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Mental Illness and Sleep Disorders

Rest for your mind, too.
Mental Illness and Sleep Disorders
Tom Greenspan
Updated 
December 21, 2022

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According to a study, one in five Americans suffers from some type of mental illness. 

To a certain degree, sleep quality can be directly related to one's mental health. This is also why therapists ask about sleep habits and patterns when diagnosing. 

Since sleep disorders generally coexist with mental health disorders, it can be hard to identify and manage symptoms accordingly. Let's look at the relationship between mental illness and sleep problems in detail. 

Relationship Between Mental Illness And Sleep Problems

Sleep disorders, like insomnia, can simultaneously be present along with several other mental illnesses. It is believed that around 40% of insomniac patients and over 45% of hypersomniac patients have at least one psychiatric condition. 

On the contrary, people with no mental health conditions are often less likely to suffer from insomnia or other sleep disorders. But due to the striking similarities between sleep and mental health, people rarely notice their effects on each other. 

Improper sleep is a common occurrence among people who suffer from mental illnesses. They usually wake up exhausted from frequent waking, falling asleep too late, or waking up too early. 

An individual with mental disorders typically spends more time in a light sleep stage than deep or REM sleep stages, which are critical for sound sleep. The below-mentioned table shows the ratios for some anxiety disorders and their connection to sleep deprivation. 

Deeper stages of sleep, like the REM stage, provide both cognitive and emotional benefits of sleep. When there is sufficient REM stage sleep, our emotions are much more balanced and can be easily regulated. This also results in our brain functioning optimally, allowing us to make good judgments and process information easily. 

Without proper REM stage sleep, our emotional state is unbalanced, irrational, and unpredictable. Furthermore, this emotional imbalance causes poor decision-making and decreased memory capacity. With these factors at play, it is pretty clear why dealing with mental disorders can be difficult. 

Now that we know the relationship between sleep and mental health problems, let's look at some of the most common mental health conditions and the specific sleep disorder associated with them. 

1. Anxiety Disorders 

Studies reveal that nearly one in five Americans suffer from various anxiety disorders. Some common disorders are generalized anxiety disorder (GAD), social anxiety disorder, phobia, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and panic disorder. 

Sleep Conditions Associated With Anxiety Disorders 

Anxiety is generally considered to stem from a severe response to stress. Irrespective of how big or small, stress can affect the nervous system deeply. However, people with anxiety disorders experience stress at a greater level, which could result from various anxious thoughts or past trauma and symptoms related to Post Traumatic Stress Disorder. 

Regardless, what makes it worse for people with anxiety is their nervous system doesn't go back to normal after stress as it does for others without the condition. 

With this intense level of anxiety, their nervous system is constantly in alert mode. This causes sleep difficulties since it is the exact opposite of relaxation and calmness needed for sleep. 

Apart from the nervous state, this can even be experienced at a hormonal level. Cortisol is the hormone related to stress, whereas melatonin is the hormone associated with inducing sleep. When there are higher levels of cortisol, it causes melatonin production to slow down and makes it more difficult for our brain to produce the required amount. 

The sleeping conditions that are commonly found in people with anxiety disorders are: 

A. Insomnia 

Insomnia is the lack of sleep or the difficulty of falling and staying asleep. People with anxiety also suffer from chronic overthinking, anxiety towards phobia triggers, or general overwhelming feelings. Heightened anxiety levels make relaxation of the mind and, in turn, falling asleep more difficult. 

Out of all, insomniacs have it the worst. They don't get enough sleep and spend insufficient time in deeper stages. This makes their mental health disorders more challenging to deal with as they feel their discomfort has no relief. 

Since there is a poor sleep or sleep disturbance, it makes them feel more tired, making coping with disorders challenging. When combined, insomnia and mental illness intensify the symptoms of each other, which ultimately creates a negative feedback cycle. This causes the individual to fall into a downward spiral and makes treatment for both conditions difficult. 

However, when these sleep disorders are left untreated, they can lead to more severe complications. A study found a significant connection between insomnia and suicidal tendencies.

B. Hypersomnia 

Hypersomnia is directly contradicting insomnia and is often known as oversleeping. With severe stress levels, individuals with anxiety can find it difficult to stay awake. Furthermore, insomniac individuals can be severely exhausted due to lack of sleep, which eventually leads to oversleeping, especially at odd hours of the day. Insomnia and hypersomnia can frequently be found together in people with anxiety.

