Mental health and sleep are closely related. Sleep problems frequently accompany mental illness, and can even be the first warning sign of a disorder. In turn, lack of sleep worsens mental health symptoms, creating a vicious cycle.
Mental illness is common, with almost 20 percent of Americans suffering from at least one mental health disorder. While only 10 to 18 percent of the general population experience sleep issues, as many as 50 to 80 percent of people with mental illness have trouble sleeping.
Mental health disorders are the largest cause of insomnia. 40 percent of insomniacs and over 46.5 percent of hypersomnias have a comorbid mental health disorder. On the other hand, only 16.4 percent of people have a mental health disorder without any kind of sleep issues.
Sleep problems are closely correlated with ADHD, anxiety disorders, bipolar disorder, depression, and schizophrenia. Below we’ll review how sleep affects several mental health disorders, and provide tips for getting better sleep.
Schizophrenia and sleep
Schizophrenia affects 1 percent of people, or 3 million Americans. Onset often occurs in late adolescence or the early 20s. Individuals with schizophrenia suffer from psychoses such as delusions and hallucinations, and experience difficulty focusing their thoughts and expressing themselves.
Up to 80 percent of people with schizophrenia have sleep problems, including:
- Irregular sleeping hours. They may fall asleep anytime during the day or night rather than during the typical overnight sleep period of most people. They may have consistently delayed melatonin release that shifts their sleep pattern later than normal, slowly shift their circadian rhythm later and later each day, or follow no consistent sleep-wake patterns at all.
- Irregular sleep quantity. They may get too much (hypersomnia) or too little (insomnia) sleep, as a result of medication side effects, fear or anxiety due to hallucinations (which may cause them to sleep more to escape, or conversely to be afraid of nightmares), or the irregular sleep hours cited above.
- Sleep apnea. Individuals with sleep apnea literally stop breathing during the night, due to blocked airways or a miscommunication between the brain and the breathing muscles.
- Less refreshing sleep overall. Due to the issues described above, people with schizophrenia experience less refreshing sleep overall because they have trouble getting sufficient amounts of REM sleep.
For many people with schizophrenia, an onset of sleep problems can be a warning sign that psychosis is starting or returning.
A 2012 study of mice found that abnormalities in the SNAP-25 gene are linked to schizophrenia as well as disrupted sleep-wake cycle, suggesting that resolving sleep issues may less or resolve schizophrenia symptoms.
Anxiety disorders and sleep
Generalized anxiety disorder, panic disorder, obsessive-compulsive disorder, social phobias, and PTSD are all associated with having anxious thoughts while trying to fall asleep at night and related insomnia.
Panic episodes may waken an individual with panic disorder from sleep, thus disrupting their overall sleep quality. Likewise, individuals with PTSD are prone to vivid re-experiencing traumatic nightmares which heighten their bedtime anxiety and also cause interrupted sleep.
Individuals with mood and anxiety disorders may be prescribed various medications such as antidepressants and mood stabilizers which can further interfere with sleep.
Insomnia not only accompanies anxiety; it can cause it. When individuals experience chronic sleep deprivation, it disrupts their serotonin and gamma-Aminobutyric acid neurotransmitter levels, which can result in anxiety. One study found that having insomnia increased one’s risk to have yet another mood or anxiety disorder one year later.
Depression and sleep
Insomnia is one of the biggest risk factors for depression. Lack of sleep worsens mood, and the effect is even worse for individuals with a mood disorder. Depressed people with sleep issues have a higher risk of suicide than depressed individuals without sleep problems.
Treatment is also complicated. While antidepressants boost mood and alertness to help treat depression, that same alertness makes the insomnia persist – and not addressing the insomnia can make individuals less responsive to treatment. But certain prescription drugs for insomnia, like Rozerem, may worsen depression. The key is to find a treatment plan that helps both issues, but not at the expense of either.
Depression and sleep issues are bidirectional. That means the problems of one can worsen the other. The good news is, that also means the improvement of one often fixes the other. For example, 35 million Americans suffer from mild depression (dysthymia). For many, their comorbid insomnia goes away once they begin taking antidepressants.
