Insomnia is a common symptom in schizophrenia. When insomnia is considered to be a symptom of schizophrenia, it is treated with antipsychotics. When it is considered to be an independent issue, it is treated with hypnotics. Physicians should weigh the risks and benefits associated with each type of medication when deciding on the course of treatment.
 Most antipsychotics help improve insomnia by prolonging total sleep time, reducing sleep latency, decreasing sleep interruptions, and increasing slow wave sleep.
 The risks of antipsychotics include "hangover," drowsiness, extrapyramidal symptoms, restless legs syndrome, and cognitive deficits. Moreover, they are associated with increase in appetite and body weight, and the ensuing metabolic disturbance induce obesity, and obesity promotes sleep apnea.
 The most commonly prescribed hypnotics are the benzodiazepine receptor agonists (BZ-RAs). The results of studies on the efficacy of BZ-RAs as hypnotics are controversial. The risks of BZ-RAs include drowsiness, cognitive deficits, falls and subsequent bone fractures, traffic accidents, delirium, worsening sleep apnea, and withdrawal symptoms.
 The use of antipsychotics or hypnotics depends on the physician's personal judgement to weigh the associated risks and benefits when treating a patient with insomnia and schizophrenia.
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