Sleep has a profound effect on mood, and sleep and psychiatric disorders often go hand in hand. Untreated sleep disorders can increase the risk of developing mental illnesses such as depression. Recent research shows that as many as two-thirds of patients with sleep disorders have a psychiatric condition, as well. The most common mental illnesses linked to sleep problems are depression, anxiety, and substance abuse. Treating sleep disorders in these patients has been proven to improve psychiatric disorders and quality of life.
People with psychiatric conditions and insomnia may have the following symptoms:
- Excessive worrying about sleep
- Difficulty falling asleep
- Agitation close to bedtime
- Racing thoughts
Anxiety Disorders and Sleep
Excessive anxiety makes a person feel nervous, tense, worrisome, and unable to relax. More than half of patients with generalized anxiety disorder have sleep disorders. The most common complaint is difficulty falling asleep or staying asleep. The high level of psychological distress and inability to relax at night makes it difficult for the person to fall asleep. Insomnia can raise anxiety levels, and nocturnal panic attacks are common. This involves the sudden awakening from sleep accompanied by extreme anxiety, heart palpitations, shortness of breath, and difficultly falling back asleep.
Tips to reduce anxiety include:
- Meditate - Focus on breathing in and out slowly and deeply and imagine yourself in a soothing environment such as a relaxing beach.
- Play calming music - This can lower your blood pressure and relax both the mind and body.
- Direct your stress and anxiety into something productive - By lending a hand to the local community through volunteering, you can take your mind off your own anxiety or fears.
- Talk to someone - Consider seeking psychological help. Medication and talk therapy are most effective when used together.
Depression and Sleep
Depression is a mood disorder characterized by intense feelings of sadness and other symptoms such as disinterest in enjoyable activities. Depression affects all aspects of a person’s life, from appetite to concentration and energy level. A person with depression may experience feelings of hopelessness and helplessness and feel worthless or suicidal. Sleep problems are very common, including insomnia, which includes difficultly falling and staying asleep, waking up too early and feeling unrefreshed upon awakening.
Studies of people with depression demonstrate prolonged sleep latency lack of slow wave (deep) sleep, and increased amount of rapid eye movement sleep. REM stands for rapid eye moment and is a phase of sleep which includes accelerated respiration, increased brain activity and muscle relaxation.
Compounding the problem is the fact that insomnia can cause depression and depression is made worse by insomnia. The risk of developing depression among student with insomnia is two times higher than for those without insomnia, according to a 34-year follow-up study of medical students at Johns Hopkins Medical Center. Insomnia is the last symptom of depression that responds to medications, and failure to treat the sleep disorder increases the risk of relapse of depression.
Patients with seasonal affective disorder (SAD) often report excessive daytime sleepiness.
Post-Traumatic Stress Disorder and Sleep
PTSD can bring about intense anxiety and lead to sleep problems. PTSD occurs after an event such as witnessing or experiencing something violent including rape, combat, or experiencing a natural disaster. This can result in a feeling of helplessness or loss of control.
PTSD overstimulates the body as the brain floods with neurochemicals, such as epinephrine and adrenaline, which, in turn, keep you awake. This makes it difficult to wind down and can eventually disrupt your regular sleep cycle. All of these problems can result in nightmares, insomnia, and excessive daytime sleepiness brought on by sleep disturbances.
Treatment for Psychiatric Disorders and Sleep Disorders
Treating co-existing sleep disorder and psychiatric conditions requires thorough examinations by experts both in sleep medicine and psychiatry. A doctor will determine the problem by asking about sleep symptoms, sleep schedule, daytime fatigue, medical history, and your use of alcohol and other substances. Your doctor may do routine blood tests or a sleep study if you are suspected of having another sleep disorder, such as sleep apnea.
Medications must be prescribed carefully as many have an effect on sleep. Anti-anxiety medications, for instance, may lead to drowsiness. Antidepressant medications may have an initial effect on causing insomnia in some patients, but this effect tapers off with continued use. Sleeping pills may be effective, as well, but they must be used as prescribed to prevent dependence.
Cognitive-behavioral therapy (CBT), also known as talk therapy, is a useful tool in addition to medication. An experienced psychotherapist uses a structured and focused treatment plan for insomnia by using behavioral strategies in order to correct harmful and negative thought patterns. This type of therapy is useful in that it addresses the root cause of the problem and outlasts the benefits of medication alone. Examples of CBT include relaxation therapy, biofeedback and development of adaptive coping strategies.
People with insomnia should practice healthy sleep hygiene and rituals to promote better sleep. This includes:
- Positive thinking
- Maintaining a set sleep/wake time
- Relaxation or meditation before bedtime
- Regular exercise, which can also boost mood
- Keeping a comfortable sleep environment
- Limiting daytime naps
- Avoiding caffeine, alcohol and nicotine before bedtime
- Avoiding watching the clock
- Using the bedroom exclusively for sleep or sex
For more information about psychiatric disorders and their potential effect on sleep, call The Los Angeles Sleep Study Institute at 1-855-690-0563.