Understanding excessive sleep in people with psychotic disorders

Background: There has been increasing attention to sleep disturbances such as insomnia in psychosis, due to its impact on symptoms, well-being, and recovery. However, excessive sleep and extended sleep duration are common in psychosis (partly linked to sedating antipsychotic medication) and have been relatively neglected, despite plausible interactions with symptoms, functioning, and broader well-being. Aim: This study aimed to explore the experience of extended sleep duration and excessive sleepiness, or their combination (hypersomnia) in people with psychotic disorders through a qualitative interview around the experience, impacts, contributors, and role of treatment. Method: Ten patients experiencing excessive sleep (defined as excessive daytime sleepiness >3 days a week; extended sleep duration of > 11 h in 24 h or >9 h at night; or a combination of these) alongside a diagnosed psychotic disorder were recruited. They met with the researcher online to participate in a semi-structured interview, which was analysed using thematic analysis. Results: Five major themes were developed: (1) The Exhausting Everyday, (2) Medication is the story? (3) Indescribable Tiredness, (4) Overruled by Sleep and (5) An Unfair Fight. Excessive sleep impacts multiple domains of individual well-being and recovery – for example, limiting patients in everyday tasks and socializing. Cycles of emotional avoidance and inactivity were identified as potential maintainers or exacerbators of excessive sleep, in addition to medication side effects. Patients reported difficulty conveying the impact of their sleepiness symptoms to clinicians or others. Conclusion: The results support that excessive sleep requires further attention as a problematic and impactful sleep presentation in this group. Further research is needed to improve recognition and assessment of problematic excessive sleep, and how existing practices or novel treatments may be applied to reduce its impact on recovery.