Sleep and psychosis: An integrative review of conceptual and neurophysiological associations.

Abstract

The association between sleep-related phenomena and psychosis has received increasing attention in recent years, as sleep disturbances (e.g., insomnia) have shown robust associations with psychotic symptoms. However, the role of other, more specific sleep processes in psychosis remains unclear, despite their potential importance as symptom-related correlates. Particularly, phenomena such as dreaming and hypnagogic experiences may share certain phenomenological features with hallucination-like experiences. Given that both sleep and psychosis involve complex neural systems, examining their neurobiological correlates may help clarify their potential relationships. Therefore, in this review, we summarize the literature on the potential connections between different sleep processes and psychosis from both conceptual and neurological perspectives. Current evidence suggests that anterior cingulate and frontal regions may be relevant to some sleep disturbances, dreaming-related processes, and psychosis-related abnormalities. However, given the broad and non-specific functions of these regions, such overlap should be interpreted cautiously. Overall, neurobiological evidence directly linking sleep-related processes to psychosis remains limited. We then conclude by highlighting current gaps in knowledge, particularly regarding the role of other sleep processes, and outlining directions for future research.