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Sleep quality vs. mental health: a complex relationship with psychosis
Alfrina Mewengkang , Tesalonika Pandolos ,
Marssel Michael Sengkey , Stevi Becher Sengkey , Raup Padillah
PII: S0165-1781(25)00090-3
DOI: https://doi.org/10.1016/j.psychres.2025.116441
Reference: PSY 116441
To appear in: Psychiatry Research
Received date: 15 December 2024
Accepted date: 8 March 2025
Please cite this article as: Alfrina Mewengkang , Tesalonika Pandolos , Marssel Michael Sengkey ,
Stevi Becher Sengkey , Raup Padillah , Sleep quality vs. mental health: a complex relationship with
psychosis, Psychiatry Research (2025), doi: https://doi.org/10.1016/j.psychres.2025.116441
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© 2025 Published by Elsevier B.V.
Correspondence
Title:
Sleep quality vs. mental health: a complex relationship with psychosis
Authors:
1. Alfrina Mewengkang
Affiliation : Universitas Negeri Manado, Manado, Indonesia
E-mail : mewengkangalfrina@unima.ac.id
2. Tesalonika Pandolos
Affiliation : Universitas Negeri Manado, Manado, Indonesia
E-mail : tesapondalos@gmail.com
3. Marssel Michael Sengkey
Affiliation : Universitas Negeri Manado, Manado, Indonesia
E-mail : mmsengkey@unima.ac.id
4. Stevi Becher Sengkey
Affiliation : Universitas Negeri Manado, Manado, Indonesia
E-mail : stevisengkey@unima.ac.id
5. Raup Padillah
Affiliation : Universitas PGRI Banyuwangi, Banyuwangi, Indonesia
E-mail : raup.padillah@gmail.com
Corresponding author at: Raup Padillah. Universitas PGRI Banyuwangi, Department of Guidance and
Counseling, Banyuwangi, Indonesia
E-mail: raup.padillah@gmail.com
Dear Editor,
We are writing to highlight the significant contributions of the recent study by (Pieters et al., 2025),
which discusses sleep and physical activity patterns in relation to daily-life symptoms in psychosis.
Sleep plays a crucial role in maintaining overall mental health, serving as a foundation for emotional
stability, cognitive function, and physical well-being (Scott et al., 2021). The relationship between sleep
and mental health is not always straightforward. Recent research has shed light on an intriguing and
complex connection: the impact of sleep quality on psychotic symptoms, such as auditory hallucinations
and paranoia (Waters et al., 2018). While poor sleep is often linked to worsening mental health,
improved sleep continuity a term that refers to the uninterrupted flow of sleep has been associated with
heightened psychotic symptoms in some individuals. This paradox highlights the intricate and
multifaceted interplay between sleep and mental health, particularly in those prone to psychosis.
Psychosis is a mental health condition characterized by a disconnection from reality. It can manifest
through symptoms such as hallucinations (perceiving things that are not present), delusions (strongly
held false beliefs), and disorganized thinking (Bansal et al., 2009; Griswold et al., 2015). Auditory
hallucinations, where individuals hear voices that others cannot, and paranoia, involving irrational
distrust or suspicion of others, are common features of psychosis (Mitropoulos, 2020). These symptoms
can profoundly disrupt daily life, relationships, and overall well-being. While psychosis can occur as
part of a primary psychiatric condition like schizophrenia (Godbout, 2016), it may also arise secondary
to other factors, such as severe stress (DeVylder et al., 2016), substance use (Mervis et al., 2021), and
sleep deprivation (Boland et al., 2022). Consequently, understanding how sleep quality influences
psychosis is vital for developing effective treatments and improving quality of life for affected
individuals.
Sleep is essential for restoring the brain and body. It consolidates memories, regulates emotions, and
supports cognitive processes (Eugene & Masiak, 2015). For mental health, achieving adequate sleep in
terms of both quantity and quality is critical. Sleep disruptions can impair mood, increase stress, and
exacerbate psychiatric conditions. Studies consistently demonstrate a bidirectional relationship between
sleep disturbances and mental health disorders (Howarth & Miller, 2024). For example, insomnia is not
only a common symptom of depression and anxiety but also a potential risk factor for developing these
conditions. In the context of psychosis, sleep problems are especially prevalent. Individuals
experiencing psychotic symptoms often report difficulties falling asleep, staying asleep, or achieving
restorative rest (Freeman et al., 2020). These disturbances can, in turn, intensify their symptoms,
creating a vicious cycle.
While poor sleep has long been recognized as a trigger for psychosis, recent findings suggest that even
improvements in sleep quality can have unexpected consequences. Studies exploring sleep continuity
the extent to which sleep remains uninterrupted have revealed a paradoxical link: in some cases,
increased sleep continuity is associated with heightened next-day psychotic symptoms, particularly
auditory hallucinations and paranoia (Brown et al., 2024). This counterintuitive relationship raises
important questions. How can better sleep lead to worse symptoms? Researchers propose several
potential mechanisms:
Sleep—especially during the rapid eye movement (REM) stage plays a role in processing emotions and
memories (Groch et al., 2013). Enhanced sleep continuity may amplify the brain’s emotional
processing, inadvertently intensifying negative or distressing thoughts that contribute to psychotic
symptoms. Sleep continuity influences the brain’s neural connectivity. While better sleep can strengthen
some cognitive pathways (Prehn-Kristensen & Göder, 2018), it may also exaggerate maladaptive
patterns in individuals prone to psychosis, such as hyperconnectivity in regions associated with threat
perception. After prolonged sleep deprivation, achieving better sleep may trigger a “rebound” effect,
where suppressed thoughts, emotions, or hallucinations resurface with greater intensity during waking
hours. Improved sleep continuity might heighten self-awareness and cognitive focus (Hsueh & Jong,
2022), making individuals more attuned to subtle psychotic experiences that they might otherwise
overlook.
The relationship between sleep quality and mental health, particularly in the context of psychosis, is
anything but simple. While poor sleep is a well-known risk factor for worsening symptoms, increased
sleep continuity can paradoxically heighten psychotic experiences like auditory hallucinations and
paranoia. This underscores the importance of a nuanced, individualized approach to sleep interventions
for those with psychosis. As our understanding of the sleep-psychosis connection deepens, there is hope
for more effective treatments that not only improve sleep but also enhance overall mental health and
well-being. In the meantime, clinicians and researchers must navigate this complex terrain with care,
balancing the potential benefits of better sleep with the risks of exacerbated symptoms. By doing so,
they can help individuals with psychosis achieve a healthier, more stable life.
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Declaration of competing interest
The authors had no advantage, no competitive processes and personal relationships that
influenced the work in the study.
