How do you sleep? That is a question I’ve started asking the majority of clients I see in my practice. And the more people I ask, the more I’ve come to realize how much sleep affects our mental health and how common sleep disorders have become. When we don’t sleep well for years, we start to think poor sleep is normal and I often hear people say things like “that’s just how I am.” I would like to stress that sleep problems are common, but certainly not normal and we should all pay attention to our sleep and how it affects how we feel. Problems with our sleep can impact both our physical and mental health in profound ways. While many clinicians tell their patients that mental health problems cause sleep issues, in fact some mental health conditions can arise due to a lack of proper sleep. Diagnoses like anxiety, depression, ADHD, and other mental health issues can result if we have inadequate sleep.
Depression & Sleep:
When we’re fatigued, we’re more likely to feel down, depressed and sluggish. Depression is a known symptom of sleep apnea and a 2017 Australian study showed that CPAP reduced depressive symptoms in 96% of the patients enrolled in the study. Another study conducted by the National Institute of Mental Health on sleep and depression found that 87 percent of patients had improvement in their depression after a course of CBT-i (cognitive behavioral therapy for insomnia). When insomnia improves or resolves, it follows that depressive symptoms get better in many patients. Depressive disorders are also common in people living with other sleep disorders, like restless leg syndrome and narcolepsy. If depression is suspected, it is essential to look at sleep as a possible cause or contributing factor.
ADD/ADHD & Sleep:
Sleep deprivation can manifest as behavioral problems in kids and teenagers. Some adolescents will experience a “tired but wired” feeling, which can look like hyperactivity and difficulty paying attention. ADD and ADHD may be diagnosed, and in fact a sleep disorder is what is causing the behavior problem. Research shows that approximately 75 percent of children and adults with ADHD have problems sleeping. And several studies have shown strong correlations between snoring and behavior problems in children. A 2013 study showed a link between obstructive sleep apnea and “elevated rates of ADHD-like behavioral issues in kids.” Before deciding to use stimulants, it is important to consider sleep as a possible cause of ADHD symptoms in children and adults.
Anxiety & Sleep:
We know that feeling anxious can interfere with sleep, but can sleep disorders cause anxiety and panic? Research shows that sleep disorders are found in over 50 percent of patients with generalized anxiety disorder. Fragmented sleep at night can result in anxious feelings during the day. Scientists have found that a lack of sleep may play a key role in activating regions of the brain involved in worrying. If we don’t enter all the stages of sleep properly, our autonomic nervous system can malfunction and create a “fight or flight” state. Repeated obstructions in breathing that occur in sleep apnea can result in a racing heart, sweating and other nervous system problems. A 2016 Dutch study concluded that when REM sleep was disturbed, it correlated with patients struggling with anxiety and putting aside emotional distress. When sleep is disrupted, it affects our neurotransmitters and can result in anxiety.
PTSD & Psychosis:
It is well documented that trauma causes nightmares and insomnia. Post traumatic stress disorder (PTSD) and traumatic stress can negatively impact sleep and cause sleep disruptions. New research that looks at veterans being evaluated for PTSD, shows that 69.2 percent of these veterans were actually at high risk for sleep apnea. And an additional observational study showed that 57 percent of the veterans in this study who were diagnosed with PTSD also met criteria for sleep apnea. Sleep deprivation can also cause psychosis. A study from the University of Bonn and King’s College showed that “Twenty-four hours of sleep deprivation can lead to conditions in healthy persons similar to the symptoms of schizophrenia.” Patients diagnosed with schizophrenia often suffer from sleep disturbances. And it has been shown that CBT-i can improve insomnia, hallucinations and paranoia.
Sleep & Physical Health:
Sleep disruption can also cause a range of physical health problems. Conditions like chronic fatigue, fibromyalgia, headaches, pain disorders, as well as heart disease, high blood pressure and diabetes have all be linked to sleep disorders. Sleep is one of the primary ways that our body heals and repairs itself, so when this system is not working properly, our body suffers. Lack of proper sleep can affect memory, concentration, cognition and mood. Many studies have shown that people who sleep poorly are at a greater risk for a number of health issues. Anything that impacts our ability to cycle through each stage of sleep should be investigated and treated before the problem becomes worse, and before we suffer the downstream symptoms of poor sleep.
How do we know if we are getting enough restorative sleep? This can be a difficult question to answer for many of us. We lie down at night and assume our body does what it needs to do to repair itself. But if you have physical or mental health symptoms, it is important to consider that your sleep may not be as restorative as it should be. We can detect sleep disorders and disturbances through a sleep study. A study in a sleep lab is the gold standard, but a home sleep study can also be an excellent screening tool and can detect breathing disruptions in the comfort of your own home. When undergoing an evaluation of your sleep, it is essential to find a clinician who understands that formal sleep disorders are not the only cause of sleep interruptions. In fact, you may not meet the criteria for a sleep disorder, but your sleep still may be causing problems. Subtle pauses in breathing during the night and a reduction of REM sleep are just a few examples of ways that our sleep can be interrupted without actually having a diagnosable sleep disorder. While some professionals believe that this type of sleep disruption is benign, don’t rule it out as a possible cause of mental or physical symptoms.
Additionally, it is important to pay attention to lifestyle factors that affect sleep. Consistent bedtimes and wake up times, only using the bed for sleep, monitoring blue light exposure at night and keeping the bedroom dark can improve sleep. Limiting caffeine during the day and not eating within 3 hours of bedtime can also help us to sleep more soundly. If you eat close to bedtime, you are more likely to experience a blood sugar crash while sleeping. And if you got to bed soon after eating, your body will be busy digesting and it may interfere with the quality of sleep you get. Another important factor is sunlight- getting outside and having direct exposure to light can help our circadian rhythm, particularly in the morning hours. You may notice that you sleep much better after a day at the beach and being in the sun, or that you have fewer symptoms in the summer when you are outside more frequently. Sunlight increases your body’s production of both vitamin D and serotonin; serotonin is a precursor to melatonin. Melatonin is what helps our body to establish restorative sleep. More sunlight exposure allows us to have better sleep.
Nutrition is also essential – eating foods that cause inflammation can have a significant negative impact on sleep. Alcohol at night can also cause sleep to deteriorate by disrupting circadian functioning. Depletion of essential vitamins and hormones (such as vitamin D and B12, for example) can be a hidden cause of sleep disorders or worsening sleep. It’s important to check these levels and work with a provider who can help balances hormones and vitamin levels to optimize sleep. And if you struggle with insomnia, CBT-i can be very effective at improving sleep without medication through behavioral techniques.
If you suffer from physical or mental health problems, consider sleep as a possible root cause. And seek out a clinician who can assist you on your journey to better sleep and better health.