Pharmacopsychiatry 2019; 52(04): 165-169
DOI: 10.1055/a-0658-1645
© Georg Thieme Verlag KG Stuttgart · New York

Treatment Options for Insomnia in Schizophrenia: A Systematic Review

Pedro Oliveira
1   Psychiatry Department, Coimbra Hospital University Centre, Coimbra, Portugal
2   Psychological Medicine Institute, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
Manuel Coroa
1   Psychiatry Department, Coimbra Hospital University Centre, Coimbra, Portugal
2   Psychological Medicine Institute, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
Nuno Madeira
1   Psychiatry Department, Coimbra Hospital University Centre, Coimbra, Portugal
2   Psychological Medicine Institute, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
› Author Affiliations
Further Information

Publication History

received 11 April 2018
revised 07 June 2018

accepted 09 July 2018

Publication Date:
30 July 2018 (online)


Background Insomnia is a common feature of schizophrenia. Although several studies have been published about the influence of certain drugs on schizophrenia patients’ sleep, there are no well-grounded recommendations about insomnia treatment in this clinical setting. The present review aimed to identify relevant empirical evidence on available treatments of insomnia in patients with schizophrenia, assessing their safety and efficacy.

Methods This is a systematic review of clinical trials investigating the effect of treatments for insomnia in patients with a diagnosis of schizophrenia. Data were obtained from Medline/PubMed, Embase, PsycInfo, and the Cochrane Library. Risk of bias was assessed in individual studies for selection, performance, detection, attrition, and reporting bias.

Results Four studies met inclusion criteria; 2 using melatonin, 1 using paliperidone, and 1 with eszopiclone. All reported positive results: melatonin increased sleep efficiency and total duration of sleep; paliperidone decreased sleep latency onset and increased total sleep time and sleep efficiency; eszopiclone decreased insomnia severity index.

Conclusions Despite a very limited number of specific studies on this matter, all 4 studies have shown good benefit/risk ratios and reviewed options—melatonin, paliperidone, and eszopiclone—might represent valid options for residual insomnia in schizophrenia.

  • References

  • 1 McGrath J, Saha S, Chant D. et al. Schizophrenia: a concise overview of incidence, prevalence, and mortality. Epidemiol Rev 2009; 30: 67-76
  • 2 Benson K. Sleep in schizophrenia pathology and treatment. Sleep Med Clin 2015; 10: 49-55
  • 3 Monti J, Monti D. Sleep in schizophrenia patients and the effects of antipsychotic drugs. Sleep Med Rev 2004; 8: 133-148
  • 4 Monti JM, Torterolo P, Perumal SR. The effects of second generation antipsychotic drugs on sleep variables in healthy subjects and patients with schizophrenia. Sleep Med Rev 2017; 33: 51-57
  • 5 Chemerinski E, Ho B, Flaum M. et al. Insomnia as a predictor for symptom worsening following antipsychotic withdrawal in schizophrenia. Compr Psychiatry 2002; 43: 393-396
  • 6 Lieberman J, Stroup T, McEvoy J. et al. Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Investigators. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med 2005; 353: 1209-1223
  • 7 Aggarwal S, Dodd S, Berk M. Restless leg syndrome associated with atypical antipsychotics: current status, pathophysiology, and clinical implications. Curr Drug Saf 2015; 10: 98-105
  • 8 Baandrup L, Jennum P, Lublin H. et al. Treatment options for residual insomnia in schizophrenia. Acta Psychiatr Scand 2013; 127: 81-82
  • 9 Moher D, Liberati A, Tetzlaff J. et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Open Med 2009; 3: 123-130
  • 10 Higgins J, Green S.Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. The Cochrane Collaboration. Accessed June 1, 2017
  • 11 Jadad AR, Moore RA, Carroll D. et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary?. Control Clin Trials 1996; 17: 1-12
  • 12 Shamir E, Laudon M, Barak Y. et al. Melatonin improves sleep quality of patients with chronic schizophrenia. J Clin Psychiatry 2000; 61: 373-377
  • 13 Suresh-Kumar PN, Andrade C, Bhakta SG. et al. Melatonin in schizophrenic outpatients with insomnia: a double-blind, placebo-controlled study. J Clin Psychiatry 2007; 68: 237-241
  • 14 Luthringer R, Staner L, Noel N. et al. A double-blind, placebo-controlled, randomized study evaluating the effect of paliperidone extended-release tablets on sleep architecture in patients with schizophrenia. Int Clin Psychopharmacol 2007; 22: 299-308
  • 15 Tek C, Palmese L, Krystal A. et al. The impact of eszopiclone on sleep and cognition in patients with schizophrenia and insomnia: a double-blind, randomized, placebo-controlled trial. Schizophr Res 2014; 160: 180-185
  • 16 Zhadanova I, Tucci V. Melatonin, circadian rhythms, and sleep. Curr Treat Options Neurol 2003; 5: 225-229
  • 17 Robinson S, Rosca P, Durst R. et al. Serum melatonin levels in schizophrenic and schizoaffective hospitalized patients. Acta Psychiatr Scand 1991; 84: 221-224
  • 18 Morin A, Willett K. The role of eszopiclone in the treatment of insomnia. Adv Ther 2009; 26: 500-518
  • 19 Wamsley EJ, Shinn AK, Tucker MA. et al. The effects of eszopiclone on sleep spindles and memory consolidation in schizophrenia: a randomized placebo-controlled trial. Sleep 2013; 36: 1369-1376
  • 20 Dolder C, Nelson M, Deyo Z. Paliperidone for schizophrenia. Am J Health Syst Pharm 2008; 65: 403-413