Friday, Oct. 20
10:45 – 11:45 (1 hr)
Meeting Room: Port McNeill (4th floor – North Tower)
Matthew McAdam*, MD; Malgorzata Rajda, MD

CanMEDS Roles:

1. Health Advocate
2. Medical Expert
3. Communicator

At the end of this session, participants will be able to: 1) Describe the sleep changes and disorders frequently associated with schizophrenia; 2) Identify the role that disrupted sleep plays in worsening the primary, secondary, and comorbid symptoms of schizophrenia; and 3) Plan an approach to assessing and managing disordered sleep in schizophrenia.

Most patients with schizophrenia live with sleep disruptions that can worsen clinical outcomes and are often underrecognized and undertreated. The prevalences of insomnia, obstructive sleep apnea (OSA), circadian rhythm abnormalities, restless leg syndrome (RLS), and periodic limb movement disorder (PLMD) are elevated in this population. Reductions in slow-wave sleep and sleep spindle density have been consistently detected in sleep studies—changes that may hinder memory consolidation. The etiology of these sleep abnormalities is multifactorial, with influences from irregularities in neural circuits and atypical neurotransmission. Positive symptoms, aberrant daily routines, and other lifestyle factors can also contribute to sleep disruption. The impacts of sleep disturbances in schizophrenia are extensive and have been linked to worsening positive and negative symptoms, cognitive and functional impairments, metabolic dysfunction, reduced quality of life, elevated suicide risk, and exacerbation of comorbidities. This workshop will review an approach to assessing sleep with practical tools. We will also cover nonpharmacologic and pharmacologic management strategies. Cognitive-behavioural therapy for insomnia remains a powerful tool but may benefit from certain modifications based on patient needs. Although antipsychotic agents can improve sleep, potential pitfalls include OSA, RLS, and PLMD worsening. The role of other hypnotic agents is also considered. Participants will learn to incorporate these assessment and management techniques into their practices, using a case-based approach with time for discussion.

References:

1. Kaskie RE, Graziano B, Ferrarelli F. Schizophrenia and sleep disorders: links, risks, and management challenges. Nat Sci Sleep 2017;9:227–239.
2. Ferrarelli F. Sleep abnormalities in schizophrenia: state of the art and next steps. Am J Psychiatry 2021;178(10):903–913.