Metabolic disturbances are a growing concern for the treatment of schizophrenia. As decreased activity and poor sleep quality are risk factors for metabolic disturbances, we investigated the activity and sleep patterns of schizophrenic patients using actigraphy. Seventy-three patients with schizophrenia spectrum disorder (mean age 29.2 ± 10.2 years, 27 females) treated with olanzapine (n = 54) or risperidone (n = 19) and 36 age- and sex-matched healthy controls were examined. Actigraphic recordings were obtained throughout seven consecutive days. The Athens Insomnia Scale (AIS) and Epworth Sleepiness Scale (ESS) were used to assess sleep and daytime sleepiness. Drug side effects were evaluated with the Udvalg for Kliniske Undersogelser (UKU) Side Effect Rating Scale and Barnes Akathisia Rating Scale (BARS). Mental status was rated with the Positive and Negative Syndrome Scale (PANSS) and Calgary Depression Scale for Schizophrenia (CDSS). The patients had lower mean 24 h-activity (p < 0.001) and mean 10 h-daytime-activity (p < 0.001), and longer time in bed (p < 0.001). Higher PANSS scores, especially in the negative symptoms scale, were related to lower activity (r_s = −0.508, p < 0.001). Higher depressive symptoms were related to lower mean 24 h-activity (r_s = −0.233, p = 0.049), longer time in bed (r_s = 0.315, p = 0.007) and higher AIS (r_s = 0.377, p = 0.001) and ESS scores (r_s = 0.321, p = 0.006). Healthy females presented higher activity than healthy males (p < 0.001). Similar but not significant gender differences were observed in the patients. These findings show that patients with schizophrenia treated with olanzapine or risperidone exhibit low physical activity and altered sleep pattern which may promote metabolic side effects. These changes are linked to negative and depressive symptoms.