Ask pretty much anyone about the quality of their sleep and you’re likely to get a negative response. Sleep issues are something most people deal with at one time or another—in fact, it’s estimated that about 50 percent of adults experience occasional bouts of insomnia, while one in 10 suffer from chronic insomnia.

Trouble falling asleep, staying asleep, or awakening too early can impact everything from your mood to your concentration to your motor functions and have even been linked to larger health problems like high blood pressure, obesity, diabetes, and heart disease.

For those with mental health issues like anxiety, depression, PTSD, bipolar disorder, schizophrenia, and drug and alcohol abuse, sleep issues can actually worsen their condition and cause major setbacks in mental health maintenance. Some studies have even linked poor sleep as an indicator of future depressive episodes for those with depression or bipolar disorder.

Which is all to say that getting the right amount of sleep and the best quality of sleep is imperative to keeping yourself mentally and physically healthy. We spoke with experts specializing in the intersection of sleep disorders and psychiatry to learn how sleep affects the brain, what that means for those with mental health issues, and what therapies and tactics can be used to help keep your circadian rhythms operating at peak performance levels.

How Do I Know If I’m Getting Enough Sleep?

The amount of sleep your body needs to function optimally varies as you age, with children and teens needing between nine and 12 hours, while adults only need between seven and nine. The majority of experts agree that anything less than six hours a night is unhealthy and can lead to a heightened risk for the aforementioned health problems.

What Does Lack Of Sleep Do To The Brain?

While not getting enough sleep can lead to occasional issues like lack of focus or feeling tired, for those with chronic insomnia the effects are more pronounced. While many people think they have insomnia, in order to be diagnosed, says Timothy Roehrs, PhD, Senior Biomedical Scientist at Henry Ford Health Center in Detroit, Michigan, you need to be evaluated by a sleep expert.

“The insomnia diagnosis typically has any one (or more) of three specific complaints—difficulty falling asleep, difficulty staying asleep, and awakening too early—at least three times a week over the course of three months.” He notes that the daytime consequences of insomnia vary from person to person, but have typically been reported as feeling fatigued, having trouble controlling your emotions, memory problems, lack of focus, and periods of depression.

How Does It Affect Those With Mental Illnesses?

According to Daniel Jin Blum, MD, Adjunct Clinical Instructor in Psychiatry & Behavioral Sciences at the Stanford University School of Medicine, “Most of the disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) have sleep disruption as one of the key features, which begs the question of is it a symptom of all of these disorders or is there some mechanism in which sleep contributes or worsens these issues.”

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Roehrs agrees and adds that current research does not allow doctors to say that insomnia causes those disorders, rather there is an “association.”  The one exception to that thought process is the relationship between sleep and depression, but more on that idea later.

One of the cruel ironies of sleep and mental illness is that for some disorders, like anxiety and PTSD, lack of sleep is a symptom of the condition—meaning that you are not getting sleep because of your condition, which in turn is only going to exacerbate the severity of the disorder as a whole. Plus, many drugs prescribed to help control the symptoms of these mental health issues can be disruptive to sleep.

In order to better understand how to handle your sleep problems, it’s important to understand how exactly sleep is linked to your specific condition. Here’s what our experts say are the hallmarks for six common mental health disorders.

Sleep And Anxiety

For people with anxiety, falling asleep can be an exercise in futility, as when they lie in bed their thoughts run towards those things that make them anxious. “Anxiety is bidirectional,” says Dr. Blum. “If you have anxiety, you are more prone to having insomnia and also vice versa—if you have insomnia you are significantly more likely to develop anxiety and anxiety disorder.”

If you are anxious about something, like a presentation at work, says Dr. Blum, your anxiety will impact your ability to go to sleep at the time that you want because your mind will be spinning, delaying your ability to fall asleep. That also will lead to an elevation of anxiety at a baseline level. “

When you look at the brain, particularly the prefrontal cortex—which is going to be helpful in dampening or tamping down on these negative emotions—it’s much more activated,” he explains. “Plus, the amygdala is going to be more active when you don’t get enough sleep. Even with just an hour less of sleep for a week, you are going to start seeing a significant impact on mood.”

Sleep And PTSD

One of the hallmarks of PTSD is nightmares, sometimes so vivid they can pull you out of your sleep cycle. “That intense fear emotion, if you’re not getting enough sleep, it’s going to amplify it and make it worse,” says Dr. Blum. More specifically, adds Roehrs, those sleep disturbances happen during the last four hours of sleep. “That’s when people dream, and it’s also when people re-experience their traumatic event.”

Sleep And Depression & Bipolar Disorder

As Roehrs mentioned earlier, depression (and, to some extent, bipolar disorder) is the only mental health issue that scientists have been able to draw a direct correlation to disturbed sleep as a possible cause. He cites over a dozen studies, including one-lifetime study done on medical students that showed an insomnia diagnosis was a predictor for some of the onset of depression.

As Blum explains it, with major depressive disorders, you’ll oftentimes see a sleep disturbance up to five weeks before a major depressive episode. More specifically, he notes, that disturbance is called early morning awakening. “People will start to wake up one to two hours earlier than they naturally would,” he says. “No matter when they’ve gone to bed or how much sleep they’ve gotten, their body is waking them up early and they can’t fall back asleep.”

One theory as to why this happens, says Dr. Blum, is that your sleep cycles and how long it takes for you to hit REM could play a role. “In a healthy individual, it’s going to take you about 90 minutes to get into that first REM cycle,” he says. “However, folks who are experiencing major depressive episodes will go into their REM cycle in about 50 minutes,” he says.

