title: Treating Sleep Problems in Patients with Schizophrenia.
abstract: BACKGROUND
  Sleep disturbance is increasingly recognized as a major problem for patients with schizophrenia but it is rarely the direct focus of treatment. The main recommended treatment for insomnia is cognitive behavioural therapy, which we have been evaluating for patients with current delusions and hallucinations in the context of non-affective psychosis.
  
  
  OBJECTIVE
  In this article we describe the lessons we have learned about clinical presentations of sleep problems in schizophrenia and the adaptations to intervention that we recommend for patients with current delusions and hallucinations.
  
  
  METHODS
  Twelve factors that may particularly contribute to sleep problems in schizophrenia are identified. These include delusions and hallucinations interfering with sleep, attempts to use sleep as an escape from voices, circadian rhythm disruption, insufficient daytime activity, and fear of the bed, based upon past adverse experiences. Specific adaptations for psychological treatment related to each factor are described.
  
  
  CONCLUSIONS
  Our experience is that patients want help to improve their sleep; sleep problems in schizophrenia should be treated with evidence-based interventions, and that the interventions may have the added benefit of lessening the psychotic experiences. A treatment technique hierarchy is proposed for ease of translation to clinical practice.
authors.affiliation: University of Oxford,Warneford Hospital,UK.
authors.forename: Felicity
authors.initials: F
authors.lastname: Waite
authors.affiliation: East London NHS Foundation Trust,UK.
authors.forename: Elissa
authors.initials: E
authors.lastname: Myers
authors.affiliation: University of California,Berkeley,USA.
authors.forename: Allison G
authors.initials: AG
authors.lastname: Harvey
authors.affiliation: Sleep and Circadian Neuroscience Institute,University of Oxford,UK.
authors.forename: Colin A
authors.initials: CA
authors.lastname: Espie
authors.affiliation: Sussex Partnership NHS Foundation Trust, andUniversity of Oxford,UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Startup
authors.affiliation: University of Oxford,Warneford Hospital,UK.
authors.forename: Bryony
authors.initials: B
authors.lastname: Sheaves
authors.affiliation: University of Oxford,Warneford Hospital,UK.
authors.forename: Daniel
authors.initials: D
authors.lastname: Freeman
mesh_terms: D015928:Cognitive Behavioral Therapy / Q000379:methods; D003702:Delusions / Q000523:psychology; D005260:Female; D006212:Hallucinations / Q000523:psychology; D006801:Humans; D008297:Male; D012559:Schizophrenia / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D012890:Sleep; D012893:Sleep Wake Disorders / Q000209:etiology / Q000517:prevention & control / Q000523:psychology / Q000628:therapy*
keywords: Psychosis; cognitive behavioural therapy; delusions; hallucinations; insomnia