It’s normal to experience a night of bad sleep every now and then. But when you can’t blame a string of sleepless nights on extra caffeine or a crying baby, your body could be sounding an alarm for your mental health.

“We need to look at sleep as a vital sign,” says Terry Cralle, MS, RN, a clinical sleep educator and expert with the Better Sleep Council (BSC). “You should bring up sleep at every single doctor’s visit, even if your healthcare provider doesn’t because if the problems persist, they’re rarely ever just sleep problems.”

What Comes First: A Sleep Problem Or A Mental Health Problem?

There’s such a strong bi-directional relationship between sleep and mental health that medical experts don’t have clear answers. “It goes back and forth, and they have to be addressed in tandem,” says Cralle. “But what we do know is untreated sleep disorders raise the risk of psychiatric issues.”

Sleep issues are a big part of the diagnosis and experience of many mental health conditions like bipolar disorder, schizophrenia, post-traumatic stress disorder (PTSD), and major depression, says Cralle. In fact, chronic sleep problems affect up to 80% of patients in a typical psychiatric practice. So it’s important to be aware of any long-lasting shake-ups to your normal sleep pattern and seek help to be sure you get the rest your mind and body need.

5 Sleep-Related Red Flags

Here’s what’s normal and what’s not when it comes to sleep behavior.  If any of these five common sleep-problem scenarios are familiar to you, speak to your doctor. While it’s true lack of sleep can do real damage to your mental health there are many effective ways to remedy a problem.

#1: You feel like you need less and less sleep.

“It’s a myth that you can acclimate to getting less sleep than you need,” says Cralle. Adults ideally should be getting at least seven to eight hours of sleep each night; getting less than that on a regular basis can land yourself in sleep deprivation territory, which has negative effects for both your physical and psychological health.

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Not only is lack of sleep linked to (and may trigger) depression, it can also exacerbate the symptoms of major depression and many other mental conditions including anxiety disorder and bipolar disorder. “The less sleep you get, the more prone you are to stress and being unable to handle stress,” says Cralle. “This is illustrative of all the mental health issues.”

#2: Your active mind won’t let you fall asleep.

Few things are worse than feeling wound up, wired, or wide awake when you’re supposed to be catching your Zzzzzs. Insomnia can start to creep in whether your mind’s racing, ruminating, or literally doing anything but shutting down.

“You should naturally fall asleep within twenty to thirty minutes,” says Cralle. “If you regularly spend one, two, or three hours trying to fall asleep, or if you wake up in the middle of the night and can’t go back to sleep, bring it to the attention of your physician.”

Approximately 50% of insomnia cases are related to depression, anxiety, or psychological stress, according to a longitudinal study of just under 25,000 adults. Having a sleep disorder is in fact a common symptom of major depression, bipolar disorders, attention deficit hyperactivity disorder (ADHD), and anxiety disorders such as PTSD. Additionally, people with chronic insomnia (when you can’t fall asleep most nights a week for three months or more) are at high risk of developing an anxiety disorder.

If you’re relying on sleep aids on a nightly basis, including a melatonin supplement, Cralle says that’s another reason to chat with your doctor. “You probably shouldn’t need to take melatonin every night, otherwise your physician should be managing it. For long-term sleep health, we should step back and ask, why isn’t this getting better? We want to get to the root of the problem.”

#3: You’re extremely tired all the time and need to nap during the day.

Naps sound heavenly in theory, but if you find yourself crashing in the middle of the day and repeatedly dozing off, that’s a nap habit you want to nip in the bud. “It’s not normal to always be sleeping during the day,” says Cralle, especially “if you sleep 10 hours a night, and you’re still tired.”

At best, midday power naps kept to 20 minutes or under may help reduce fatigue and bump up alertness, but feeling powerless to daytime naps is a different story.

Take a good look at how much sleep you’re getting at night and how you’re functioning in the daytime: Do you feel rested when you wake up? Do you rely on caffeine to get through the day? Being easily fatigued is a common symptom of depression and anxiety disorders. Another bad sign is falling asleep without warning, such as at your desk in the middle of the day: That could be a sign of narcolepsy, which is a serious sleep condition that requires medical attention.

#4: You’re sleeping in but still can’t seem to get up in the morning.

It’s one thing if your WFH situation lets you enjoy an extra 30 minutes of sweet REM sleep. It’s another thing if you can’t bring yourself to get out of bed in the morning, hours after you wake up.

Excessive sleep (also called hypersomnia, or sleeping too much) accompanied by this bed-locked state is one of the hallmark signs of a depressive episode, which can show up in many mental illnesses. If you’re currently feeling overwhelmed by stress, sadness, or anxiety in the morning, know that you’re not alone. Reach out to your doctor or someone you trust who can offer support and assist you in getting the help you need. (Check out our directory of mental health resources with support you can access right now.)

#5: You’re woken up regularly by your own gasping, choking, or snoring.

Loud snoring is slumber-disruptive for sure, but it can also have an unexpectedly deep significance when it comes to your mental health. “I’ve had patients with untreated sleep apnea, and often they’re depressed,” says Cralle.

Obstructive sleep apnea (OSA)—a common form of sleep-disordered breathing—is a highly prevalent comorbidity in depression. In one study, over 93% of patients with depression also had OSA; and a CDC study with nearly 10,000 adults showed that symptoms of OSA are associated with major depression.

In Cralle’s clinical experience, the mental health outcomes after properly treating patients for sleep apnea are evident in the follow ups: “The grouchiness and irritability are gone—they’re like a whole new person.”

If you find yourself experiencing any of these sleep issues, talk with your healthcare provider. “Proper sleep isn’t just the ultimate preventive self-care, it can help with the management of mental health and psychological issues, and really impacts the quality of life,” says Cralle. “It’s so foundational to our overall well-being that if we ignore it, we’re missing the whole thing.”

One bad night’s sleep can be written off, but when it starts to become three of four nights a week, seek help. Before it gets to be a bigger problem, try these psychologist-approved sleep strategies.

[Read This Next: Why Not Getting Enough Sleep Could Be Harming Your Mental Health]

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Last Updated: Sep 13, 2020