Nightmares in patients with psychosis: the relation with sleep, psychotic, affective, and cognitive symptoms
Open accessAbstract
OBJECTIVE: To examine the prevalence of nightmares in people with psychosis and to describe the link between nightmares and sleep quality, psychotic, affective, and cognitive symptoms. METHODS: Forty participants with psychotic symptoms completed an assessment of nightmares, sleep quality, positive symptoms of psychosis, affect, posttraumatic stress, social functioning, and working memory. RESULTS: Among the patients, 55% reported weekly distressing nightmares. Experience of more frequent nightmares was related to poorer sleep quality and sleep efficiency. More distressing nightmares were positively associated with greater delusional severity, depression, anxiety, stress, and difficulties with working memory. CONCLUSIONS: Nightmares might be common in those with psychosis and are associated with increased day- and nighttime impairment. Future research should investigate treatments for nightmares, for people presenting with psychotic symptoms.
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The level of distress associated with nightmares correlated with severity of delusions, remaining significant after controlling for nightmare frequency.
“The authors found that the level of distress associated with the nightmares correlated with the severity of delusions, with this association remaining significant after controlling for nightmare frequency.”
From The role of sleep dysfunction in the occurrence of delusions and hallucinations: A systematic review (2015) · cites this paper as Sheaves, Onwumere, et al., 2015
55% of patients with psychotic disorders experience weekly distressing nightmares, compared to a 0.9-6.8% estimated prevalence in the general population.
“A high proportion of patients with psychotic disorders have also been found to experience weekly distressing nightmares: 55% (in comparison to a 0.9–6.8% estimated prevalence in the general population) (Sheaves, Onwumere, et al., 2015).”
From The role of sleep dysfunction in the occurrence of delusions and hallucinations: A systematic review (2015) · cites this paper as Sheaves, Onwumere, et al., 2015
The most common sleep disorders in people with psychosis are insomnia and problematic nightmares, experienced by around half of people with psychosis.
“The most common sleep disorders, experienced by around half of people with psychosis, are insomnia and problematic nightmares. 9-11”
From Towards an Integrative Account of Potential Mechanisms Mediating the Path From Sleep Dysfunction to Hallucinations (2025) · cites this paper as [10]
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Sleep and circadian difficulties in schizophrenia: presentations, understanding, and treatment
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“…psychosis are clearly high (e.g., see Bagautdinova et al., 2023; Freeman, Taylor, Molodynski, & Waite, 2019; Lunsford-Avery, LeBourgeois, Gupta, & Mittal, 2015; Ma, Song, Xu, Tian, & Chang, 2018; Sheaves, Onwumere, Keen, Stahl, & Kuipers, 2015; Waite, Sheaves, Isham, Reeve, & Freeman, 2020).”
Azargoonjahromi, A., & Bahrampour, Z. (2025) · Sleep Medicine · doi:10.1016/j.sleep.2025.106690 · Cited by 17 · see citing works
A study of nightmares in patients with psychiatric disorders
Akkaoui, M. A., d’Ortho, M., Gourévitch, R., Pham‐Scottez, A., Benhamou, P., Atoui, Y., Lejoyeux, M., & Geoffroy, P. A. (2021) · Psychiatry and Clinical Neurosciences · doi:10.1111/pcn.13319 · Cited by 14 · see citing works
Wang, Z., Zhang, K., Long, H., Sun, J., Liu, J., & Hu, L. (2023) · Sleep Medicine · doi:10.1016/j.sleep.2023.03.026 · Cited by 12 · see citing works
Rogers, E. N., Gresswell, D. M., & Durrant, S. J. (2023) · Schizophrenia Research · doi:10.1016/j.schres.2023.10.010 · Cited by 11 · see citing works
“…frequent nightmares is associated with poorer sleep quality and efficiency, and with greater delusional severity, depression, and anxiety in SSDs (Sheaves et al., 2015), emotional regulation may offer a mediating link between nightmares and suicide risk (Ward-Ciesielski et al., 2018), thus…”
Bad dream, nightmares and psychopathology: a systematic review
Faccini, J., & Del-Monte, J. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1461495 · Cited by 10 · see citing works
Báthori, N., Polner, B., & Simor, P. (2022) · Schizophrenia Research · doi:10.1016/j.schres.2022.05.020 · Cited by 11 · see citing works
Boland, C., Gallagher, P., & Clarke, M. (2020) · Irish Journal of Psychological Medicine · doi:10.1017/ipm.2019.58 · Cited by 10 · see citing works
“Approximately 10 – 55% of people with schizophrenia report frequent nightmares (Mume, 2009; Michels et al. 2014; Sheaves et al. 2015) compared to the general population rate of approximately 2 – 6% (Li et al. 2010; Sandman et al. 2013).”
