Unfortunately, according to research conducted by The National Institute of Mental Health, one in five US citizens struggles with some type of mental illness. The severity and duration vary from person to person. A devastating fact is that only a very small percentage of that people is under medical treatment.
Sleep disorders are potential symptoms of almost every mental disease. About 40% of people who seek medical help for sleeping problems, physicians discover they also have a psychiatric condition. On the flip side, it’s very rare to struggle with a sleep disorder without a mental health problem. Less than 20% of people with a mental health condition don’t have any sleep issues.
We could say that sleep quality can be used to measure the quality of our mental health. For this reason, psychiatrists always ask patients about sleep behaviors and habits when making a diagnosis. It is important to mention that sleep disorders often coexist with depression, panic disorders, ADHD, anxiety, schizophrenia, and bipolar disorder. Sleep issues associated with these mental health disorders make it more challenging to manage and alleviate the symptoms and to experience the benefits of medical treatment. Learn how mental illness and sleep disorders are connected.
The Relationship Between Mental Illness and Sleep
Poor sleep can be a symptom, but also a cause of mental illness. Sleep issues can contribute to the development of mental disease, prolong it and make it more difficult to cope with. As mentioned in the beginning, sleep disorders are commonly comorbid with other mental disorders. Insomnia is the biggest sleep problem psychiatric patients struggle with, apart from their condition. According to studies, 40% of insomnia patients and 45% of hypersomnia patients have a mental illness. People without mental illness have significantly lower rates of insomnia. The difference is so striking that nobody doubts the connection between sleep disorders and mental illness anymore.
You may be wondering how much sleep people with a mental health condition get? According to surveys, people who have mental illness often report their sleep is nonrestorative. They also struggle with midnight awakenings, falling asleep too late, waking up too early and waking up feeling fatigued.
Studies show that people with a mental health condition experience significant changes to their sleep architecture. Typically, they spend more time in lighter sleep that is less restorative, and less time in deep and REM sleep. Lack of sleep and the effects of sleep deprivation make it more challenging to manage and cope with the symptoms of their mental illness. Due to sleep deprivation, these patients are more emotionally sensitive, and irritable. They also may have a hard time to regulate their emotions, reactions and are prone to poor decision making. It’s easy to see how this mindset makes it rather hard to cope with the mental disease.
The worst thing is that mental illness and insomnia aggravate the effects of each other, creating a vicious cycle that once starts, pushes the patient in a downward spiral. This makes treating both conditions particularly hard. Let’s take a closer look at some mental diseases that are associated with sleep disorders.
Unfortunately, many US citizens struggle with different kind of anxiety disorders, starting from general anxiety, social anxiety and obsessive-compulsive disorder (OCD), to phobias, PTSD and panic disorder.
Anxiety is typically a reaction to stress, and stress, no matter how insignificant, affects the nervous system. Individuals suffering from anxiety experience stress on a more acute level, and it typically occurs due to obsessive or anxious thoughts or due to PTSD. Regardless of the cause of their stress, they cannot process it as a healthy person.
Their anxiety constantly keeps their nervous system alert and makes it very difficult to relax and unwind before sleep. When we are under a lot of stress, a stress hormone called cortisol significantly raises and prevents the production of the sleep-inducing hormone melatonin. The more stressed we are, the more cortisol is produced, further decreasing melatonin levels and making it almost impossible to fall asleep at night.
People suffering from anxiety are generally prone to experiencing insomnia or hypersomnia. Insomnia is the inability to fall or stay asleep. Many patients suffer from anxious thoughts or struggle with anticipatory anxiety toward certain phobia triggers which is so overwhelming that it makes it impossible to relax the mind and fall asleep in the evening.
When it comes to hypersomnia or oversleeping, patients often oversleep as a response to stress or simply exhaustion from insomnia. Insomnia and hypersomnia commonly occur together in many cases of anxiety disorders.
Apart from the two, nightmares are a common symptom of PTSD, and in them, the patient re-experiences and relives the trauma he or she went through in the first place. Those who have panic disorder may experience nocturnal panic attacks. A nightly panic attack typically wakes up the affected person who feels extreme panic or fear. The attack can also be accompanied by sweats, chest pain, and increase heart rate.
To treat anxiety-related sleep disorders, it’s best to practice psychotherapy, especially cognitive behavioral therapy (CBT). CBT is considered one of the best ways to treat insomnia and a variety of mental health issues. The principles of CBT include reframing your negative thoughts, educating yourself about healthy emotional responses, and learning to recognize the thoughts and behaviors interfering with your daily life and sleep. The point is to replace your negative reactions and thoughts with healthier reactions.
It’s estimated that around 16 million adults suffer from depression. People struggling with this mental illness typically have suicidal ideas, experience feelings of sadness and despair and lose interest in all the activities they previously enjoyed.
Individuals with depression commonly suffer from insomnia or hypersomnia. According to studies, insomnia is a major risk factor for suicide among the population. One study found that individuals with insomnia are 6 times more likely to develop depression, and those with both conditions are more likely to stay depressed. In addition to insomnia, people with depression may be prone to sleep problems such as hypersomnia or oversleeping, and obstructive sleep apnea (OSA). Around 40% of young adults and 10% of older adults with depression also suffer from oversleeping. When it comes to OSA, this sleep disorder is also a significant risk factor for developing depression.