Bipolar disorder and sleep
Bipolar disorder affects 3 percent of Americans, or 6 million adults. In addition to severe changes in mood, behavior, and energy levels, individuals with bipolar disorder may also experience the following sleep problems:
- Insomnia, or difficulty falling or staying asleep
- Hypersomnia, or oversleeping, especially during depressive episodes
- General sleeplessness, where individuals feel fine even when they’ve had significantly less sleep, although this abnormal sleeping pattern eventually catches up with them
- Delayed sleep phase syndrome, where the individual has a delayed circadian rhythm, causing them to naturally start to fall asleep or wake up later than others and experience excessive daytime sleepiness as a result
- Irregular sleep-wake patterns from manic episodes and related hyperactivity at night
- REM sleep issues like vivid nightmares
- Sleep apnea affects one-third of individuals with bipolar disorder, resulting in less restful sleep overall and excessive daytime sleepiness
For individuals with bipolar disorders, different sleep issues may arise depending on when they are in a manic or depressive state.
In fact, for 75 percent of individuals with bipolar disorder, sleep problems are one of the biggest warning signs that they are about to experience a manic episode. For example, sleep loss from chronic sleep deprivation or even a night of jet lag can induce a manic episode. Manic periods are so arousing that individuals can go for days without sleep, or sleep drastically less amounts than usual and not feel tired. However, that lack of sleep makes its mark in other ways, as they’ll still experience the other symptoms of sleep deprivation felt by everyone, including increased irritability, trouble focusing, reduce judgment, depressed mood.
As they enter depressive episodes, bipolar people may experience insomnia or hypersomnia, both extremes which cause further imbalances in mood and increased anxiety.
In between manic and depressive episodes, individuals with bipolar disorder experience poorer quality sleep, occasional insomnia, and interrupted sleep.
Sleep tips for individuals with mental health disorders
There are various psychotherapies that treat mental illness, sleep therapies for sleep problems, and other behavioral changes that can help individuals with mental health disorders sleep better at night.
1. Practice good sleep hygiene.
It all starts with good sleep habits. Good sleep hygiene includes keeping the bedroom cool, dark, and quiet, and limiting stimulating activity before bed, such as watching television, using the computer, or engaging in heavy exercise. Heavy meals, as well as alcohol, drugs, and caffeine, should be avoided in the early evening and late night hours.
2. Be careful with napping.
For individuals with excessive daytime sleepiness, power naps of 20 minutes can help give a sense of refreshment. However, naps longer than 20 minutes should be avoided as they can contribute to insomnia later that night.
3. Try sleep therapy.
There are various psychotherapy options that assist individuals with mental health disorders. There are also many specific therapies designed to treat comorbid sleep problems.
- Cognitive behavioral therapy (CBT) has proven very effective for treating insomnia. CBT first helps the patient recognize their harmful or disruptive thought patterns and habits. Then, they learn to replace them with positive thoughts and better ways to cope so they can calm anxieties surrounding sleep as well as the rest of their lives. One study in particular found that six 20-minute sessions of CBT resulted in a nearly 50 percent decrease in insomnia, 20 percent decrease in depression and anxiety, and 25 percent decrease in paranoid thoughts, and 30 percent decrease in hallucinations.
- Sometimes taught as part of CBT, meditation and deep breathing exercises can soothe anxious thoughts and help relax the body for sleep. You can find audio files of guided meditation and relaxation exercises on the MIT Medical website.
- Sleep restriction therapy involves setting a strict bedtime and waketime, and only staying in bed for that allotted amount of time, regardless of how much sleep the individual actually enjoys. Eventually the body gets used to the new sleep-wake cycle and begins to sleep and wake at the proposed appropriate time. A small 2013 study found that sleep restriction therapy improved sleep and reduced symptoms of insomnia for patients with bipolar disorder.
- Chronotherapy works similarly by gradually adjusting the bedtime and waketime. It’s a newer therapy and the research is still bearing out.
- Bright light therapy helps reset a person’s circadian cycle and make them feel more awake in the morning. Exercising outside in the morning in areas of bright sunlight can provide a similar effect.
