Hybrid sleep-wake states in psychosis: Examining a comprehensive array of unusual sleep and dream experiences in patients with psychosis compared to non-clinical controls

Abstract

Psychosis has been likened to dream-like mentation permeating waking, with hallucinatory experiences, flawed logic, and salience of one’s internal world over sensory perception. Some exceptional dream and sleep experiences have been viewed as representing hybrid states between sleep and waking, for example, dreams of falling/flying, dreams of awakening, lucid dreams, sleepwalking, hypnagogic hallucinations, and sleep paralysis. Several of these phenomena have been associated with psychopathological distress in general, and schizotypy and dissociative experiences in particular - dimensional manifestations of core experiences in psychotic disorders. To better understand sleep-wake mechanisms in psychosis, we wished to examine a host of sleep and dream experiences in patients with psychotic disorders. N = 75 patients were compared to n = 72 non-clinical controls on various exceptional sleep/dream experiences, as well as several universal dream themes. The clinical group had poorer sleep quality, and elevated dream phenomena including a general sleep experiences factor (e.g., awakening dreams, falling/flying dreams), lucid dreams, and hypnagogic/hypnopompic hallucinations, even when accounting for sleep quality. Dreams of persecution and grandiosity were elevated in the clinical group, but grandiosity seemed to be confounded by atypical antipsychotic medication use. We exploratorily examined differences between affective and non-affective psychosis but those analyses are limited by sample size. To conclude, researching dreams may shed light on blurred boundaries between wake and sleep in psychosis.