SLEEPING WITH ONE EYE OPEN: How Homelessness Can Lead to Psychosis

By Maryellen Hess CameronCancer InCytes MagazineVolume 3, Issue 1, Summer 2014

Sleeping under a bridge. Sleeping on a park bench. Sleeping in a car.

These images spring to mind when someone talks about homelessness because these are common places for the homeless. The misnomer is in the word “sleeping.” While homeless people may catch a couple of hours of sleep here and there, it is neither restful nor sufficient for good health.Cameron_OneEyeOpen_Pg-1 Personal wellness depends on at least seven or more hours of restful sleep per night. There is laboratory evidence that short sleep durations of 4-5 hours have negative physiological and neurobehavioral consequences. Homeless people have little opportunity to obtain even this level of good sleep for many obvious reasons:

  • Safety is compromised by homelessness. Robbery and assault are constant threats.
  • Police interrupt people sleeping outside. Sometimes they will wake people up just to tell them to move along, as if they have anywhere else to go.
  • In some communities, homelessness is now a crime and the police have to arrest homeless people.
  • Other homeless people may wake a sleeping person for more innocent reasons. It could be just to bum a cigarette. It could be a person in the throes of a manic episode, characterized by rambling, and rapid speech.
  • Something as universal as the urge to go to the bathroom can be a big interruption to sleep. Unlike a housed person, a homeless person must find a public bathroom open all night. Before they can even do that, they have to gather up all their belongings so they won’t get stolen. There is no chance they will easily return to sleep.
  • Weather conditions are a huge factor. Do we really think a person can sleep well in the rain or cold? Excessive heat can be equally disruptive to a person’s sleep. Think of tossing and turning during a heat wave.
  • Shelters are stretched to capacity. In my community we have waiting lists for the shelters.
  • Even shelters are not particularly restful places. They resolve the obvious issue of exposure to the elements. People have at least a cot and a pillow. But shelter residents are mixed in with others who talk at night, pace or snore loudly enough to drown out a train.

It is intuitive that severely mentally ill people are at risk of homelessness. They struggle to maintain steady income. They are often estranged from family or friends, leaving them without any support systems. Their symptoms and related behaviors interfere with lease compliance, leading to eviction.On the other hand, there have always been…
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