Sleep and psychosis: An integrative review of conceptual and neurophysiological associations.
Zhiyu Cui, Linlin Fan
Progress in Neuro-Psychopharmacology and Biological Psychiatry August 14, 2026 DOI: 10.1016/j.pnpbp.2026.111895 (opens in new tab)
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Study at a glance
AI-extracted from the abstract| Characteristics | Review Peer reviewed |
|---|---|
| Topics | Dreaming Lucid dreaming |
| Keywords | Schizophrenia Sleep disturbances Sleep inertia Sleep paralysis Sleep-related hallucination |
| Key findings | The authors argue that current evidence suggests anterior cingulate and frontal regions may be relevant to sleep disturbances, dreaming-related processes, and psychosis-related abnormalities, but direct neurobiological evidence linking sleep processes to psychosis remains limited. |
Abstract
The association between sleep-related phenomena and psychosis has received increasing attention in recent years, as sleep disturbances (e.g., insomnia) have shown robust associations with psychotic symptoms. However, the role of other, more specific sleep processes in psychosis remains unclear, despite their potential importance as symptom-related correlates. Particularly, phenomena such as dreaming and hypnagogic experiences may share certain phenomenological features with hallucination-like experiences. Given that both sleep and psychosis involve complex neural systems, examining their neurobiological correlates may help clarify their potential relationships. Therefore, in this review, we summarize the literature on the potential connections between different sleep processes and psychosis from both conceptual and neurological perspectives. Current evidence suggests that anterior cingulate and frontal regions may be relevant to some sleep disturbances, dreaming-related processes, and psychosis-related abnormalities. However, given the broad and non-specific functions of these regions, such overlap should be interpreted cautiously. Overall, neurobiological evidence directly linking sleep-related processes to psychosis remains limited. We then conclude by highlighting current gaps in knowledge, particularly regarding the role of other sleep processes, and outlining directions for future research.
In the evidence
This study is part of the evidence base for a synthesis in the library. Here is how each one recorded it.
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State of the evidence: Dreaming Unclear
Argues that anterior cingulate and frontal regions may be relevant to sleep disturbances, dreaming-related processes, and psychosis-related abnormalities, but that direct neurobiological evidence linking sleep processes to psychosis remains limited.
Synthesized
Comparable studies
Other narrative reviews on lucid dreaming, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| The cognitive neuroscience of lucid dreaming | 2019 | Review | |
| My Dream, My Rules: Can Lucid Dreaming Treat Nightmares? | 2019 | Review | |
| What about dreams? State of the art and open questions | 2022 | Review | |
| The Dream of God: How Do Religion and Science See Lucid Dreaming and Other Conscious States During Sleep? | 2020 | Review | |
| Insight and Dissociation in Lucid Dreaming and Psychosis | 2018 | Review |
Citations in the library
Cites 36
- Lucid Dreaming: a State of Consciousness with Features of Both Waking and Non-Lucid Dreaming Sleep September 1, 2009
- A systematic review of variables associated with sleep paralysis Sleep Medicine Reviews June 8, 2017
- Metacognitive Mechanisms Underlying Lucid Dreaming Journal of Neuroscience January 21, 2015
- Frequent lucid dreaming associated with increased functional connectivity between frontopolar cortex and temporoparietal association areas Scientific Reports December 6, 2018
- Nightmares in Patients with Psychosis: The Relation with Sleep, Psychotic, Affective, and Cognitive Symptoms The Canadian Journal of Psychiatry August 1, 2015
and 31 more in the library