The dynamic relationship between sleep and psychotic experiences across the early stages of the psychosis continuum

BACKGROUND: Psychotic disorders develop gradually along a continuum of severity. Understanding factors associated with psychosis development, such as sleep, could aid in identification of individuals at elevated risk. This study aimed to assess (1) the dynamic relationship between psychotic experiences (PEs) and sleep quality and quantity, and (2) whether this relationship differed between different clinical stages along the psychosis continuum.

METHODS: We used daily diary data (90 days) of individuals ( N = 96) at early stages (i.e. before a first diagnosis of psychosis) along the psychosis continuum. Multilevel models were constructed with sleep quality and sleep quantity as predictors of PEs and vice versa. Post-hoc, we constructed a multilevel model with both sleep quality and quantity as predictors of PEs. In addition, we tested whether associations differed between clinical stages.

RESULTS: Within persons, poorer sleep predicted next day PEs ( B = -0.02, p = 0.01), but not vice versa. Between persons, shorter sleep over the 90-day period predicted more PEs ( B = -0.04, p = 0.002). Experiencing more PEs over 90-days predicted poorer ( B = -0.02, p = 0.02) and shorter ( B = -1.06, p = 0.008) sleep. We did not find any significant moderation effects for clinical stage.

CONCLUSIONS: We found a bidirectional relationship between sleep and PEs with daily fluctuations in sleep predicting next day PEs and general patterns of more PEs predicting poorer and shorter sleep. Our results highlight the importance of assessing sleep as a risk marker in the early clinical stages for psychosis.