Sleep, Paranoia, And Psychosis: How Poor Sleep Affects Mental Health

Not getting enough sleep can have significant impacts on your mental well-being. Occasional difficulty sleeping can be normal, but people with sleep disorders who experience sleep deprivation can face many challenges. Below, learn how sleep affects your mental health, how a lack of sleep can lead to paranoia and other symptoms, and how you can get help.

The importance of sleep for mental health

Research has found an association between mental health and sleep. Although many studies focus on links between sleep and mental disorders such as anxiety and depression, evidence also shows that sleeping problems can be associated with other mental health conditions. 

For example, research has found that poor sleep may be related to psychosis. Psychosis refers to a collection of psychiatric symptoms that result in a loss of contact with reality. Potential symptoms of psychosis may include: 

• Hallucinations, which involve sensing things that are not really there, such as auditory or visual hallucinations 
• Delusions, which are fixed, false beliefs, such as that others are trying to hurt them
• Disorganized thinking and speaking

Experiencing symptoms of psychosis, which can include paranoia, is sometimes referred to as having a “psychotic episode” or “psychotic break.” It is important to note that there can be many different causes of psychosis. In some cases, psychosis can be caused by a specific mental illness with psychotic features, such as severe depression, bipolar disorder, or schizophrenia spectrum disorders. However, psychotic symptoms can also arise due to causes such as misuse of alcohol or drugs, certain prescription medications, and sleep deprivation.

The association between sleep problems and psychosis

An extensive body of research has explored the association between sleep problems and increased risk of psychosis-like symptoms, including paranoia. 

For instance, one study assessed the prevalence of sleep problems and their association with psychotic symptoms in the general population, offering a global perspective using a community-based cross-sectional study. The researchers found that sleep problems were associated with “significantly higher odds for at least one psychotic symptom in the vast majority of countries.”A more recent study looked at the effects of disturbed sleep and psychotic experiences in people who are at risk for paranoia and found that sleep disturbances may not only occur because of psychotic symptoms but can also affect how these symptoms are expressed in daily life. Psychotic symptoms like paranoia can contribute to sleep disturbances, and sleep disturbances can contribute to symptoms of paranoia. 

In addition, recent research has found sleep disturbances to be associated with more severe positive symptoms in psychotic disorders as well as in those at ultra-high-risk for developing psychosis. In the context of psychotic disorders, positive symptoms refer to changes in behaviors or thoughts, such as hallucinations or delusions. 

In terms of paranoia, specifically, a recent systematic review and meta-analysis found a small-to-medium significant association between sleep and paranoia, with this relationship typically mediated by negative affect. This meta-analysis included a wide mix of studies, including some that used a self-report measure of disrupted sleep and some that used more robust measures for sleep dysfunction, such as the Insomnia Severity Index. 

Additional research has explored the factors that may mediate the relationship between sleep quality and paranoia. In a recent study, researchers investigated the emotional factors that may mediate the relationship between sleep quality and paranoia by recruiting healthy volunteers without a mental health diagnosis and having them complete a series of measures assessing paranoia, negative emotions, alexithymia (the inability to recognize and describe emotions), and perceptual anomalies. The researchers then used mediation analysis to identify factors that explain the variance between the independent variable of sleep and the dependent variable of paranoia. Their analyses found that alexithymia predicted paranoia, and they found some evidence that alexithymia may mediate the relationship between sleep quality and paranoia. It’s worth noting that this study focused on healthy humans, so further research investigating this link in a clinical group (i.e., a group of individuals with clinical symptoms of psychosis) may be important. 

A recent study published in Schizophrenia Bulletin Open also found that patients with psychotic disorders have more sleep problems, including long sleep duration and insomnia symptoms, compared to the general population. To conduct the study, researchers invited patients with schizophrenia spectrum disorders, bipolar disorder, and psychotic depression to participate through various healthcare settings throughout Finland, and all participants gave written informed consent before the study protocol began. 

Understanding how sleep affects the brain: Non-REM and REM sleep

Understanding more about sleep, specifically rapid-eye movement (REM) and non-REM sleep, can help individuals understand how sleep, paranoia, and sleep disorders affect the brain. During non-REM sleep, people move between light sleep and deep sleep. Many processes in the body slow down, like brain activity, breathing rate, and eye movements. Also during non-REM sleep, the body repairs tissues, strengthens its immune response, and builds muscle and bone. Newer research also shows that non-REM sleep is important for rest and restoration, as well as learning and memory.

REM sleep is associated with dreaming. During this sleep period, brain waves are similar to wakefulness, but the skeletal muscles are essentially paralyzed, and breathing becomes slightly erratic and irregular. The eyes also move behind closed lids, which is how this type of sleep gets its name. REM sleep is also thought to play a significant role in learning and memory.

Sleep disorders

Multiple types of sleep disorders can affect sleep quality, including the following. 

Sleep paralysis

People with sleep paralysis feel that they cannot move their bodies right before falling asleep or when waking up at night. This experience occurs when the body is between different stages of sleep. Some people with this condition experience hallucinations. Hallucinations caused by sleep paralysis fall into several categories, including the sense that there is an intruder in the room or pressure being applied to the chest. To get sleep paralysis diagnosed, a person may undergo a sleep study.

Those who experience multiple sleep paralysis episodes in a six-month period may be diagnosed with recurrent isolated sleep paralysis. Recurrent sleep paralysis can lead to significant anxiety surrounding sleep. Sleep paralysis is only temporary, lasting a few seconds or minutes, but this experience can be scary, affecting sleep quality and a person’s ability to function the next day.

