Recent studies have shown that many Americans are finding it harder and harder to get a decent amount of sleep, but why? Studies have pointed to physical issues, like obstructive sleep apnea, as well as mental health issues, like stress and depression.
It's been proven that losing weight can greatly improve symptoms of sleep apnea. But what about treating mental health issues? In a question similar to the "chicken versus the egg" conundrum, could sleep problems traditionally thought to be symptoms of mental disorders actually be the cause of the mental disorders? Could treating sleep disorders help heal mental health problems?
As research expands, answers to questions like this are sought after.
It’s obvious that our bodies and minds want and need sleep, but what exactly is happening when we start snoozing?
According to the Harvard Medical School, there are two main categories of sleep, each with its own important functions.
During rapid eye movement, or REM sleep, heart rate and breathing return to levels comparable to those seen when awake. At the same time, our bodies become paralyzed, ensuring that we don’t act out our dreams. This period of dreaming has been shown to contribute to emotional well-being, memory and learning ability, though the manner of connection is not yet entirely understood.
The National Sleep Foundation (NSF) reports that during the deepest stages of sleep, our body also grows and repairs tissues, restores energy and releases hormones essential to functions like muscle development.
When in “quiet,” or non-REM sleep cycles, heart rate and body temperature decrease and breathing slows and becomes regular. In this stage the immune system is bolstered and strengthened.
Sleeping builds our immune system and can even contribute to maintaining a healthy weight. According to the NSF, ”If sleep is cut short, the body doesn’t have time to complete all of the phases needed for muscle repair, memory consolidation and release of hormones regulating growth and appetite.”
Furthermore, it seems that the disruption of sleep affects stress hormones and neurotransmitters, interrupting one’s ability to think, process information, and regulate their emotions. It is because of this mechanism of sleep that, according to Harvard Medical School, “insomnia may amplify the effects of psychiatric disorders, and vice versa.”
Harvard Medical School reports that while 10-18% of American adults overall are affected by chronic sleep issues, anywhere from 50-80% of patients in an average psychiatric practice are plagued with these problems.
The Sleep-Mental Health Connection
It has traditionally been the assumption that insomnia and other sleep problems were simply symptoms of the psychiatric issues that these patients with sleep issues were already being treated for.
However, the frame through which these issues are considered is starting to shift.
“The medical profession is becoming more aware of the correlation between sleep and emotional disorders,” said William Kohler, M.D., Medical Director of the Florida Sleep Institute, in an interview with dailyRx.
Some research has now shown that sleep issues might increase the likelihood of mental health problems. Harvard Medical school reports that it might even be the case that sleep problems “might even directly contribute to the development of some psychiatric disorders.”
If this is shown to be true, it might mean big breakthroughs for some sufferers of mental health disorders. For some, they might be able to improve their psychiatric symptoms by getting a handle on their sleep issues.
“I see it fairly often in patients that overall well being is improved with appropriate treatment of their sleeping disorder,” said Dr. Kohler. “An enormous correlation exists between the two because the neurotransmitters involved in both emotional disorders and sleep are similar.”
Sleep and Specific Disorders
Types of sleep disorders, like types of psychiatric disorders, includes a long list of issues. Common sleep problems are insomnia, sensations that cause disruptive movement (restless legs syndrome), narcolepsy and sleep apnea.
The interaction between these issues and mental health problems varies from patient to patient and disorder to disorder, but can be significant. According to The Harvard Medical School, “the overlap between sleep disorders and various psychiatric problems is so great that researchers have long suspected both types of problems may have common biological roots.”
Patients with bipolar disorder experience periods of extreme ups called mania and extreme lows called depressive states. Since sleep is tied to emotional regulation, when issues with sleep are present, the moods of bipolar patients can be affected and relapses or episodes can be triggered.
Studies have found that 69-99% of bipolar patients suffer from insomnia or a decreased urge to sleep during periods of mania. Conversely, anywhere from 23-78% sleep too much (a condition called hypersomnia) during a depressive period.
Sleep problems are common for those with various types of anxiety disorders, perhaps most notably, PTSD, or post-traumatic stress disorder. Insomnia in PTSD patients can block benefits from therapy and extend a pattern of negative and painful memories and emotions.
The presence of insomnia might also indicate an increased risk of developing anxiety. A Michigan longitudinal study that followed 1,000 21-30 year-old adults showed that sleep problems were prefaces for an anxiety disorder 27% of the time.
Patients with ADHD, or attention deficit hyperactivity disorder, also often suffer from a variety of sleep issues, including short sleep cycles, restless sleep and trouble falling asleep. According to Harvard Medical School, “the symptoms of ADHD and sleeping difficulties overlap so much it may be difficult to tease them apart.”
It is estimated that anywhere from 65-90% of people with major depression also are affected by some type of sleep disorder, most commonly insomnia.
Much like with anxiety, some studies have shown that sleep disorders can lead to an increased risk of depression. In the Michigan study mentioned earlier, people who reported instances of insomnia were four times as likely to suffer from depression three years down the road. In this study, the presence of sleep problems acted as harbingers of later depression 69% of the time.
Much like with bipolar disorder, the mood-managing aspect of sleep can severely affect people with depression. According to Harvard Medical School, “Depressed patients who experience sleep disturbances are more likely to think about suicide and die by suicide than depressed patients who are able to sleep normally.”
While the mechanisms of connection and causation are still being explored, the tie between sleep and mental health is clear.
An easy way to help take care of yourself mentally is to try to get a good night’s sleep, and seek professional help if you are having problems.
Even if a causal relationship between sleep problems and psychiatric problems is not yet 100% clear, there are plenty of proven benefits and functions of sleep. Talk to your doctor if you are in need of grabbing a few more Z’s.