Unfortunately, antidepressants used to treat depression can make insomnia even worse. Sometimes, antidepressant medications such as amitriptyline, trazodone, or mirtazapine can be used to treat insomnia. These medications are known as SSRI drugs. Antidepressant medicines can negatively affect insomnia by making the patient feel active and energetic which makes it difficult to fall asleep at night. However, these drugs can help the patient alleviate sleep maintenance insomnia, or ability to stay asleep at night.
In most cases, treating depression, especially in milder cases, makes insomnia go away. Similar to treating anxiety-related sleep disorders, to handle insomnia caused by depression, it is best to practice CBT. In case the person suffers for the seasonal affective disorder (SAD), light therapy, which involves sitting in front of a specialized light device for a set period of time each day, has shown great results. The goal of light therapy is to reset the patient’s circadian clock. Typically, the patient is exposed to bright light in the morning to help him wake up and prepare for the day, while early afternoon treatment helps them to stay awake and avoid hitting the hay too early.
ADHD is a neurobiological disorder typically diagnosed in childhood. It’s estimated it affects 5% of children and that it can persist in adulthood as well. The disorder is characterized by behavioral changes and symptoms such as hyperactivity, impulsivity, and inability to focus.
Sleep problems associated with this disorder are mostly fragmented sleep. Insomnia occurs in 75% of patients, and some researchers believe this occurs due to a delayed circadian rhythm. Apart from sleep maintenance insomnia, these individuals also struggle with midnight awakenings.
Apart from insomnia, common ADHD-related sleep disorders include excessive daytime sleepiness, sleep-disordered breathing (sleep apnea), periodic limb movement and restless leg syndrome. Both PLMD and RLS are characterized by an urge to repeatedly move the legs while lying in bed or during sleep. The movements are so intense that the affected person finds relief only by jerking their limbs which makes falling asleep and resting pretty difficult.
Excessive daytime sleepiness is another common symptom of many ADHD- related sleep disorders. Due to their sleep problems, these patients are more likely to be tired during the day, even if they get the same amount of sleep as people without ADHD.
Unfortunately, the medications used to treat attention deficit disorder often cause sleep problems. Some ADHD medication has stronger effects on sleep. In case you suffer from ADHD and experience sleep problems, you should talk to your doctor and look for alternative solutions such as CBT. Cognitive behavioral therapy is a special method for treating various conditions, including sleep problems, by learning to develop healthy responses to your symptoms and changing your thought patterns and negative behavior. When it comes to CBT for ADHD, the focus is to calm down the body and the mind and to alleviate hyperactivity symptoms. Stimulus control techniques and exercises that involve progressive muscle relaxation are also recommended. Other treatment options that showed great results are sleep restriction therapy, where therapists set a sleep schedule for their patient. For success, the patients must strictly stick to the schedule and spend only those hours in bed. Naps and sleep time outside of that schedule are not allowed. In case the patient has a delayed circadian rhythm, light therapy might be recommended. Lastly, if a patient is struggling with RLS or PLMD, using a weighted blanker may help to alleviate symptoms. The general rule is to use a blanket that weighs 10% of your body weight, plus 1 pound.
Schizophrenia is a severe mental illness that doesn’t affect many people. It’s estimated, one 1% of Americans have this mental disease. This psychosis prevents the patient to process reality, manage their emotions, and communicate with others. Severe hallucinations also accompany the condition. Sleep problems related to this mental disease include irregular sleep patterns and inconsistent sleep volume.
Patients who have schizophrenia tend to sleep at any point during the day or night. Scientists believe this is caused by a delayed melatonin release that shifts the circadian rhythm. When it comes to inconsistent sleep volume, patients typically don’t get enough sleep on a daily basis. Sometimes they are prone to insomnia, and sometimes they oversleep. Sleep problems also occur as a side effect of the strong medications they are taking.
In order to treat schizophrenia, psychiatrists use the first generation of antipsychotics, but also some atypical ones, such as clozapine, olanzapine, and quetiapine. The last three mentioned have positive effects on sleep, and typically help schizophrenic patients to sleep longer. Some medications help to improve their slow-wave sleep, while some increase REM latency, similar to SSRI drugs help people with depression. CBT can also aid in alleviating the psychotic symptoms of schizophrenia.
Bipolar disorder affects around 3% of US citizens. People suffering from this condition experience severe mood swings in behavior, energy, and mood. These swings also affect their sleep. If the person is in a state of mania, they will be full of energy and sleep very little. Even if they go long hours without snoozing, they won’t feel the need to sleep. When it a state of depression, the patient will probably experience hypersomnia or oversleeping. Irregular sleep patterns are also common in both states. Apart from the mentioned, bipolar disorder patients may also struggle with sleep apnea. Sleep-disordered breathing can sometimes spark another manic episode or make it hard to deal with episodes of depression. Whatever sleep issues these patient experience, it makes it generally more difficult to handle the symptoms of bipolar disorder.
Even in between their episodes, patients with disorder experience lower quality sleep, and have more difficulties falling asleep and staying asleep than healthy individuals. In order to treat bipolar disorder-related sleep problems, it is best to practice cognitive behavioral therapy or CBT-I, a type of treatment specially developed to treat insomnia. Sleep restriction and stimulus control have also shown great results.