“One of the primary benefits of REM sleep is that it helps us with emotion processing. One idea is that the brain is trying to help process this excess of mood in your sleep, leading you to REM cycle faster, but it just isn’t enough to get you through a major depressive episode and you have this truncation of your sleep.” This also holds true for bipolar disorder, he notes, where either too little or too much sleep can start to precede or maintain a manic and/or depressive episode.

And, if that wasn’t enough, evidence points to some common antidepressants, like SSRI’s also causing sleep problems, as their primary effect, says Dr. Blum, is delaying your REM state at night.

Lack of sleep isn’t the only potential problem for those who suffer from depression. Getting too much sleep can also throw your circadian rhythms out of whack and lead to some of the same results. As Dr. Blum explains, “If you are sleeping too much it can increase fatigue and the time you are awake, making it less likely they are to do activities that will activate your mood and get you going.”

Sleep And Schizophrenia

For those with schizophrenia, getting enough sleep doesn’t tend to be the issue, says Dr. Blum, but rather when that sleep is occurring. Many with schizophrenia may find themselves experiencing sleep that is not consolidated—i.e. they sleep both at night and in fragmented napping during the day. “The danger there is that that kind of sleep disturbance can amplify some symptoms of schizophrenia-like hallucinations and hearing voices,” says Dr. Blum.

Sleep And Alcohol & Substance Abuse

One of the main misconceptions around alcohol use is that it helps you fall asleep — which is partially true. Depressants and sedatives can help you initially to fall asleep, but you are more likely to have non-restorative sleep or wake up too early. “Initially what alcohol does is it enhances slow-wave sleep (i.e. non-REM) and for someone who has insomnia it actually normalizes slow-wave sleep,” says Roehrs. But, he notes, tolerance to that develops within three nights, meaning that in order to get the same effect, more alcohol is needed each night, increasing your dependence on it.

Interestingly, Dr. Blum notes that research has shown that your circadian rhythms (i.e. if you are a morning person or a night owl) can have a direct effect on your propensity to abuse drugs and alcohol. For the most part, he notes, that’s because your body is telling you it isn’t ready for sleep, however, your social and career obligations might not allow for that—meaning that you take depressants like alcohol or opioids to help you fall asleep or use stimulants during the day to make up for not getting enough sleep.

Disturbed sleep can also be associated with relapses for those that are in recovery. “There are two [sleep-associated] markers for relapse,” explains  Roehrs. “The first of those is a shortening of REM latency. Normally it takes a person 90 to 120 minutes to go into REM sleep, but if you go into REM sleep in less than 90 minutes, we refer to that as a short REM latency, which we’ve found is predictive of relapse in alcoholism.” There’s also a theory, he says, that shows a deficiency in slow-wave sleep — the stage in which your arousal threshold is the highest and it takes a strong stimulus to wake you up—can be predictive of relapse.

What Are Some Treatments For Disordered Sleeping?

#1: Make sure you are practicing good sleep hygiene.

That means maintaining a dark, cool sleep area, removing all electronic devices and stimuli from the room, and maintaining a consistent bedtime.

#2: Consider a form of cognitive therapy.

If you find that you are still having issues with sleep, talk to your provider about cognitive behavioral therapy for insomnia (CBTI). While CBT exists for issues like depression and PTSD, Dr. Blum says that those don’t help with insomnia. CBTI, however, has been shown to help manage many mental health conditions by addressing sleep issues, which appear to decrease the severity and frequency of the condition. “Cognitive behavioral therapy for depression will help alleviate the depression, but it won’t improve sleep,” he explains. “CBTI will improve the sleep and improve the depression on par with cognitive behavioral therapy for depression—essentially you get the exact same effect, plus improving sleep without even targeting mood, which tells me that sleep could be the underlying cause there.”

There are many different methods in CBTI that have been shown to be extremely beneficial for different conditions. For instance, one common method, called sleep restriction, has shown to have a significant improvement for those with bipolar disorder and depression. Explains Dr. Blum, “A way to lengthen how much sleep you are getting is to restrict the ability to be in bed to the average amount that you are sleeping.” Meaning if you normally sleep for six hours but are spending nine hours in bed, only get into bed six hours before you need to wake up. “This increases your ability to sleep and you are going to feel much sleepier and fall asleep much better,” he says.

#3: Look into image therapy. 

For those with PTSD,  Dr. Blum says that studies conducted by Veterans Affairs have shown success with image rehearsal therapy (IRT). The multi-step treatment involves writing down the details of the nightmare upon awakening from it, rewriting the dream on another piece of paper and changing the narrative to be positive, then going back to bed with the intention of having a positive dream that resembles the new narrative you have created. This essentially helps you to “re-program” your nightmares to make them less frequent or intense over time.

#4: Avoid self-medicating.

Both doctors we spoke to recommend CBTI over other methods like sleeping pills because it addresses the source of the insomnia, rather than creating a dependence on substances for a short-term fix.

Getting a good night’s sleep on a regular basis is not just good for your health, it’s a crucial part of mental health maintenance. Monitor your sleep habits and be sure to speak to your doctor about any changes in your sleep patterns as they could be warning signs for depressive episodes or an indicator that you need additional assistance managing your condition. As Dr. Blum notes. “More sleep means better able to take care of your emotions and move your life forward.”

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Last Updated: Oct 7, 2020