Insomnia is one of the more common sleep problems that people experience. In fact, one in three Americans doesn’t get enough sleep and around 10% of all Americans suffer from chronic insomnia. Roughly 20% of Americans experience short-term insomnia, which lasts around three months, and 35% experience brief bouts of it. In this article we will shed some light on the relationship between insomnia and mental health.
How is Insomnia Being Diagnosed?
Many people will use the term to describe their lack of sleep, but certain criteria need to be met before a diagnosis can be made. Indeed, a doctor does need to diagnose insomnia. What does that look like? As per the DSM (the Diagnostic and Statistic Manual of Mental Disorders), this is how insomnia is defined, thus this is used for diagnosis by professionals.
- Difficulty Getting to Sleep
- Once you do fall asleep, trouble staying asleep. Or, waking up early and being unable to get back to sleep (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181745/).
- Before you can be diagnosed with insomnia, the disturbances must be negatively impacting your ability to function at school, work or in managing your relationships and daily responsibilities. The symptoms must persist for three nights a week over at least three months.
There are far-reaching effects on the body that come with an inability to sleep. It isn’t just as simple as a rough night tossing and turning. It can result in daytime issues, too. There is a struggle to process information, solve problems, and carry out typical daily tasks. That’s just for starters, though.
Have you ever noticed how grumpy and irritable you are when you’ve had a rough night’s sleep? Now, imagine how awful that would be if it was a regular occurrence.
Then there’s the impact it can have on your diet. A lack of sleep leaves your body desperate for energy, and that is what drives you to eat nasty carbohydrates and sugary foods. It’s difficult to maintain a healthy diet when your body is craving a quick high.
Then, there’s the mental health aspect. Not only does insomnia often lead to depression, but it can also increase the risk of a substance abuse problem. A joint study (on an association between poor sleep and suicide in the elderly, Bernet, et al. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4283786/) found that adults, aged 66 to 90, who experienced poor sleep were are at a greater risk of suicide during the 10 year period the study ran.
Have you struggled with sleep? Have you spent nights tossing and turning because you feel anxious about an appointment, an interview, a move or an exam? Anxiety can make it difficult for your brain to relax, which is what you need to get to sleep.
That is something that everyone experiences every once in a while, but for anyone with mental health issues, it can be a more consistent one. If you suffer from anxiety or depression, then you already have an issue that will impact your ability to sleep.
The Bidirectional Relationship Between Mental Health and Insomnia
Insomnia can be affected by a wide range of social, physical, emotional, and mental issues. The relationship between mental health and insomnia is described as bidirectional. This simply means that one of them can exacerbate the other, and vice versa. The issue is that it’s difficult to determine which of the problems came first. For some, it starts with sleep issues and develops into a mental health issue. While others will suffer from insomnia because of their mental health issue(s).
If you suffer from anxiety, depression or bipolar disorder, then this increases the chance you have of developing insomnia (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3972485/). As many as 50% of people who struggle with insomnia are also dealing with a mental health disorder. Likewise, people who experience insomnia have a higher risk of developing depression.
Perhaps the most important point regarding the directional relationship is that no matter what caused the problem initially, either of them can worsen the other. So, if you started with a sleeping problem, it will likely have developed into anxiety. In turn, if it was anxiety you had, to begin with, it has probably affected your ability to sleep. It is very much a cyclical relationship.
On the flip side, if you can address one problem, it will likely also improve the other issue. This will, of course, require you to determine which problem came first. So, treating your anxiety or depression will likely help you get to sleep. Treating insomnia will help you manage the symptoms of anxiety and depression that you have experienced. So, improving one issue can benefit the other.
Generally, if you visit your primary care physician with a sleep problem, they will also look for symptoms of mental health issues.
Am I Depressed?
If you have trouble sleeping it doesn’t necessarily mean that you are depressed or suffering from any other mental health issues. However, if you are experiencing a sleep problem, then you are at greater risk of developing a mental health problem. So, it really is vital that you address a sleep problem as soon as possible.
Doctors have learned plenty about the nervous system over the years, the problem is we don’t have a clear picture of sleep regulation, anxiety, and mood and the brain processes responsible for them. There are regions of the brain that overlap and we don’t really know how they interact. We don’t know how these interactions influence. Of course, there may also be genetics at play, as well as the experiences in our life. So, that means that someone with insomnia isn’t guaranteed an anxiety or depression problem. There are many more factors at play than that, but we do know that the risk of a mental health problem increases when there are sleep issues.
If you are experiencing a bout with insomnia, then there will be a variety of symptoms that could indicate you have a mental health issue developing. If you are experiencing any of the following symptoms, then you should speak with your primary care physician about your sleep problems.
You feel depressed or sad
You have a lack of interest in your usual activities
- A lack of appetite
- Feeling guilty
- Feeling worthless
- Trouble concentrating
- Regular thoughts of death
If you experience any of these symptoms, you should visit your doctor. Your doctor can help you work through the symptoms to determine which issue preceded which, and come up with a treatment strategy to help you improve your problems. Addressing these issues as soon as possible can help prevent further issues. Not only can they recommend and educate you on sleep habits, but they may suggest a temporary use of medication.
Do I Have Insomnia?
In case you have an existing mental health issue, it does not mean that you will develop insomnia. It simply increases your risk. If you manage your mental health issue and have healthy sleep habits, then it should mitigate your risk of developing insomnia.
What are healthy sleep habits? The first step to achieving a healthy sleep habit is to go to bed at the same time each night and rise at the same time every morning. That means getting up early on your days off, too. You should also refrain from drinking caffeinated beverages after 2 pm, avoid alcohol, and develop a relaxing routine for your evenings. If you start to toss and turn, then you should get up and do something that will relax you. It might be yoga, it could be meditation, it may be writing out your worries, a soothing playlist or reading a book.
You should always avoid spending more time in bed when you are feeling anxious, frustrated or worried. If you want to create your own sleep routine, then writing in a journal before bed might be a good place to start. This is your opportunity to write out all of your worries and anxieties before your head ever hits the pillow. Both anxiety and stress can impact your sleep habits, even if you don’t have insomnia. Everyone is affected by anxiety and stress differently, so a quick resolution of stress is bound to improve your sleep habits.
It is possible that sleep problems persist even after your stress has been resolved. This can result in insomnia because you have gone from one stress to a new stress about your sleep problems. Either way, if sleep problems continue you should speak to your doctor to help you deal with your stress or any other issue that may crop up.
Insomnia & Mental Health
So, you get the picture of how the two are linked. Does it look the same for every mental health disorder or are there specifics for each of them? Well, as it turns out – there are specifics you can look for in different mental health issues.
Insomnia is a potential symptom for pretty much every mental illness. Around 40% of people who seek treatment regarding a sleep disorder also have a mental illness. On the flip side, it’s incredibly rare to have a mental illness and no sleep problem. Less than 20% of people with a mental illness don’t have an issue with sleep problems. You could look at sleep as a barometer for your mental health, whether you have an illness or not. This is why when you visit a psychiatrist they will ask you about your sleep routine.
When you have a mental illness as well as a sleep issue, it can exacerbate your symptoms and make management of your illness much more difficult. So, it’s a symptom as well as it can be a cause. A lack of sleep makes it difficult to deal with those mental health issues, and it can extend your struggle with them as well.
For mental health patients, they generally report that their sleep isn’t restorative. They wake throughout the night, wake up too early, struggle to fall asleep until the early hours, and when they wake up, they are still exhausted. There is no opportunity for REM sleep to kick in, and this is the most important stage of sleep. It’s that deep sleep where your brain stores memories, and repairs itself. This is why your behavior can be so affected by a lack of sleep. Therefore, it makes sense that a lack of sleep would inhibit your ability to manage your mental illness.
Now, we’ll break down the sleep disorders that commonly impact the most common mental health disorders and what you can do about it.
Watch this short video about insomnia and mental health:
Right now, around one in five people in America have some type of anxiety disorder. There is a variety of them – in addition to generalized anxiety disorder, there is OCD (Obsessive-Compulsive Disorder), PTSD (Post-Traumatic Stress Disorder), panic, and social anxiety disorders.
There are several sleep issues that are associated with anxiety disorders. Anxiety stems from stress, and whether it’s major stress or even a little stress, it has an impact on your nervous system. People who deal with anxiety disorders generally experience acute stress. It could be the trauma that they are coping with or obsessive thoughts. Regardless of the cause, the problem is that their nervous systems won’t just reset as it does for people who aren’t living with an anxiety disorder.
It’s this constant state of anxiety that has the nervous system on high alert all of the time. So, is it any wonder that people with anxiety orders have trouble sleeping? While your body produces melatonin to send you off to sleep, the stress hormone cortisol overrides it. The more stress you experience, the more difficult it is for your brain to produce the necessary melatonin to put you to sleep at night.
People with anxiety experience a number of sleep disorders, chief among them is insomnia. It’s common for people with anxiety to feel overwhelmed, so, there is a struggle to relax enough to get to sleep. For people with PTSD, nightmares are common. It’s much like a panic attack, but it interrupts sleep.
As far as treatment goes, CBT is probably one of the most effective ways to tackle insomnia that is related to anxiety. In fact, there’s a specialization that is devoted to dealing with insomnia. CBT is a common treatment course for anxiety. The specialized version simply helps the patient to reframe their negative thoughts. It’s all about educating patients about healthy habits for sleep and learning how to recognize the behaviors and thoughts that will interfere with sleep.
