University of Oulu

Erik Cederlöf and others, Substance Use and Sleep Problems in Patients With Psychotic Disorders, Schizophrenia Bulletin Open, Volume 4, Issue 1, January 2023, sgac073,

Substance use and sleep problems in patients with psychotic disorders

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Author: Cederlöf, Erik1,2,3; Holm, Minna1; Ahti, Johan2;
Organizations: 1Finnish Institute for Health and Welfare, Helsinki, Finland
2Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
3SleepWell Research Program, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
4Niuvanniemi Hospital, University of Eastern, Kuopio, Finland
5University of Turku, Turku, Finland
6Institute for Molecular Medicine Finland (FIMM), Helsinki, Finland
7Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
8Department of Psychiatry, University of Tampere, Tampere, Finland
9Karolinska Institutet, Solna, Sweden
10Department of Psychiatry, Oulu University Hospital, Oulu, Finland
11Department of Psychiatry, Research Unit of Clinical Neuroscience, University of Oulu, Oulu, Finland
12Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.3 MB)
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Language: English
Published: Oxford University Press, 2022
Publish Date: 2023-09-06


Background: Substance use and sleep problems are common in patients with psychotic disorders, but their associations in these patients have not been evaluated. We aimed to investigate associations between substance use and sleep problems in a large nationwide cohort of patients with a psychotic disorder.

Study Design: This study is part of the Finnish SUPER study, which belongs to the Stanley Global Neuropsychiatric Genomics Initiative. In this cross-sectional, multicenter study, participants (N = 8616) were recruited from primary and specialized healthcare. Patients with schizophrenia, schizoaffective disorder, bipolar disorder, and psychotic depression were included. Information on current alcohol (Alcohol Use Disorders Identification Test-Concise) and cigarette use as well as on lifetime illicit drug use, including cannabis, benzodiazepines, amphetamines, and opioids, was collected using questionnaires. The sleep outcomes in our logistic regression analysis were short (≤6 h) and long sleep (≥10 h) duration, difficulties initiating asleep, early morning awakenings, fatigue, and poor sleep quality (SQ).

Results: Self-reported substance use was associated with a higher prevalence of sleep problems. After adjustments with age, gender, diagnostic group, and living status, hazardous alcohol use (eg, poor SQ odds ratio [OR] = 1.80, 95% CI: 1.49 to 2.16, P < .001), current smoking (short sleep duration OR = 1.28, 95% CI: 1.08 to 1.52, P = .005), and lifetime benzodiazepine misuse (difficulties initiating sleep OR = 2.00, 95% CI: 1.55 to 2.48, P < .001) were associated with sleep problems.

Conclusions: Substance use was associated with sleep problems. Our findings underline the potential benefits of screening substance use when treating sleep problems in patients with psychotic disorders.

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Series: Schizophrenia bulletin open
ISSN: 2632-7899
ISSN-E: 2632-7899
ISSN-L: 2632-7899
Volume: 4
Issue: 1
Article number: sgac073
DOI: 10.1093/schizbullopen/sgac073
Type of Publication: A1 Journal article – refereed
Field of Science: 3124 Neurology and psychiatry
Funding: This work was supported by the Stanley Center for Psychiatric Research at Broad Institute. EC and TP were supported by grants from Finska Läkaresällskapet (#9-1600-15 and #8-1353-9). MH was supported by a grant from the Academy of Finland (#310295). The work was also supported by the University of Helsinki (TYH20919315). EC received a grant from the Juha Vainio Foundation (202100043). The funding organizations had no role in the design or execution of the study; in the collection, management, analysis, or interpretation of data; in preparation, review, or approval of the manuscript; or in the decision to submit the manuscript for publication.
Copyright information: © The Author(s) 2022. Published by Oxford University Press on behalf of the University of Maryland's school of medicine, Maryland Psychiatric Research Center. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (, which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact