An algorithmic approach to the management of insomnia in patients with schizophrenia

Abstract

Insomnia is an important problem in patients with schizophrenia and is an emerging area of interest for researchers. We propose a treatment algorithm that synthesizes the various psychological and pharmacological interventions for insomnia in this population.

Our selective literature review incorporates English language articles from 4 medicine databases through May 2016. Selected articles discuss risk factors and treatments for insomnia, as well as comorbid sleep disorders that coexist in this population.

Various lifestyle factors and comorbid sleep disorders may predispose patients with schizophrenia to insomnia. Cognitive-behavioral therapy for insomnia shows promising results in treating insomnia in patients with schizophrenia spectrum disorders. Additionally, studies of eszopiclone and melatonin have yielded significant results in short-term trials that evaluated both subjective and objective insomnia symptoms.

We have summarized the relevant literature regarding the treatment of insomnia in this patient population and propose an algorithm comprising 6 sequential steps, beginning with the assessment of sleep complaints and medication adherence. This is followed by a targeted treatment of any co-occurring sleep disorders, and ends with psychoeducation, cognitive-behavioral therapy, and pharmacotherapy. This algorithm provides a detailed guideline to improve the assessment and therapeutic intervention for managing insomnia among patients with schizophrenia.