van der Wijk, G., Blaskovich, B., Farahzadi, Y., & Simor, P. (2020) · Sleep Medicine · doi:10.1016/j.sleep.2020.07.014 · Cited by 9 · see citing works
Successful treatment of nightmares may reduce psychotic symptoms in schizophrenia
Seeman, M. V. (2018) · World Journal of Psychiatry · doi:10.5498/wjp.v8.i3.75 · Cited by 9 · see citing works
Kelly, W. E. (2019) · Dreaming · doi:10.1037/drm0000118 · Cited by 9 · see citing works
Allen, S. F., Gardani, M., Akram, A., Irvine, K., & Akram, U. (2020) · Behavioral Sleep Medicine · doi:10.1080/15402002.2020.1862848 · Cited by 9 · see citing works
“Indeed, recent research highlights the predominant role of nightmare intensity and consequential distress, rather than incidence, as key factors in influencing psychiatric difficulties (Akram, Gardani, et al., 2020; Levin & Fireman, 2002; Pietrowsky & Köthe, 2003; Sheaves et al., 2015, 2016).”
BackgroundInfluentialReliability and validity of the Chinese version of the Nightmare disorder index in adolescents
Zhuang, Y., Wang, L., Song, T., Dietch, J. R., Wang, T., Qi, M., Liu, J., Zhou, S., & Chen, J. (2023) · Stress and Health · doi:10.1002/smi.3228 · Cited by 8 · see citing works
Sheaves, B., Cropley, V. L., Moseley, P., Woodruff, P. W. R., Punton, G., Speth, C., Speth, J., Meerlo, P., & Brederoo, S. G. (2025) · Schizophrenia Bulletin · doi:10.1093/schbul/sbaf107 · Cited by 6 · see citing works
“9,10,110 Lastly, it is possible that constructs across different levels of explanation do not truly align, for example: (1) lived-experience reports of difficulty tracking the source of perceptual experiences vs performance on source monitoring tasks; (2) attentionally driven top-down processes…”
Nightmare frequency and nightmare distress in psychiatric inpatients
Schredl, M., Anzenberger, E., & Schilling, C. (2024) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-024-01891-z · Cited by 5 · see citing works
“These correlations have also been found in previous studies [ 5 , 18, 38, 49 ].”
Nightmares in Migraine: A Focused Review
Gazerani, P. (2021) · Behavioral Sciences · doi:10.3390/bs11090122 · Cited by 5 · see citing works
“, patients with posttraumatic stress disorder (PTSD) [65], patients with borderline personality disorder [66], and patients with schizophrenia [67]), however, this estimation appears higher.”
BackgroundTanskanen, T. E., Wegelius, A., Härkönen, T., Gummerus, E.-M., Stenberg, J., Selinheimo, S., Alakuijala, A., Tenhunen, M. L., Paajanen, T. I., Järnefelt, H., et al. (2024) · BMJ Open · doi:10.1136/bmjopen-2023-076129 · Cited by 4 · see citing works
“…such as excessive daytime fatigue, an extended nocturnal sleep period, 7 15–18 irregularities of circadian rhythms in sleep/wake patterns, excessive sleep, decreased activity when awake 19 and the experience of frequent nightmares, 20 are also commonly observed among patients with schizophrenia.”
BackgroundZhong, B., Xu, Y., Xie, W., & Lü, J. (2019) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s202813 · Cited by 4 · see citing works
Nightmare experience in bipolar I and II disorders.
