Sleep and Mental Health – Ways to Improve Both

Mental health includes our emotional, psychological, and social well-being. It affects how we think, feel, and act. It also helps determine how we handle stress, relate to others, and make healthy choices. Mental health is important at every stage of life, from childhood and adolescence through adulthood.

The objective of this article is to examine the association between inadequate sleep and mental health. CDC says “One-third of US adults report sleeping less than the recommended amount, and approximately 20% live with a mental illness”. Although the terms “poor mental health” and “mental illness” are often used interchangeably, poor mental health and mental illness are not the same. A person can experience poor mental health and not be diagnosed with a mental illness. Likewise, a person diagnosed with a mental illness can experience periods of physical, mental, and social well-being.

Why is mental health important for overall health?

Mental and physical health are equally important components of overall health.

Mental health illness includes many different conditions such as anxiety, depression, stress, and other psychological illnesses. Depression, schizophrenia, and bipolar disorder increases the risk for coronary heart disease, hypertension, diabetes, dyslipidemia, metabolic syndrome, and obesity, stroke, and substance abuse disorders. Severe mental disorders need psychological treatment and require regular visits to a health care provider lowering workplace productivity. Therefore, mental health is as important as physical health.

Sleep

Sleep is a naturally recurring state of mind and body, characterized by altered consciousness, relatively inhibited sensory activity, reduced muscle activity and inhibition of nearly all voluntary muscles during rapid eye movement sleep, and reduced interactions with surroundings.

Brain activity fluctuates during sleep, increasing and decreasing during different sleep stages that make up the sleep cycle. In NREM (non-rapid eye movement) sleep, overall brain activity slows, but there are quick bursts of energy. In REM sleep, brain activity picks up rapidly, which is why this stage is associated with more intense dreaming.

Each stage plays a role in brain health, allowing activity in different parts of the brain to ramp up or down and enabling better thinking, learning, and memory. Research has also uncovered that brain activity during sleep has profound effects on emotional and mental health.

American Academy of Sleep Medicine emphasize the importance of an adequate night’s sleep, which is defined as 7 or more hours per night with no upper limit. Anything less than this amount may lead to the development of various chronic diseases.

Studies have demonstrated an association between inadequate sleep and frequent mental distress, and sleep deprivation causes substantial negative health outcomes.

How Is Mental Health Related to Sleep?

Sufficient sleep, especially REM (rapid eye movement) sleep, facilitates the brain’s processing of emotional information. During sleep, the brain works to evaluate and remember thoughts and memories, and it appears that a lack of sleep is especially harmful to the consolidation of positive emotional content. This can influence mood and emotional reactivity and is tied to mental health disorders and their severity, including the risk of suicidal ideas or behaviors.

As a result, the traditional view, which held that sleep problems were a symptom of mental health disorders, is increasingly being called into question. Instead, it is becoming clear that there is a bidirectional relationship between sleep and mental health in which sleeping problems may be both a cause and consequence of mental health problems.

Obstructive sleep apnea (OSA) is another aspect of sleep that has been linked to mental health. OSA is a disorder that involves pauses in breathing during sleep and a reduction in the body’s oxygen levels, creating fragmented and disturbed sleep. OSA occurs more frequently in people with psychiatric conditions and may detract from their physical health and heighten their risk of serious mental distress.

Sleep and Specific Mental Health Problems

The way that sleep and mental health are related becomes more apparent by reviewing what is known about how sleep is tied to a number of specific mental health conditions:

