Sleep disturbances are common during the first year of psychosis and bipolar disorder, with subjective sleep issues closely linked to depression, prodromal psychotic symptoms and suicidal thoughts, while actigraphy shows disorder-specific differences.
The majority of patients in the early stages of psychosis or bipolar disorder reported poor sleep quality, depressive symptoms, and suicidal thoughts.
Poor subjective sleep quality was strongly correlated with depressive symptoms and prodromal psychotic features.
Actigraphy revealed reduced total sleep time in patients compared to healthy controls.
Actigraphy demonstrated disorder-specific differences in sleep latency, with bipolar disorder patients showing longer sleep latency than psychosis patients.
Both subjective and objective sleep assessments were used simultaneously in a cross-sectional design during the early illness phase.
Routine evaluation of both subjective and objective sleep may serve as early indicators of vulnerability and guide intervention strategies in severe mental illness.
This research suggests that sleep problems are extremely common in people who have recently developed psychosis or bipolar disorder, affecting the majority of patients within their first year of illness. Using both questionnaires and wrist-worn activity monitors (actigraphy) worn for seven nights, researchers found that patients slept about an hour less per night than healthy individuals, and that poor sleep was closely linked to depression and early warning signs of psychosis. Notably, two-thirds of patients reported suicidal thoughts, and these were connected to poor sleep quality. The study also found that different diagnoses showed different sleep patterns: people with bipolar disorder took about twice as long to fall asleep (around 161 minutes) compared to those with psychosis (around 80 minutes). This suggests that sleep problems are not identical across these conditions and may reflect underlying differences in brain functioning. The combination of subjective (self-reported) and objective (actigraphy-measured) sleep assessment provided a more complete picture than either method alone. This research suggests that routinely checking sleep in people newly diagnosed with serious mental illness could help identify who is most at risk for worsening symptoms or suicidal thoughts. Because the study was small (20 patients total) and cross-sectional, larger studies are needed to confirm these findings, but the results support the idea that sleep monitoring could be a practical, low-cost tool for early intervention in mental health care.
Baldini V, Iannucci F, Venezia N, Pasquino F, Gnazzo M, de Ronchi D, et al.. (2026). Sleep in Early Psychosis and Bipolar Disorder: Preliminary Results on Actigraphic and Self-Reported Markers of Vulnerability.. Early intervention in psychiatry. https://doi.org/10.1111/eip.70160