Ma, G., Ma, K., Zhu, Q., Shen, C., Wang, C., Wang, J., Fan, H., & Wang, W. (2018) · Dreaming · doi:10.1037/drm0000072 · Cited by 4 · see citing works
Sleep, Nightmares and Schizophrenia
Seeman, M. V. (2017) · Journal of Sleep Disorders and Management · doi:10.23937/2572-4053.1510017 · Cited by 4 · see citing works
“Nightmares occasion significant distress and need to be taken seriously by the medical profession because they have been closely linked to suicidal behavior [18,19].”
BackgroundSahu, N., Patil, P. S., Asmita, & Longkumer, I. (2024) · Cureus · doi:10.7759/cureus.70044 · Cited by 3 · see citing works
“Frequent nightmares can lead to considerable psychological consequences, including heightened levels of anxiety, depression, and an increased risk of developing other mental health disorders [7].”
BackgroundMoya-Lacasa, C., Paniagua, G., Couce-Sánchez, M., Romero-Jiménez, S., García-Fernández, A., Sáiz, P. A., García‐Portilla, M. P., & González-Blanco, L. (2025) · Comprehensive Psychoneuroendocrinology · doi:10.1016/j.cpnec.2025.100321 · Cited by 1 · see citing works
“Our results are consistent with previously published literature reporting a correlation of distress related to nightmares with daytime anxiety and depressive symptoms in patients with BD [59].”
Shao, X., Wang, C., Shen, C., Jia, Y., & Wang, W. (2020) · Bulletin of the Menninger Clinic · doi:10.1521/bumc.2020.84.3.278 · Cited by 1 · see citing works
Mahfoud, D., Ahdab, J. E., Helwe, S., Topalian, M., Tarabay, C., Rifi, K., Haddad, G., Obeïd, S., & Hallit, S. R. (2023) · Perspectives In Psychiatric Care · doi:10.1155/2023/5511158 · Cited by 1 · see citing works
Scarpelli, S., Alfonsi, V., & Gennaro, L. D. (2025) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780197602751.013.21 · Cited by 1 · see citing works
Childhood Trauma and Consequential Impact on Sleep
Aas, M., Hennion, V., Birkenæs, V., Alameda, L., & Étain, B. (2023) · Springer eBooks · doi:10.1007/978-3-031-31547-3_83 · Cited by 1 · see citing works
Identifying and Assessing Barriers to Optimal Outcomes for Psychosis: An Important Research Focus
Tibbo, P. G. (2015) · The Canadian Journal of Psychiatry · doi:10.1177/070674371506000801 · Cited by 1 · see citing works
The role of sleep in predicting paranoia in non-affective psychosis: an experience sampling studyPreprint
Rehman, A., Lee, A. J., Biello, S. M., & Gumley, A. I. (2019) · doi:10.31234/osf.io/83bt5 · Cited by 1 · see citing works
Schizofreniespectrum- en andere psychotische stoornissen
van Deth, R. (2017) · Bohn Stafleu van Loghum eBooks · doi:10.1007/978-90-368-1045-6_2
Effectively Assessing Sleep and Circadian Rhythms in Psychosis
Cosgrave, J., Klingaman, E. A., & Gehrman, P. (2019) · Elsevier eBooks · doi:10.1016/b978-0-12-815012-2.00011-0
Nightmare distress and subsyndromal psychotic experiences
Becker, P. M. (2020) · Sleep Medicine · doi:10.1016/j.sleep.2020.09.023
Troubles psychotiques et troubles du sommeil : revue de la littérature
Lussier-Valade, M., Désautels, A., & Godbout, R. (2019) · Santé mentale au Québec · doi:10.7202/1073528ar
Báthori, N., Moustafa, A. A., & Polner, B. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-820005-6.00010-4
Akram, U., Gardani, M., Irvine, K., Allen, S. F., Ypsilanti, A., Lazuras, L., Drabble, J., Stevenson, J. C., & Akram, A. (2019) · SSRN Electronic Journal · doi:10.2139/ssrn.3457432
“symptoms of psychosis (Sheaves et al., 2015) where distress accompanying the experience of voices and unusual beliefs differentiates the need for intervention (Davies et al.”
