We all know we feel better after a good night’s sleep. However, sleep can easily feel like an inconvenience, something we have to do that takes us away from the temptations of Netflix or scrolling through Instagram. I recently read Matthew Walker’s book ‘Why We Sleep’, and it changed my mind about where sleep should come on my list of priorities. In this book, Walker explains clearly how sleep is not just vital for childhood development, but also school performance, learning and memory, a reduced risk of Alzheimer’s disease, protecting against weight gain, boosting the immune system, and of course, our mental health.
Sleep problems and poor mental health
Sleep disturbances and mental illness tends to go hand in hand. For example, a large population-based study has found a correlation between poorer mental health and either less than 7 hours of sleep a night, or more than 9 hours sleep each night (Kaneita et al, 2007). Teenagers in this study who reported poorer sleep also reported having worse mental health. This result has also been replicated in older adults, with sleep problems predicting the number of both physical and mental health concerns reported by participants (Reid et al, 2006).
Rather than a simple causal relationship between poor sleep and mental illness, research suggests that there is actually a bidirectional relationship between them. For example, episodes of insomnia can often precede and occur during a depressive episode (Franzen & Buysse, 2008). People with depression who reported worse levels of sleep prior to treatment have also been shown to have a poorer response to a combination of psychological and pharmacological treatment (Drew et al, 1997). This could possibly be explained by the close link between insomnia and depression, in particular when we examine the role of serotonin in both conditions. Not only are reduced levels of serotonin associated with depression, but as the serotonergic system involved in regulating the sleep-wake cycle, lower levels of serotonin could also impair our ability to fall asleep and wake up when planned (Adrien, 2002).
Treatments for insomnia in mental illness
Treatments for insomnia in patients with mental illness can also help to reduce symptoms associated with their illness. One treatment is a variation of Cognitive Behavioural Therapy, called CBT-I, which aims to affect the cognitive factors associated with insomnia, such as excessive worrying or an inability to switch off, in addition to encouraging a regular sleep pattern. The diagram below shows how CBT-I can be used to break the cycle of insomnia.
This treatment has been used to successfully reduce the number of manic or depressive episodes in a sample with bipolar disorder, when compared to a control group who just received psychosocial education. Participants in the CBT-I group also reported reduced severity of insomnia during the 6 month follow up period (Harvey et al, 2015). In addition to depression, one review paper has also found that CBT-I can be helpful in reducing severity of both insomnia and other symptoms in people with PTSD or alcohol dependence (Sánchez-Ortuño & Edinger, 2012).
However, it should be noted that although treating insomnia can reduce some of the symptoms associated with mental illness, it is not enough to treat the insomnia alone. Therefore it is recommended that interventions to improve insomnia should occur concurrently with the recommended treatment for that specific illness (Sánchez-Ortuño & Edinger, 2012).
As always, thanks very much for reading! I’m planning out posts for the next few weeks, so if there’s anything you’d like me to write about then just leave a comment below.
Adrien, J., 2002. Neurobiological bases for the relation between sleep and depression. Sleep medicine reviews, 6(5), pp.341-351.
Dew, M.A., Reynolds, C.F., Houck, P.R., Hall, M., Buysse, D.J., Frank, E. and Kupfer, D.J., 1997. Temporal profiles of the course of depression during treatment: predictors of pathways toward recovery in the elderly. Archives of general psychiatry, 54(11), pp.1016-1024.
Franzen, P.L. and Buysse, D.J., 2008. Sleep disturbances and depression: risk relationships for subsequent depression and therapeutic implications. Dialogues in clinical neuroscience, 10(4), p.473.
Harvey, A.G., Soehner, A.M., Kaplan, K.A., Hein, K., Lee, J., Kanady, J., Li, D., Rabe-Hesketh, S., Ketter, T.A., Neylan, T.C. and Buysse, D.J., 2015. Treating insomnia improves mood state, sleep, and functioning in bipolar disorder: A pilot randomized controlled trial. Journal of consulting and clinical psychology, 83(3), p.564.
Kaneita, Y., Ohida, T., Osaki, Y., Tanihata, T., Minowa, M., Suzuki, K., Wada, K., Kanda, H. and Hayashi, K., 2007. Association between mental health status and sleep status among adolescents in Japan: a nationwide cross-sectional survey. The Journal of clinical psychiatry, 68(9), pp.1426-1435.
Reid, K.J., Martinovich, Z., Finkel, S., Statsinger, J., Golden, R., Harter, K. and Zee, P.C., 2006. Sleep: a marker of physical and mental health in the elderly. The American journal of geriatric psychiatry, 14(10), pp.860-866.
Sánchez-Ortuño, M.M. and Edinger, J.D., 2012. Cognitive-behavioral therapy for the management of insomnia comorbid with mental disorders. Current psychiatry reports, 14(5), pp.519-528.