Getting a good night’s sleep is important for several reasons. For one, it can improve your mood. Without it, however, you can lose a lot more than a sunny disposition. For one, sleep deficiency can cause physical health issues like kidney and heart disease, stroke and diabetes. It also has a cyclical relationship with mental health.
While 10-18% of American adults experience sleep issues, the number jumps to 50-80% when looking at a typical psychiatric office’s patients. These numbers seem to suggest a connection between mental health and sleep. In particular, patients with anxiety, depression, bipolar disorder and attention deficit hyperactivity disorder are the most likely to experience some kind of difficulty sleeping.
Mental health has a unique relationship to sleep, since many conditions can cause sleep problems or have unique ways of impacting sleep. Understanding the details of these conditions and how they interact with one another can help identify potential issues and seek treatment.
What are the common mental health conditions?
Mental health conditions can affect a person’s cognitive ability, emotions and behavior. They can impact a person’s day-to-day life, and they can vary in severity from mild to extreme. There is a wide range of conditions that can impact a person’s mental health, and each has its own symptoms and treatment options.
Depression
Depression is usually accompanied by persistent feelings of sadness, hopelessness, and a loss of interest in engaging in various activities. This can include neglecting personal responsibilities and duties such as hygiene, work, school or relationships. A 2020 study by the National Institute of Mental Health (NIMH) estimated that within a year, 21 million Americans (or 8.4% of the population) had experienced a major depressive episode.
Anxiety disorders
Though they can express themselves in different ways, anxiety disorders are generally characterized by excessive fear or worry that can interfere with a person’s daily life. This includes panic disorders. According to the Anxiety & Depression Association of America (ADAA), anxiety disorders are the most common mental illness in the US, affecting more than 19% of adults annually.
Phobic disorder
A phobic disorder, or phobia, is a type of anxiety disorder in which an individual experiences intense fear or revulsion to an object or situation. People with phobias will react to a specific phenomenon, and in some cases, alter their lifestyle to avoid contact with a phobia trigger. Phobias are estimated to affect 12.5% of adults during their lifetime.
Obsessive-compulsive disorder (OCD)
People with OCD often have intrusive thoughts and engage in unwanted, repetitive behaviors to reduce anxiety. Potential obsessive thoughts include dwelling on germs and cleanliness or feelings of aggression. Compulsive behavior includes repeatedly counting something or washing hands an excessive amount.
While in many cases these can be seen as normal behavior, these behaviors and thoughts can be categorized as OCD when they are uncontrollable or begin to interfere with an individual’s life. NIMH identifies OCD as a condition affecting 1.2% of the US population, with women accounting for three times as many cases as men.
Schizophrenia
A person with schizophrenia may experience symptoms such as disordered thinking, hallucinations and delusions that can limit their ability to function normally. Approximately 1% of American adults experience schizophrenia. In men, symptoms begin to appear during their late teens or early 20s. In women, symptoms typically develop later, with schizophrenic behavior developing into their 20s or 30s.
Bipolar disorder
Individuals with bipolar disorder experience extreme shifts in mood and energy. These shifts are categorized into manic episodes (characterized by euphoria or irritability) and depressive episodes (characterized by sadness, indifference, and depression). The frequency and nature of these episodes can help to diagnose which type of bipolar disorder a person is experiencing as well.
Post-traumatic stress disorder (PTSD)
Although many people experience trauma inevitably in life, these events have the potential to trigger PTSD. This condition can cause symptoms like nightmares, intense anxiety, and flashbacks. It can also co-occur with other conditions such as depression, substance use and memory disorders. According to the US Department of Veterans Affairs, PTSD affects 5% of adults each year.
How is mental health related to sleep?
As mentioned, mental health and sleep are closely related. In 2021, researchers from the CDC observed the relationship between sleep and mental distress, and found that participants who averaged less than 6 hours of sleep were 2.5 times more likely to experience frequent mental distress. Although this simply shows a strong correlation between the two and not a causality, you can make the connection that lack of sleep can worsen symptoms of a mental health disorder.
For example, in clinical samples, nearly 75% of depressed patients reported symptoms of insomnia. Since sleep can affect the overall quality of life and happiness, issues falling asleep can lead to worse depression.
As such, getting enough sleep can help maintain good mental health by reducing depression and anxiety.
Sleep and specific mental health problems
Some mental health and sleep issues can be more directly related to one another. In some cases, one condition will feed into or cause another. Other conditions have properties that make a co-occurring condition more likely.
- Anxiety/depression and insomnia: Both anxiety and depression can affect sleep — making it harder to fall asleep and even leading to insomnia. The resulting insomnia can make depression and anxiety worse, and the cycle will continue.
- Bipolar disorder: During manic episodes, a person may not feel the need to sleep. During depressive episodes, a person may sleep excessively.