4. Explore natural remedies.
Melatonin supplements help kickstart melatonin production in the brain. These can be helpful for insomnia or anyone who has difficulty falling asleep due to a period of mania or delayed sleep-phase syndrome. Valerian root can also help induce sleep. Both melatonin supplements and valerian root are widely available at pharmacies.
5. Keep a sleep diary.
If you’re concerned you may have a comorbid sleep disorder, a sleep diary can help you track your sleep habits. Note when you fell asleep and when you woke up, the total amount of time you were asleep, and anything abnormal that happened during your sleep, such as nightmares or snoring. If you find you’re not getting enough sleep, you can meet with a sleep specialist for a diagnosis and share your diary with them.
General mental health resources
- Managed by the U.S. Department of Health & Human Services, MentalHealth.gov shares resources on recognizing signs of a disorder, and treatment options. The SAMHSA Treatment Referral Helpline (877-726-4727) connects individuals with live help finding local mental health and treatment services, available 8am to 8pm Eastern on weekdays.
- The National Alliance on Mental Illness manages multiple support programs, hosts fundraising and awareness events, and provides mental health resources on its website. Their helpline is available weekdays from 10am to 6pm Eastern via phone (800-950-NAMI) or SMS (text “NAMI” to 741-741).
- The National Institute of Mental Health is the governmental research agency for mental health disorders. The site shares the latest news, research findings, and educational resources for mental illnesses.
- The TeenMentalHealth.org toolbox on healthy sleeping breaks down the connection between sleep and mental health. The site’s other resources aim to translate scientific knowledge into learnings applicable to teenagers.
Resources for schizophrenia
- The National Institute on Mental Health provides a detailed overview of schizophrenia, symptoms, risk factors, treatments, and options for joining clinical studies.
- Living with Schizophrenia is a UK-based advocacy organization that provides educational information on schizophrenia and connects affected individuals, caregivers, and health professionals.
- The Schizophrenia Research Forum shares the latest research findings and scientific papers related to schizophrenia.
- Individuals with schizophrenia, caregivers, and family members can connect with peers on forums such as the Schizophrenia subreddit, Psych Central, PsychForums, and Schizophrenia.com.
Resources for anxiety disorders
- The National Institute on Mental Health provides a detailed overview of different types of anxiety disorders, symptoms, risk factors, treatments, and options for joining clinical studies.
- The Anxiety and Depression Association of America is a non-profit focused on preventing anxiety and depression mood disorders. They provide resources for individuals and health professionals, including a local therapist directory, and share helpful diagnostic FAQs for individuals.
- Multiple online forums connect individuals with anxiety disorders, including the Anxiety subreddit, the Mental Health Forum, AnxietyForum, Anxiety Central, and Social Anxiety Support.
Resources for depression
- The National Suicide Prevention Lifeline is available 24/7 at 800-273-8255 for free, confidential support. Please call for immediate help from trained health crisis professionals.
- The National Institute on Mental Health provides a detailed overview of depression, symptoms, risk factors, treatments, and options for joining clinical studies.
- The UCLA Sleep Disorders Center explains the connection between sleep and depression, and how it can affect different age groups and genders differently.
- Individuals with depression and suicidal feelings can discuss their thoughts privately and lean on their peers for support on multiple online forums, including the Depression subreddit, Depression Forums, Take This Life, and Suicide Forum.
Resources for bipolar disorder
- The Depression and Bipolar Support Alliance organizes peer support groups, shares diagnostic and treatment information, and hosts events to promote overall wellness for individuals living with depression or bipolar disorder.
- The National Institute on Mental Health provides a detailed overview of bipolar disorder, symptoms, risk factors, treatments, and options for joining clinical studies.
- The International Bipolar Foundation connects affected individuals and their caregivers with local treatment resources, events, and support groups.
- Two popular blogs written by individuals with bipolar disorder are BPKids and Bipolar Lives. Both discuss managing weight gain while taking medication for bipolar disorder.
- There are various forums dedicated to bipolar disorder, including the bipolar subreddit, the BpHope Community, and Psych Central.