Sleep is a basic need of our body, vital for physical, mental, and emotional well-being. It is also necessary for proper cognitive functioning. Sleep disorders or disruptions in sleep may cause functional impairment. Generally, two types of sleep occur every night in 3-5 cycles.
- Rapid Eye Movement or REM Sleep
- Non-Rapid Eye Movement (Non-REM) Sleep
Typically, non-REM type sleep includes three different phases, including deep sleep. How much sleep a person needs varies according to age and from person to person. However, according to the National Sleep Foundation, an average adult requires 7-9 hours of peaceful sleep every night for proper behavioral and cognitive functioning. Insufficient sleep may result in serious repercussions. Many studies show that sleep deprivation may leave a person vulnerable to reduced cognition, attention lapses, mood shifts, and delayed reactions.
Some people may become tolerant of sleep deprivation, but their bodies and brains may suffer when they don’t get enough sleep. Less sleep may feel normal, and they might not be aware of the deficiencies in their body. Moreover, sleep deprivation puts you at risk of developing several medical conditions and chronic diseases. These include stroke, type-2 diabetes, poor mental health, and heart disease.
Psychiatric and sleep disorders generally occur together, and when a sleep disorder is left untreated, it can increase the risk of psychiatric conditions like anxiety and depression. Most sleep disorder patients suffer from psychiatric disorders. The most common psychiatric disorders related to sleep deprivation include stress, depression, and substance abuse.
In psychiatry, insomnia is considered to be the most common disorder. Almost every second adult suffers from one or more sleep disorders like difficulty in sleeping, difficulty staying asleep, or sticking to a consistent sleeping schedule. Sleep disorders are highly prevalent in people with depression, schizophrenia, and other mental illnesses.
Although physicians would treat patients with mental illness before treating sleep disorders, most patients would discuss their sleep disorders with physicians. This makes it essential to provide this group of patients with guidance for diagnosing and treating insomnia.
Once the behavioral, psychiatric, or any medical cause of sleep disorder is identified, appropriate treatment needs to be given.
How can Sleep Affect Mental Health?
Every 90 minutes during sleep, a regular sleep cycle occurs between REM and Non-Rem sleep. However, as the rest progresses, the time spent on one type of sleep varies. During quiet sleeping, a person advances through four stages of deep sleep. Muscles relax, heart rate decreases, breathing slows down, and body temperature drops. During the deepest stage of quiet slumber, the body develops psychological changes and improves the body’s immune system.
During rapid eye movement or REM sleep, the eye movement occurs rapidly under the eyelids. During this phase, dreaming occurs, heart rate, blood pressure, body temperature, and breathing rate increase. REM sleep is also the phase of sleep where memory consolidation happens.
Sleep disruption or deprivation highly affects the levels of stress hormones and neurotransmitters in the body. It also wreaks havoc on the brain, causing significant damage to the emotional and thinking regulations. That said, sleep disorders like sleep apnea and insomnia may amplify the effects of mental health problems.
The Science Behind Sleep Disorder and Mental Health Relation
During sleep, brain activity largely fluctuates. It increases or decreases during different stages of sleep, making up the sleep cycle. In Non-REM sleep, the brain’s overall activity slows down, but there is a quick burst of energy during this phase. In REM sleep, brain activity rapidly picks up; hence, this stage includes intense dreaming.
Each stage of sleep plays a vital role in brain health, allowing various brain activities to increase or decrease. This will enable better cognitive skills, including learning, memory, and thinking. Research also made it clear that brain activities during sleep profoundly impact a person’s mental and emotional health.
Sufficient sleep simplifies the processing of emotional information by the brain. The brain works during sleep to evaluate and process memories and thoughts. Therefore, sleep deprivation can impair the brain’s capacity for positive emotion consolidation and affects emotional reactivity and mood, which may lead to psychiatric disorders.
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Due to this, the traditional view that suggested sleep disorders are the symptoms of psychiatric problems has come under question. Instead, it is now clear that mental health and sleep have a bidirectional relationship. We can clearly denote that sleep disorders can be the consequence and/or the cause of problems related to mental health.
Obstructive sleep apnea (OSA) is also linked to mental health. OSA is a sleep disorder involving pauses of breathing while asleep. It causes a reduction in the oxygen levels in the body, resulting in obstructive sleep problems. This type of sleep disorder is commonly found in people with mental illness. OSA can also weaken the physical health of a person with a psychiatric condition and increase the risk of severe mental distress.
According to research, about 90% of depression patients complain about the quality of sleep, while two-thirds of people undergoing major episodes of depression experience insomnia. Nearly 40% of patients with mental conditions complain of problems falling asleep, maintaining sleep, or getting awake in the morning, while several reports all three.
Psychological Effects of Deprivation of Sleep
There are over 70 types of sleep disorders. The most common of them are:
- Insomnia (difficulty falling asleep or staying asleep)
- Obstructive sleep apnea (pause of sleep during sleep)
- Narcolepsy (extreme sleepiness)
- Various movement syndrome (unpleasant sensations, causing night fidgeting)
The type, impact, and prevalence of sleep disorders vary according to the psychiatric diagnosis. The overlapping of psychiatric problems and sleep disorders is so common that researchers suspect both sleep and psychiatric disorders have common roots.