- Substance abuse: Substance misuse can have a disruptive effect on sleep patterns, which can present itself through insomnia or nightmares. Substance abuse can also exacerbate anxiety and depression.
- PTSD: Nightmares and flashbacks during sleep can ultimately lead to insomnia and daytime fatigue.
While many of these conditions may necessitate professional help, in some cases, making behavioral adjustments can help have a positive impact.
What are the common sleep disorders?
Sleep disorders can affect a person’s sleep habits in several detrimental ways. In addition to various ways of making it difficult for people to get to sleep, sleep disorders can have other equally undesirable effects.
Insomnia disorder
Insomnia is a sleep disorder that potentially affects a person’s ability to sleep, as well as the restfulness of sleep when it occurs. Short-term bouts of insomnia may be brought about by stress or other lifestyle changes. Once a person adjusts to a new environment or the stressor goes away, insomnia may end as well. Studies on insomnia worldwide vary. Since it is often a comorbidity with other conditions, it is frequently missed by primary care doctors.
Sleep apnea
People who experience sleep apnea will unknowingly experience difficulty breathing while sleeping, therefore limiting the intake of oxygen during the night. Although sleep apnea may look like loud snoring, it’s also accompanied by other symptoms such as gasping and choking during the night, and fatigue during the day time. Sleep apnea affects about 26% of US adults between the ages of 30 and 70.
Non-rapid eye movement sleep arousal disorders (NREM)
A NREM disorder is characterized by sleep behaviors such as sleepwalking and sleep terrors. This condition is sometimes a comorbidity with another sleep condition, such as RLS, insomnia or sleep apnea. As a result, treating that other condition may have a positive effect on NREM.
Nightmare disorder
A patient experiencing a nightmare disorder has frequent or recurring disturbing nightmares. Nightmare disorder affects 2-8% of the population. Although it can be diagnosable on its own, a nightmare disorder typically co-occurs among people with narcolepsy, depression, PTSD and anxiety.
Rapid eye movement sleep behavior disorder (RBD)
Patients living with RBD can experience dream enactment, during which their sleeping body moves in reaction to a dream. These movements can include violent movements that result in harm to the patient themselves or nearby sleepers. RBD impacts an estimated 1% of adults between 40 and 80.
Narcolepsy
Cases of narcolepsy include extreme fatigue during the day, including uncontrollable sleep. Narcolepsy can also cause a lack of muscle function and sleep paralysis. This can be particularly dangerous if it happens while driving or operating machinery. Symptoms typically present themselves between seven and 25 years old, but can occur earlier or later.
Hypersomnia disorder
Individuals experiencing hypersomnia have difficulty staying awake during the day., While symptoms of hypersomnia sound similar to narcolepsy, both conditions differ in a key way. While both lead to inordinate amounts of sleep, hypersomnia lacks the uncontrollable sleep that characterizes narcolepsy.
Restless legs syndrome (RLS)
Individuals facing RLS experience leg discomfort that can be alleviated through movement. This discomfort can present itself through burning, itching or tingling sensations. These symptoms typically occur the most at night which makes it especially difficult to rest since these sensations intersect with typical resting times. An estimated seven to 10 percent of the population experience RLS.
Circadian rhythm sleep-wake disorders
A circadian rhythm disorder affects a person’s internal clock, disrupting their natural sleep-wake cycle. These disorders can cause difficulty falling asleep at night, or the desire to sleep during traditional waking hours. While surveys show that up to 3% of adults experience a circadian rhythm disorder, these numbers may be higher since symptoms can be confused with insomnia.
Ways to improve sleep and mental health
If you or a loved one have been diagnosed with or suspect you may have a mental health condition or sleep disorder, you must address these symptoms. While you may be able to treat some of the symptoms yourself to an extent, a professional will typically give a more holistic understanding of your condition along with a comprehensive treatment plan. Either way, finding a sufficient treatment plan should be a priority. Otherwise, some conditions can worsen over time or have significant impacts on health and well-being.
Improving sleep hygiene and habits
One way to address potential sleep disorders is by recognizing your sleep habits and making changes to potential problem areas. The act of sleep hygiene is to stay consistent in these habits.
Experts suggest some tips for improving sleep through good sleep hygiene.
- Establish a schedule: Create a consistent routine for going to bed and waking up. This regulates your circadian rhythm and helps you feel more tired during the night.
- Create a comfortable sleep environment: Take measures to ensure your bedroom is dark, quiet and comfortable. If not, you’ll most likely wake up throughout the night and be unable to fall back asleep.
- Avoid food and drink before bed: This includes meals, caffeinated beverages and alcoholic drinks. Alcohol and caffeine can be disruptive to sleep. The body also processes food differently at night, storing it as fat rather than allowing the calories to burn off naturally during the day.
