Poor sleep can make us feel down, worried, and stressed. So it’s no surprise that how well we sleep has a direct impact on our physical and mental health. Sleep problems such as insomnia are a common symptom of many mental illnesses, including anxiety, depression, schizophrenia, bipolar disorder, and attention deficit hyperactivity disorder (ADHD).
The relationship between insomnia and mental illness is bidirectional: about 50 percent of adults with insomnia have a mental health problem, while up to 90 percent of adults with depression experience sleep problems.
Sleep problems can also create a loop, slowing recovery from mental illness. People with depression who continue to experience insomnia, for instance, are less likely to respond to treatment for depression. They are also at greater risk of relapse than those without sleeping problems.
Emotional processing
It is unclear how insomnia makes a person more likely to develop mental illness. Research suggests, however, that it may affect our ability to process negative emotions.
In one study, sleep-deprived people were found to show greater emotional reactivity to unpleasant images than to pleasant images or images with neutral emotional content. People who weren’t sleep-deprived showed no differences in emotional reactivity.
In another study, brain scans revealed that people with insomnia showed greater activity in the brain’s emotional processing area when they used a strategy to reduce their negative reactions to images than when they did not use this strategy.
That suggests insomnia makes it difficult to react appropriately to negative emotions. This may exacerbate their sleep difficulties and make them vulnerable to experiencing depression.
Cognitive behavior therapy treatment of insomnia includes training in how to interpret emotional information less negatively.
There is also some evidence that mental illnesses may arise from problems within brain circuits that overlap with those that regulate our body clocks or sleepiness timing system.
Everyone needs sleep, but many of us have problems with it. You might recognize some of the experiences listed below, or have other difficulties with sleep that aren't mentioned here.
You might:
Have problems that disturb your sleep, such as panic attacks, flashbacks, nightmares, or psychosis
Find it hard to wake up or get out of bed
Often feel tired or sleepy – this could be because you're not sleeping enough, not getting good quality sleep, or because of health problems
Sleep a lot – which could include sleeping at times when you want, or need, to be awake.
If you're having problems sleeping, you might:
Be more likely to have psychotic episodes – poor sleep can trigger mania, psychosis, or paranoia, or make existing symptoms worse
Feel lonely or isolated – for example, if you don't have the energy to see people or they don't seem to understand
Struggle to concentrate, or make plans and decisions
Feel irritable or do not have the energy to do things
Have problems with day to day life – for example, at work or with family and friends
Be more affected by other health problems, including mental health problems.
Treating of mental illness and insomnia
Treatment of mental illness is likely to lead to some improvement in sleep problems, especially for mild symptoms of mental illness.
But insomnia tends to persist unless it is directly targeted for treatment. In one research trial, 51 percent of individuals who overcame depression after psychological treatment (cognitive behavior therapy) or medication were still experiencing insomnia.
The first-line treatment for insomnia is good sleeping habits and taking care of any underlying conditions that may be causing the problems with sleeping. But when these are not enough, other treatment options can be considered.
Good sleeping habits
The first-line treatment for the treatment of insomnia can include maintaining a regular sleep schedule, avoiding stimulating activities like exercise before bed, and having a comfortable sleep environment.
Relaxation techniques
Deep breathing, progressive muscle relaxation, and mindfulness can help people become aware of their bodies and decrease anxiety about going to sleep.
Medication
Many psychiatric drugs are used to promote sleep in people with insomnia. One should be careful regarding the risk of becoming “over-sedated” by using other drugs and alcohol when taking some of these medications. Doctors don't generally recommend staying on medication for more than a few weeks but there are a few medications that have been approved for long-term use.
Herbal remedies
Melatonin and valerian root are two herbal remedies that are available at many pharmacies and other locations. The effectiveness of these treatments has not been proven for most people, and neither treatment has been approved by the FDA.
Sleep restriction
This is a form of therapy that increases “sleep efficiency” by decreasing the amount of time that a person spends in bed awake. This involves very strict rules regarding the amount of time that a person can lay in bed at night which gradually increases over time.
Cognitive-behavioral therapy
This therapy can help you control or eliminate negative thoughts and worries that keep you awake.
Light therapy
Also known as phototherapy, this can be specifically helpful in people with a condition called “delayed sleep phase syndrome.”
Exercise is associated with improved sleep quality. Talk with your health care provider about the kind of exercise that will work for you.
There is some evidence that both medication and psychological treatment of insomnia (via cognitive behavior therapy) will improve the symptoms of mental health problems.
So can mental illness be prevented by treating insomnia?
A recent Australian research trial with 1,149 participants does suggest that treatment of insomnia reduces depression symptoms.
Participants who completed a cognitive behavior therapy-based insomnia intervention showed a lower incidence of depression symptoms than those who were given health information with no insomnia treatment content.
If you have insomnia, speak to your doctor. If warranted, he or she can refer you to a specialist sleep doctor or psychologist. They can assess how your insomnia and any associated mental health difficulties interact and tailor your treatment accordingly.