Research shows that about 70% to 90% of adults and about 90% of children with major depression experience various sleep disorders. Most depression patients have insomnia, and nearly one in every five depression patients faces Obstructive Sleep Apnea. OSA, insomnia, and other sleep disorders may also increase the risk of depression. A study of around 1000 adults aged 21-30 showed that people with a reported history of insomnia were four times more likely to develop major depression than an average person. Moreover, it is observed that sleep disorders develop long before depression in most cases.
OSA, insomnia, and other sleep disorders affect the results of people with depression. Patients with mental illnesses like stress who experience insomnia are less likely to benefit from treatment than those with no signs of sleep disorders. Additionally, sleep disorder patients who report improved mood with antidepressant therapy are at risk for a depression relapse later on. Patients with major depression who also have insomnia or other sleep problems are more likely to think of suicide than those who sleep normally.
A majority of patients with manic bipolar disorder experience insomnia or a lesser need for sleep during the episode. In bipolar disorder, about 40-60% of patients suffer from hypersomnia (a condition with excessive sleeping), while some may experience restless sleep or insomnia. Sleep disorders like insomnia may worsen before a bipolar depression to mania episode. Sleep problems may impact the mood adversely and can contribute to relapse.
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Sleep disorder affects most adult patients with anxiety disorder, and these problems are prevalent in people with a mental health condition called post-traumatic stress disorder. Sleep disorders also occur in phobias, obsessive-compulsive disorders (OSD), and panic disorders. People with anxiety disorder usually take more time to fall asleep and have less deep sleep compared to a healthy person. Anxiety disorder patients also have a risk of developing insomnia. While only 27% of the people with insomnia and other sleep orders experience anxiety, 69% of them have a risk of developing major depression.
Sleep problems like OSA and insomnia can worsen anxiety disorder or may prevent recovery. Sleep disruption in post-traumatic stress disorder or other psychiatric disorders may contribute to retaining negative emotional memories and prevent such patients from benefiting from therapies to extinguish fear.
Attention Deficit Hyperactivity Disorder
Most children with ADHD experience various sleep disorders, including shorter sleep duration, difficulty falling asleep, and restless sleeping. Sleeping problems and ADHD commonly overlap, making it difficult to keep them apart. Sleep-disordered breathing problems affect nearly one-fourth of children suffering from ADHD, restless legs syndrome, and periodic limb movement disorder. Children with such sleeping problems may become inactive, emotionally unstable, and hyperactive.
Lifestyle Changes to Improve Mental Health and Sleep Quality
In many cases, experts recommend the same type of treatment for most common sleep problems, regardless of whether the patient also experiences psychiatric disorders. The treatment is mostly a combination of PAP therapy, psychotherapy, behavioral strategies, lifestyle changes, and medication. Here are a few lifestyle changes that one can implement for improving mental health and sleep quality.
Changes in Diet: As we know, caffeine, nicotine, and alcohol add to sleeplessness; the consumption of these should be avoided when experiencing sleep and psychiatric disorders. Alcohol depresses the body’s nervous system, which may help people fall asleep, but this effect wears off soon enough, and people wake up. On the other hand, nicotine is a stimulant that increases thinking and heart rate. Avoiding these substances is the best option, but one can also avoid these before going to bed.
Physical Activity: Activities like yoga and aerobics can help people fall asleep quicker, get quality sleep, and wake up less often at night.
Sleep Hygiene: The habit of sleeping better can be developed. Good sleeping hygiene is a term used for including tips, such as maintaining a regular sleep-wake schedule, using the bedroom only for sleep, keeping a dark space in the bedroom, and reducing distractions in the bedroom. Many experts also recommend staying awake for a long time to get more restful sleep.
Relaxation: Relaxation techniques like meditation, deep breathing, and progressive muscle relaxation can help counter sleep disorders, racing thoughts, and anxiety.
Cognitive Behavioral Therapy (CBT): People with sleep disorders like insomnia become preoccupied that they will not fall asleep easily. Cognitive-behavioral activities (CBT) may help them change negative expectations and build the confidence of getting better sleep. These activities can help them change their thinking to attribute personal problems during the day to sleep deprivation. CBT activities examine the pattern of thinking and reformulate negative thoughts.
Sleep problems and psychiatric disorders are linked to each other in important ways. In contrast to the traditional view of the relationship between the two, where sleep problems are considered symptoms of psychiatric disorders, there is growing evidence that the relationship between sleep and psychiatric disorders is complex and includes bi-directional relation. Although a lot has been found about the sleep-psychiatric disorder’s relationship, much is still unknown. Studies are required to determine if treating sleep disorders can improve symptoms of psychiatric disorders such as major depressive disorder.
As sleep disorders are highly linked to psychiatric disorders, they can increase the risk of developing or worsening mental health problems. Hence, it is important to treat sleep problems at an early stage to prevent them from developing into serious psychiatric disorders.