- Remove electronics and other distractions: Try to refrain from using smartphones, watching TV or listening to music in the bedroom. Having access to these activities and devices can cause distractions during the night. Noise and light from devices disrupt sleep and lead to less restful slumber.
Diagnosing and treating sleep disorders
To diagnose sleep disorders, a healthcare professional will want to analyze some data related to your sleep health. This includes looking at medical history, performing sleep studies, or requiring you to maintain a sleep journal, detailing your sleep habits.
These measures are meant to observe any abnormalities or potential triggers that cause an issue. The more complete a picture of a patient’s sleep schedule and habits, the more effectively the doctor will be able to diagnose and offer treatment.
Who treats sleep disorders and mental health concerns?
Depending on the specific disorder, the treatment strategy will vary. As such, the healthcare professional needed will vary as well. However, several specialists and general practitioners often specialize in certain conditions and can help treat these conditions.
- Primary care physician: Often, a treatment journey will begin with the patient’s primary care physician. While they may not be able to diagnose these conditions, they’ll be familiar with a patient and their history, so they’ll be able to recognize signs of abnormalities. They can then offer a referral to a specialist who can offer a more specific diagnosis and subsequent care.
- Psychologist: A psychologist can help identify underlying factors that lead to issues with sleep or mental health. A psychologist may ask a patient to make a sleep diary detailing sleep habits to identify whether there are underlying factors contributing to a condition.
- Therapist: A licensed psychotherapist can help patients through psychotherapy. This can be especially helpful for patients where stress and day-to-day worries lead to issues with sleep.
- Psychiatrist: As opposed to a therapist, a psychiatrist has a doctorate specializing in mental health treatment. These physicians can diagnose and treat mental illnesses with a plan combined with medication and lifestyle changes as needed.
- Somnologist (Sleep physician): A somnologist is a sleep doctor. These specialists diagnose and treat patients with sleep disorders. Using examinations like sleep studies, somnologists seek to understand a patient’s sleep issues, figure out the cause, and then take measures to treat patients.
These healthcare professionals will examine an individual’s situation and condition. From there they may prescribe a treatment plan.
Types of therapy
Treatment options may vary based on the individual and their mental health condition or sleep disorder. Some forms of therapy may even be useful for addressing multiple issues. In general, however, the following treatments are the most commonly prescribed:
- Psychotherapy: In psychotherapy, a patient will talk through their issues with a licensed mental health professional — either individually or in a group of others that experience the same condition. Psychotherapy may be helpful in several contexts, including working through issues that may lead to a lack of sleep.
- Cognitive and behavioral therapy (CBT): As an alternative to medication, cognitive-behavioral therapy can be used to treat insomnia and some mental health conditions. With the help of a mental health professional, patients will learn to recognize behavior that leads to symptoms, and find ways to change this behavior. CBT can be extremely effective because each recommendation is catered to the individual and their needs
- Pharmacology: Medication can often quell the symptoms of a condition. In some cases, pharmacology is part of a long-term treatment plan. Medication may also be used as symptoms occur or as part of a combined regimen along with therapy or other treatments.
- Light therapy: Often associated with treatments for seasonal depression, light therapy involves daily exposure to bright light for at least 30 minutes. Since light can affect a person’s internal clock, light therapy can be a useful treatment for circadian rhythm disorders.
- CPAP therapy: Continuous positive airway pressure (CPAP) treatment involves the use of a device to assist with breathing through the night. This therapy helps treat breathing-related sleep disorders like sleep apnea.
- Exercise: Experts say that getting exercise can help people sleep better at night. While it may seem logical to assume that exercising before bed would tire the body out and make sleeping easier, the opposite may be true. Exercise can release endorphins that lead to increased brain activity. Experts suggest refraining from exercise within two hours of an individual’s intended bedtime.
Each individual’s experience with mental health and sleep disorders is different. As a result, a person’s response to treatments can vary as well. Consulting a professional will help to give a person personalized treatment catered to their individual needs.
Additional mental health resources
People experiencing or looking to learn about mental health conditions can look at the following links for useful information and other resources.
- SAMSHA’s National Helpline: This service offers 24/7 support for those with mental illness and their families, and can help to direct people to important help and resources.
- MentalHealth.gov: This government resource offers information, articles, and guidance directed at different groups of people who may be experiencing mental health issues.
- National Alliance on Mental Illness: This organization promotes advocacy, education and support for people and families affected by mental illness.
Additional sleep disorder resources
The following links provide some resources for people with sleep disorders trying to understand their options and looking for information.
- MyApnea.org: This resource provides information and support from others with sleep apnea.
- AASM Sleep Education: This page provides resources and articles focusing on various aspects of sleep. This includes information on a variety of sleep disorders.
- Healthy Sleep Diary: This downloadable sleep diary helps to keep track of your sleep schedule and record various details about sleep habits.
