Sleep in Schizophrenia: Exploring Subjective Experiences of Sleep Problems, and Implications for Treatment.
abstract: Sleep dysfunction is a pervasive issue in schizophrenia and psychosis. Current knowledge is drawn almost exclusively from studies using quantitative research methodologies that include measures and tools developed in healthy population groups. Qualitative studies investigating the first-person perspectives of sleep problems are therefore important for designing better assessment and treatment tools to meet consumer needs. Focus groups were conducted to elicit detailed information regarding the personal experience of sleep problems, their antecedents and impact, in 14 individuals with schizophrenia-spectrum disorder who experienced insomnia during their illness. Thematic analysis was applied to examine the data and draw treatment implications for sleep management. Insomnia was ubiquitous and frequently co-occurred with other sleep difficulties (nightmares, sleep walking, acting out dreams, etc.) in this group. Discussions revealed themes common across insomnia populations (role of negative mood states and cognitive intrusions) and also new themes on factors contributing to sleep problems in schizophrenia: (1) beliefs that sleep problems cannot be changed; (2) trauma and adversity; (3) lifestyle choices and lack of motivation; and (4) medication side effects. Sleep problems also had profound impact on daytime dysfunctions and disability. The findings point to novel issues that may benefit from consideration in the treatment of sleep problems in schizophrenia. Unhelpful cognitions and behaviours about sleep can be addressed with psychological interventions, activity scheduling and motivational interviewing techniques. Seeking a first-person perspective is vital for identifying issues that will impact on treatment success and recovery.
authors.affiliation: Clinical Research Centre, Graylands Hospital, North Metropolitan Area Health Service Mental Health (NMHS MH), Private Mailbag No 1, Claremont, Perth, WA, 6910, Australia. vivian.chiu@research.uwa.edu.au.|School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, WA, Australia. vivian.chiu@research.uwa.edu.au.
authors.forename: Vivian W
authors.identifier: 0000-0002-0462-8028
authors.initials: VW
authors.lastname: Chiu
authors.affiliation: The Marian Centre, Subiaco, Perth, WA, Australia.
authors.forename: Melissa
authors.initials: M
authors.lastname: Ree
authors.affiliation: School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, WA, Australia.
authors.forename: Aleksandar
authors.initials: A
authors.lastname: Janca
authors.affiliation: Clinical Research Centre, Graylands Hospital, North Metropolitan Area Health Service Mental Health (NMHS MH), Private Mailbag No 1, Claremont, Perth, WA, 6910, Australia.|School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, WA, Australia.
authors.forename: Flavie
authors.initials: F
authors.lastname: Waters
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects; D001294:Attitude to Health; D003071:Cognition; D015928:Cognitive Behavioral Therapy; D015897:Comorbidity; D005260:Female; D017144:Focus Groups; D006801:Humans; D008019:Life Style; D008297:Male; D009042:Motivation; D020447:Parasomnias / Q000139:chemically induced / Q000523:psychology* / Q000628:therapy; D011618:Psychotic Disorders / Q000523:psychology / Q000628:therapy; D036301:Qualitative Research; D012559:Schizophrenia / Q000628:therapy*; D012565:Schizophrenic Psychology; D007319:Sleep Initiation and Maintenance Disorders / Q000139:chemically induced / Q000523:psychology* / Q000628:therapy; D012893:Sleep Wake Disorders / Q000139:chemically induced / Q000523:psychology / Q000628:therapy
chemical_list: D014150:Antipsychotic Agents
keywords: Cognitive-behavioural therapy (CBT); Consumer-perspective; Insomnia; Schizophrenia; Sleep problems; Thematic analysis