• Depression: Depression (major depressive disorder) is a common and medical illness that negatively affects how one feels, the way one thinks and acts. It is a group of conditions associated with the elevation or lowering of a person’s mood.Historically, sleeping problems were seen as a consequence of depression, but growing evidence suggests that poor sleep may induce or exacerbate depression. The difficulty in identifying clear cause and effect reflects what is believed to be a bidirectional relationship in which sleep problems and depressive symptoms are mutually reinforcing.
• Seasonal Affective Disorder: Seasonal affective disorder is a subtype of depression that most often affects people during times of the year with reduced daylight hours. This condition is closely tied to the disruption of a person’s internal biological clock, or circadian rhythm that helps control multiple bodily processes, including sleep. Not surprisingly, then, people with seasonal affective disorder tend to sleep too much or too little or experience changes to their sleep cycles.
• Anxiety Disorder: Anxiety disorders have a strong association with sleeping problems. Worry and fear contribute to a state of hyper arousal in which the mind is racing, and hyper arousal is considered to be a central contributor to insomnia. Sleep problems may become an added source of worry, creating anticipatory anxiety at bedtime that makes it harder to fall asleep.
• Bipolar Disorder: Bipolar disorder involves episodes of extreme moods that can be both high (mania) and low (depression). A person’s feelings and symptoms are quite different depending on the type of episode; however, both manic and depressive periods can cause major impairment in everyday life.

In people with bipolar disorder, sleep patterns change considerably depending on their emotional state. During manic periods, they usually feel less need to sleep, but during depressed periods, they may sleep excessively.

• Schizophrenia: Schizophrenia is a mental health disorder characterized by a difficulty in differentiating between what is and is not real.

People with schizophrenia are more likely to experience insomnia. Poor sleep and symptoms of schizophrenia may be mutually reinforcing, so there are potential benefits to stabilizing and normalizing sleep patterns.

• ADHD: Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that involves reduced attention span and increased impulsiveness.

Sleeping problems are common in people with ADHD. They may have difficulty falling asleep, frequent awakenings, and excessive daytime sleepiness. There is evidence of a bidirectional relationship between sleep and ADHD.

Ways to Improve Both Sleep and Mental Health

Mental health conditions can disrupt sleep, and lack of sleep can affect mental health. This makes for complex connections between sleep and mental health. It also means that treatment for both issues can go hand-in-hand.

Every individual’s situation is different, so the optimal ways to improve mental health and sleep problems depends on the person. Because these conditions can have a major impact on quality of life, it’s important to receive proper care, which entails working with a trained health professional. A medical doctor or psychiatrist can review the potential benefits and risks of different types of treatments, including prescription medications.

While treatment plans can vary considerably, some approaches that may be considered to help with sleep and mental health are described below:

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) describes a type of counseling known as talk therapy. It works by examining patterns of thinking and working to reformulate negative thoughts in new ways.

Different types of CBT have been developed for specific problems such as depression, anxiety, and bipolar disorder. In addition, CBT-I (CBT for insomnia) has a proven track record in reducing sleeping problems. A large clinical trial also showed that CBT-I could reduce symptoms of many mental health conditions, improving emotional well-being and decreasing psychotic episodes.

Whether and how types of CBT can be combined or sequenced to address both sleep and mental health problems is subject to ongoing research, but for many patients, help from a trained counselor to reframe their thinking can meaningfully improve both their sleep and mental state.

Improve Sleep Habits

A common cause of sleeping problems is poor sleep hygiene. Stepping up sleep hygiene by cultivating habits and a bedroom setting that are conducive to sleep can go a long way in reducing sleep disruptions.

Examples of steps that can be taken for healthier sleep habits include:

• Having a set bedtime and maintaining a steady sleep schedule
• Finding ways to wind-down, such as with relaxation techniques, as part of a standard routine before bedtime
• Avoiding alcohol, tobacco, and caffeine in the evening
• Dimming lights and putting away electronic devices for an hour or more before bed
• Getting regular exercise and natural light exposure during the daytime
• Maximizing comfort and support from your mattress, pillows, and bedding
• Blocking out excess light and sound that could disrupt sleep

Finding the best routines and bedroom arrangement may take some trial and error to determine what’s best for you, but that process can pay dividends in helping you fall asleep quickly and stay asleep through the night.

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Sources

1. https://www.cdc.gov/mentalhealth/learn/index.htm 

2. https://www.sleepfoundation.org/mental-health 

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