A long snooze goodnight – How antipsychotics affect sleep

On a whim, I lowered my dose of olanzapine from 10 to 5mg a couple of weeks back. Like so many schizophrenics, I can’t shake the idea that in a perfect universe, I’m medication-free. We’ll see how this one pans out. I’m starting to see the effect. While I feel fine mentally, my sleep is altered. One of the consequences of a drug like olanzapine is that it makes you sleep more. Quite a bit more. I often clock in on ten hours, so more than the recommended eight. 

I’ve read studies that people who sleep more are just like people who don’t sleep enough at a higher risk of dying than those who get the “perfect” amount of sleep. The problem with these studies is that they fail to take into account that many of the people who spend extra time in dreamland are often sick, hence they sleep a lot. Sick people die because they’re sick, not because they sleep too much. It’s cause and effect, so it can very well be that there’s no adverse effect from excessive sleep. Regardless, if I could get myself out of bed a couple of hours earlier, that’s some extra time I could spend on my novel writing.

The first thing I’ve noticed is that it takes me longer to go to sleep now. On 10mg there’s a knockout effect that sets in half an hour to an hour after taking the pill. That feeling that I must fall asleep now. With it missing, I’m getting used to reading in bed until the small hours, which hasn’t happened to me in years. Olanzapine in higher doses doesn’t only work in putting me to sleep, but I’ve also used it from time to time against anxiety. At the maximum dose of 20mg, it makes me drowsy to the point where I’m almost asleep, which takes my mind off any worries.

In addition to a slight case of insomnia, my sleep quality has changed. For years, I’ve only remembered fragments of my dreams, if anything. Before olanzapine, I used to remember my dreams more or less every night. It looks like dream recollection is back. I wake up several times a night from vivid dreaming. It’s explained by the interesting fact that many antipsychotics don’t just increase the total sleep time but also the time spent in stage 2 sleep. It’s the stage when you’re fully asleep and unaware of your surroundings, so-called deep sleep. 

Considering how much time we spend asleep, it’s surprising how much of it is still a mystery. There’s a good book on the topic, Why we sleep, by sleep scientist Matthew Walker. While Walker might take it a bit far in blaming almost all society’s problems on lack of sleep, there’s something to be said for the detrimental effects when you don’t get enough of it. Every time I’ve slid into psychosis, it’s been foreshadowed by insomnia, sleepless nights, and erratic thinking. For that reason, I’m always cautious with things that affect my sleep, whether it’s coffee late at night or cutting back on olanzapine. Since I have no other adverse effects, I’ll stay on 5mg for now and observe how the sleeping monster develops. This morning, I was stuck in a river in India surrounded by cobras, so maybe there is something to be said for not remembering your dreams.

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