Insomnia

Insomnia is the most common sleep disorder. As many as 10% of adults have a severe form of this condition. People with insomnia can have difficulty falling or staying asleep. Some people may experience short-term insomnia that lasts for a few days, but long-term, chronic insomnia can last for three months or longer and cause many challenges, including mental health conditions and a higher risk of long-term chronic health problems.

Hypersomnia

Hypersomnia occurs when people experience extreme sleepiness during the day, even though they have gotten enough sleep the night before. People with hypersomnia may fall asleep during the day and struggle to function in their daily lives. 

Sleep apnea

There are two types of sleep apnea: central sleep apnea and obstructive sleep apnea. Although the causes are different, both conditions cause a person to periodically stop breathing while sleeping. This lack of breathing can cause a lack of oxygen, interfering with sleep quality.

Beyond these disorders, there are various other conditions that can impact sleep patterns, including restless leg syndrome, nightmare disorders, and mood disorders such as depression, which can frequently occur with comorbid insomnia.

Symptoms of sleep disorders

Symptoms of sleep disorders can vary depending on the type, but common symptoms relate to not getting enough rest and may include the following: 

• Taking a long time to fall asleep at night
• Waking up several times throughout the night
• Having difficulty falling back asleep after waking up during the night
• Desiring naps during the day
• Feeling tired throughout the day

The impact of sleep deprivation

Getting adequate sleep is important for both mental and physical health. Research shows that sleep deprivation can have significant effects on a person’s mental health. One review found that sleep deprivation had many effects on mental health, including persecutory delusions or paranoia, and that “psychotic symptoms develop with increasing time awake.” Sleep deprivation can also impact physical health, causing challenges like hypertension and a risk of heart disease. 

Recognizing early warning signs of psychosis

Before psychosis develops, a person may exhibit changes in behavior that can be early warning signs of psychosis. These may include:

• Difficulty thinking clearly
• Withdrawing socially 
• Uneasiness with others 
• Sudden drop in school or work performance 
• Disrupted sleep 

Recognizing these early signs in the prodromal phase of psychosis, which refers to the period of subclinical symptoms before the full onset of psychosis, can be very important, as early intervention may help prevent symptoms from worsening. Early psychosis intervention may help reduce symptom severity and support better future outcomes.

Treatment options for sleep disorders

Sleep disorder treatments can vary depending on the cause, type, and severity. Possible treatment options can include the following. 

Light therapy for sleep disorders and mental health symptoms 

Light therapy involves sitting in front of a light that produces rays similar to sunlight. Light therapy can help adjust the levels of natural melatonin in the body to encourage a more regular sleep cycle. Using this option about 30 to 60 minutes after waking up may regulate your body’s circadian rhythm. 

Medication for falling asleep

A doctor may prescribe medication to someone with a sleep disorder to help them sleep or make them more alert during the day. Medication is often a temporary option. If you are interested in exploring medication options to help improve sleep, you may consider contacting sleep medicine specialists or treatment centers for professional insight and guidance.

The BetterHelp platform is not intended to provide any information regarding which drugs, medications, or medical treatments may be appropriate for you. The content provides generalized information that is not specific to one individual. You should not take any action without consulting a qualified medical professional.

Orofacial myofunctional therapy

Orofacial myofunctional therapy may be an effective treatment for some people with sleep apnea, as it can help with tongue positioning and strengthen the muscles that control the upper airway and lips. This option should be discussed with your primary care physician or a sleep specialist, as it is a medical intervention. 

Cognitive-behavioral therapy for insomnia and REM sleep issues 

Cognitive-behavioral therapy for insomnia (CBT-I) is a type of CBT that aims to help people learn how to fall asleep faster and stay asleep longer. CBT-I can be an effective treatment for people with chronic insomnia. The therapy may also be effective in combination with other approaches, like medication. 

Sleep hygiene approaches

Adopting healthy sleep hygiene practices may also help you achieve more restful sleep. Common pieces of sleep hygiene advice include consuming nighttime meals at least three hours before bedtime, avoiding caffeine and alcohol consumption in the evenings, and adopting a consistent sleep schedule, where you are maintaining sleep and wake times even on the weekends. If you experience high levels of stress before bed, utilizing coping strategies such as meditation, mindfulness, and deep breathing exercises may help you reduce stress and find calm.

Tips for falling asleep

Getting support from a mental health professional

If you are having trouble sleeping or experiencing symptoms of sleep deprivation like paranoia, therapy may help you overcome the challenges affecting your sleep. A therapist can help you identify any stressors or underlying issues that may be affecting your sleep or guide you through cognitive behavioral therapy (CBT) techniques you can use at home. However, if you’re experiencing sleep disruptions, driving to an appointment or meeting with someone face-to-face may dissuade you from seeking help. Online therapy can be a convenient, flexible alternative to in-person treatment. 

With an online therapy platform like BetterHelp, you can work with a licensed mental health professional from the comfort of your home at a time that works for your schedule. In addition, you can take advantage of support resources like support groups and worksheets. Research shows that online therapy can be an effective treatment for insomnia. A recent randomized controlled trial found that online delivery of CBT for insomnia was just as effective as face-to-face CBT for insomnia severity, resulting in “similar improvements on other sleep and daytime functioning outcomes.”