Disrupting sleep: the effects of sleep loss on psychotic experiences tested in an experimental study with mediation analysis
Open accessAbstract
Our view is that insomnia may be a causal factor in the occurrence of psychotic experiences such as paranoia and hallucinations. However, the causal relationship is not established. The aim of the study was to investigate the causal role of insomnia in psychotic experiences via a sleep restriction manipulation. The study was a within-subjects crossover design that included a planned mediation analysis. Sixty-eight nonclinical volunteers underwent a sleep loss condition (restricted to 4 h sleep for 3 nights) and a control condition (standard sleep) in randomized order in 2 consecutive weeks, with a weekend washout period. Psychotic experiences (paranoia, hallucinations, grandiosity, and cognitive disorganization) and candidate mediating variables (negative affect and related processes, working memory, decision making, and perceptual processing) were assessed before and after each condition. Actigraphy verified an average sleep duration of 5 h 15 min in the sleep loss condition, vs 6 h 58 min in the control condition. After the sleep loss condition, relative to the control condition, participants reported significant increases in paranoia, hallucinations, and cognitive disorganization, with no significant changes in grandiosity. The sleep loss condition was also associated with significant increases in negative affect, negative self and other cognitions, worry, and working memory impairment. Mediation analyses indicated that changes in psychotic experiences were mediated by changes in negative affect and related processes, but not memory impairment. The overall conclusion is that insomnia has a causal role in the occurrence of certain psychotic experiences, and that a key route is via negative affect.
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Disrupting sleep in healthy volunteers induces sub-clinical increases in hallucinatory experiences.
“Disrupting sleep in healthy volunteers induces sub-clinical increases in hallucinatory experiences. 2”
From Towards an Integrative Account of Potential Mechanisms Mediating the Path From Sleep Dysfunction to Hallucinations (2025) · cites this paper as [2]
Sleep disruption causally contributes to the occurrence of hallucinatory experiences.
“Over the past decade, manipulation studies have provided sound support for the causal role of sleep disruption in the occurrence of hallucinatory experiences.”
From Towards an Integrative Account of Potential Mechanisms Mediating the Path From Sleep Dysfunction to Hallucinations (2025) · cites this paper as [2]
Sleep loss impairs working memory.
“The role of working memory in the sleep-hallucinations relationship has been experimentally tested in general population groups, confirming that sleep loss impairs working memory; 2 , 19”
From Towards an Integrative Account of Potential Mechanisms Mediating the Path From Sleep Dysfunction to Hallucinations (2025) · cites this paper as [2]
Self-reported stress mediated 43.4% of the relationship between sleep loss and hallucinatory experiences.
“Self-reported stress mediated 43.4% of the relationship between sleep loss and hallucinatory experiences.”
From Towards an Integrative Account of Potential Mechanisms Mediating the Path From Sleep Dysfunction to Hallucinations (2025) · cites this paper as [2]
In Reeve et al.'s sleep restriction experiment with healthy volunteers, levels of hallucinatory experiences were significantly higher after restricted sleep (4 hours for 3 nights) compared with standard sleep.
“In Reeve et al.’s 2 sleep restriction experiment with healthy volunteers, levels of hallucinatory experiences (assessed across multiple sensory domains) were significantly higher after restricted (4 hours for 3 nights) vs standard sleep.”
From Towards an Integrative Account of Potential Mechanisms Mediating the Path From Sleep Dysfunction to Hallucinations (2025) · cites this paper as [2]
There was no support for a mediating role of working memory in the effect of sleep loss on the occurrence of hallucinatory experiences.
“however, there was no support for a mediating role of working memory in the effect of sleep loss on the occurrence of hallucinatory experiences. 2”
From Towards an Integrative Account of Potential Mechanisms Mediating the Path From Sleep Dysfunction to Hallucinations (2025) · cites this paper as [2]
The loss of functional connectivity of the prefrontal cortex following sleep disruption may be the neurological underpinning of negative affect that mediates the relationship between sleep loss and hallucinations.
“Hence, the loss of functional connectivity of the prefrontal cortex following sleep disruption may be the neurological underpinning of negative affect that was shown to mediate the relationship between sleep loss and hallucinations (as reported at the psychological level). 2”
From Towards an Integrative Account of Potential Mechanisms Mediating the Path From Sleep Dysfunction to Hallucinations (2025) · cites this paper as [2]
Two studies with non-clinical participants found that attentionally driven top-down processes may be resilient against the effects of sleep deprivation.
“Both studies found that these attentionally driven top-down processes may be resilient against the effects of sleep deprivation. 2 , 19”
From Towards an Integrative Account of Potential Mechanisms Mediating the Path From Sleep Dysfunction to Hallucinations (2025) · cites this paper as [2]
Symptoms of depression and anxiety were not significant mediators in a non-clinical experimental study.
“However, symptoms of depression and anxiety were not significant mediators in a non-clinical experimental study.”
From Towards an Integrative Account of Potential Mechanisms Mediating the Path From Sleep Dysfunction to Hallucinations (2025) · cites this paper as [2]
Manipulation studies in non-clinical populations have confirmed that sleep dysfunction is a causal factor in the occurrence of hallucinatory experiences.
“Manipulation studies in non-clinical populations have since confirmed that sleep dysfunction is indeed a causal factor in the occurrence of hallucinatory experiences.”
From Towards an Integrative Account of Potential Mechanisms Mediating the Path From Sleep Dysfunction to Hallucinations (2025) · cites this paper as [2]
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Self-citation
- Authors
- Reeve, S., Emsley, R., Sheaves, B., & Freeman, D.
- Affiliations
- University of Oxford (GB)
- Manchester Academic Health Science Centre (GB)
- Corresponding author
- Reeve, Sarah
- Venue
- Schizophrenia Bulletin
- Publisher
- Oxford University Press (OUP)
- Published
- 2017-08-04
- Volume
- 44
- Issue
- 3
- Pages
- 662-671
- ISSN
- 0586-7614 (ISSN-L)
- 1745-1701
- PMC
- PMC5890488
- OpenAlex
- W2744422692
- Cited by
- 131
- References
- 59
- Citations by year
- 2026: 6 · 2025: 12 · 2024: 12 · 2023: 15 · 2022: 15 · 2021: 17 · 2020: 20 · 2019: 18 · 2018: 13 · 2017: 3
- FWCI
- 19.11
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by
- Locations
- Schizophrenia Bulletin (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion, other-oa)
- UEA Digital Repository (University of East Anglia) (submittedVersion)
- Research Portal (King's College London) (submittedVersion, cc-by)
- Funders
- Wellcome Trust (098461, 098461/Z/12/Z)
- National Institute for Health and Care Research (RP-2014-05-003, 2014-05-003)
- University of Oxford
- Medical Research Council (098461/Z/12/Z)
- Balliol College, University of Oxford
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
- Keywords
- sleep deprivation, insomnia
- MeSH terms
- Adult, Affect, Female, Hallucinations, Humans, Sleep Initiation and Maintenance Disorders, Male, Paranoid Disorders, Psychotic Disorders, Schizophrenia, Sleep Deprivation, Cross-Over Studies, Young Adult, Cognitive Dysfunction
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