BackgroundInfluentialRoberts, J. M., & Lennings, C. J. (2018) · Springer eBooks · doi:10.1007/978-3-319-33228-4_100
Roberts, J. M., & Lennings, C. J. (2016) · Springer eBooks · doi:10.1007/978-3-319-32132-5_100-4
Sleep After Traumatic Brain Injury
Mollayeva, T. (2022) · Springer eBooks · doi:10.1007/978-981-16-0123-1_32
Schizofreniespectrum- en andere psychotische stoornissen
Peters, A., Brakema, L., van de Hoeve, M., Spoelstra, K., & Knegtering, H. (2020) · Bohn Stafleu van Loghum eBooks · doi:10.1007/978-90-368-2524-5_10
Childhood Trauma and Consequential Impact on Sleep
Aas, M., Hennion, V., Birkenæs, V., Alameda, L., & Étain, B. (2023) · Springer eBooks · doi:10.1007/978-3-030-98711-4_83-1
Tomacsek, V., Báthori, N., Likar, M., Hermann, P., Zoltán, V., & Simor, P. (2026) · Journal of Sleep Research · doi:10.1111/jsr.70300
Troubles du sommeil et déterminants psychopathologiques
Faccini, J. (2022) · theses.fr (ABES) · doi:10.70675/fd05872cz888az41cez96bdzbc308491be49
Hokayem, C., Haddad, G., Fawaz, M. A., Hallit, R. R., Malaeb, D. N., Obeïd, S., Hallit, S. R., & Fekih‐Romdhane, F. (2026) · International Journal of Social Psychiatry · doi:10.1177/00207640261433235
“…of heightened threat processing, autonomic hyperarousal and hypervigilance, which are core features of anxiety responses rather than depressive symptomatology, sensitizing consequently individuals to intrusions and anomalous perceptual experiences (Faccini & Del-Monte, 2024; Sheaves et al., 2015) .”
Targeting Sleep to Improve Outcomes in Psychosis: Digital and Non-Pharmacological Interventions
Baldini, V., Gnazzo, M., Varallo, G., Ronchi, D. D., Pelizza, L., Menchetti, M., & Plazzi, G. (2026) · Medicina · doi:10.3390/medicina62071269
“Nightmare disorder affects 30–60% of patients with schizophrenia spectrum disorders and contributes independently to sleep fragmentation, distress, and suicidal risk [51].”
Sleep and psychosis: An integrative review of conceptual and neurophysiological associations
Cui, Z., & Fan, L. (2026) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2026.111895
- Authors
- Sheaves, B., Onwumere, J., Keen, N., Stahl, D., & Kuipers, E.
- Affiliations
- University of Oxford (GB)
- National Health Service (GB)
- King's College London (GB)
- Corresponding author
- Sheaves, Bryony
- Venue
- The Canadian Journal of Psychiatry
- Publisher
- SAGE Publications
- Published
- 2015-08
- Volume
- 60
- Issue
- 8
- Pages
- 354-361
- ISSN
- 0706-7437 (ISSN-L)
- 1497-0015
- PMC
- PMC4542515
- OpenAlex
- W2409122525
- Cited by
- 74
- References
- 62
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 5 · 2023: 6 · 2022: 4 · 2021: 4 · 2020: 11 · 2019: 10 · 2018: 5 · 2017: 10 · 2016: 4 · 2015: 5
- FWCI
- 12.05
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Canadian Journal of Psychiatry (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion)
- Funders
- Wellcome Trust (098461)
- National Institute for Health and Care Research (NF-SI-0611-10103)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Life Sciences › Neuroscience › Cognitive Neuroscience › Sleep and Wakefulness Research
- Keywords
- nightmares, psychosis, sleep quality, sleep efficiency, delusions, depression, anxiety, stress, working memory, post-traumatic stress, social functioning
- MeSH terms
- Adolescent, Adult, Aged, Anxiety, Delusions, Depression, Dreams, Female, Humans, Male, Memory, Short-Term, Middle Aged, Psychotic Disorders, Severity of Illness Index, Sleep, Stress, Psychological, Young Adult
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