| Summary: | It is common in mental health care to ask about people’s days but comparatively rare to ask about
their nights. Most patients diagnosed with schizophrenia struggle at night-time. The next-day effects
can include a worsening of psychotic experiences, affective disturbances, and inactivity, which in
turn affect the next night’s sleep. Objective and subjective cognitive abilities may be affected too.
Patients commonly experience a mix of sleep difficulties in a night and across a week. These
difficulties include: troubles falling asleep, staying asleep, or sleeping at all; nightmares and other
awakenings; poor-quality sleep; oversleeping; tiredness; sleeping at the wrong times; and problems
establishing a regular sleep pattern. The patient group is also more vulnerable to obstructive sleep
apnoea and restless legs syndrome. We describe in this article how the complex presentation of nonrespiratory sleep difficulties arises from variation across five factors: timing, mental state, need for
sleep, self-care, and environment. We set out ten illustrative patterns of such difficulties experienced
by patients with non-affective psychosis. These sleep problems are eminently treatable with
intensive, focussed psychological therapy delivered over approximately eight sessions. We describe
key techniques and their typical order of implementation for the ten presentations. Sleep problems
are an important issue for patients. Giving them the therapeutic attention patients often desire
brings both real clinical benefit and improves views of services. Treatment is also very likely to lessen
psychotic experiences and mood disturbances, while improving daytime functioning and quality of
life. Tackling sleep difficulties can be a route towards the successful treatment of psychosis.
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