As many as 75% of people with depression also suffer from insomnia. This is a massive risk factor for suicidal ideation as well. In fact, insomniacs are six times more likely to suffer from depression. With bidirectional insomnia and depression working together, those people are at higher risk to stay depressed (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3108260/).
For women with depression, they are more likely to have sleep problems. There is also SAD (season affective disorder), this seasonal depression can impact sleep as well.
When it comes to treatment, there is an issue with antidepressants. One of the side effects of many of them that it can worsen insomnia. Which can contribute to worsening depression. This is often why people work with their doctors to find the right antidepressant. There are antidepressants that have a sedative effect and can help you manage both your sleep disorder as well as your mental illness. Don’t be afraid to speak to your doctor about changing medications if yours isn’t working for you.
In an ideal world, treating your depression should help you erase your insomnia problem. This is, of course, unless insomnia is the primary issue. Many people notice a difference in their sleep issues when they begin taking antidepressants.
CBT is also effective in treating insomnia in depression. As is light therapy, specifically for people with SAD. Light therapy is just using a special light to help you reset your circadian clock. That way, you will wake at the right time and be ready for sleep when the time comes.
ADHD (Attention-deficit/hyperactivity disorder)
It’s common for the medication and the symptoms that accompany ADHD to disrupt sleep. There are a number of sleep disorders that are common in people with ADHD. In addition to insomnia, ADHD patients often experience sleep apnea, as well as restless leg syndrome and periodic limb movement disorder. Though, this is more common in children.
As far as insomnia goes, around 75% of ADHD patients struggle with it. This could be down to a delay in circadian rhythm. Additionally, they struggle to get to sleep and once asleep, they struggle to stay asleep.
Many people experience heavy daytime sleepiness as a symptom. It’s this excessive tiredness that interferes with the overall quality of their life. This is more common in ADHD patients, even if they get the same sleep as people without ADHD.
In terms of treating insomnia in ADHD patients, there is more than one option. In addition to CBT, there are long-acting medications that can impact sleep routine. So, if you are an ADHD patient with sleep problems, it’s something that you need to discuss with your doctor. This can be addressed in your treatment plan.
When it comes to CBT for ADHD patients, it’s about calming the body and mind, as well as focusing on relaxing the muscles progressively. Sleep restriction therapy is often used to treat ADHD patients. This strict schedule is often an effective tactic. As is light therapy. A weighted blanket may offer relief to those who suffer from restless leg syndrome symptoms.
There are different sleep problems that come with bipolar disorder. This will depend on whether the patient is in a state of depression or mania.
Often, those with bipolar disorder often struggle with hypersomnia during their states of depression. During mania episodes, sleeplessness is the most common problem. Sleeplessness isn’t the same as insomnia. The former is where patients go through long periods with no sleep whatsoever. They don’t feel the need to sleep. Insomnia, however, can affect bipolar disorder patients whether they are experiencing depression or mania.
Irregular patterns of sleep are also common, whether it be delayed sleep phase syndrome or otherwise. This delay in circadian rhythm tires later than is considered normal. So, they go to sleep later and they wake up later, too. This disrupts their routine and can make it difficult to operate on a traditional schedule. It’s a little bit like constantly being jet-lagged.
Sleep apnea is also common in patients with bipolar disorder. It’s this that can spark episodes of mania, but it also makes coping with depression much more difficult. Ultimately, any sleep problem makes it more difficult to cope with the symptoms of your associated illness. With manic episodes, though, it catches up with a person, and it spirals into a deep depressive stage. A lack of sleep is a good indication that a manic episode is coming, even a simple upset in sleep routine can trigger this, including jet lag. Overall, bipolar disorder patients tend to experience a much lower quality of sleep than non-BPD individuals.
For BPD patients, the most effective way to treat insomnia is with cognitive behavioral therapy. However, sleep restriction therapy is also a particularly effective method. Some patients may respond to stimulus control techniques as well.
There have long been links between insomnia and mental health. Ultimately, how you proceed is dependent on which issue was the trigger. A good doctor will work with you to get to the root of whether your sleep disorder is causing your mental health issues or whether the opposite is true.
There are plenty of treatments available to get your body into a healthier sleep routine. It’s just a matter of finding the one that will work most effectively for you. In addition to CBT, light therapy, and sleep restriction therapy, there are plenty of things you can do at home to make a difference. Start with your diet, look at your caffeine intake, consider your bedtime habits and what you can do to put your body in the mood for sleep. Turn off the television, put your phone and tablet down, and engage in a relaxing activity in the hours before you head to bed.