C. Nightmares 

Nightmares usually stem from severe PTSD. It results in the individual reliving their trauma in an intense, vivid dream, thus triggering their trauma symptoms. 

D. Nocturnal Panic Attacks 

Nocturnal panic attacks are commonly seen in people with panic disorders. They are similar to daytime attacks, the only difference being their occurrence in non-REM stage sleep. Individuals with nocturnal attacks wake up feeling extremely anxious, sweat profusely, and experience pain in their chest with increased heartbeats. 

Treatment 

Psychotherapy, specifically cognitive behavior therapy (CBT), is by far the most effective treatment for people with anxiety-related sleep disorders. 

Cognitive behavioral therapy is generally recommended for those with anxiety and related disorders. CBT-I is a therapy style specifically meant to treat insomnia while applying the same treatment method used in regular CBT. 

Ideally, therapists work closely with the patients to improve their ability to ignore negative thoughts and form a healthy relationship with sleep. They also help the patients identify the causes of their anxiety that result in sleep disturbance and provide healthier alternatives. 

2. Depression 

It is estimated that approximately 16 million adults suffer from major depressive symptoms. The most common symptoms are negative perspective, loss of interest, suicidal behavior, etc., which affects one's quality of life. 

Sleep Conditions Associated With Depression 

Insomnia is present in around 75% of people with depression and is a major contributor to suicide among today's population. A study conducted on the matter found that people with chronic insomnia are six times more prone to this psychiatric disorder than people without insomnia. The study also found that people with severe depression and insomnia are more likely to stay depressed. 

People with depression may have greater difficulty falling and staying asleep. They also sleep for significantly fewer hours, have disrupted sleep, and rarely spend time in the REM sleep stage. 

Insomnia is generally associated with sadness, which, combined with psychiatric disease, can result in chronic sadness. Various kinds of research have been conducted on insomniacs, and all of them consistently show that insomnia increases the risk of developing mental illness.

Women who suffer from depression have a higher chance of experiencing sleep disorders. People with the seasonal affective disorder (SAD), a seasonal form of depression, experience various sleeping disorders at different seasons of the year. 

Additionally, people with insomnia and depression may experience the following sleep problems: 

A. Hypersomnia 

Hypersomnia is also known as oversleeping. With regard to depression, hypersomnia affects approximately 40% of young adults and 10% of older adults who suffer from depression.

B. Obstructive Sleep Apnea 

Obstructive sleep apnea (OSA) is also significantly related to depression. People with sleep apnea are over five times more susceptible to major depression than those without. OSA or obstructive sleep apnea, is a breathing-related sleep disorder where the person stops breathing for a short moment during sleep. This lowers the oxygen levels in the blood and causes sleep disruptions. 

Treatment 

The usual treatment for depression is prescribed antidepressants. However, most antidepressants are known to cause or worsen insomnia, making the individual feel more anxious. 

Sedating antidepressants such as amitriptyline, trazodone, or mirtazapine are the most commonly prescribed SSRI drugs for people with sleep disorders. The effect of the medication on the individual is entirely subjective, and some patients who consume antidepressants respond to them by being more energetic or aware. 

This sudden surge of energy can make it difficult to fall asleep despite improving depression symptoms. Fortunately, treating depression often results in sleep disorders or insomnia disappearing. This is especially true in the case of mild depression (dysthymia), a common mental health condition that causes sleep disturbances. 

Some people respond positively to the medication and find that their insomnia and psychiatric symptoms have become mild. Like anxiety disorders, CBT can be effective for people suffering from depression and insomnia. CBT focuses on changing the perception of negative thoughts that cause sleep disturbances, converting them into healthy thoughts. 

Yet another treatment that can be beneficial for people with depression, specifically SAD and hypersomnia, is light therapy. It involves being seated in front of a special light device for a certain period to reset the patient's circadian clock. Practicing light therapy early morning can help wake patients up for the day, and ensure they aren’t tired in the afternoon. 

3. Attention-Deficit/Hyperactivity Disorder 

Attention deficit/hyperactivity disorder, also known as ADHD, is a neurological condition usually diagnosed in an individual's early years. Nearly 5% of children are diagnosed with ADHD and it can persist throughout their lives. This disorder is usually diagnosed by behavioral factors such as inattentiveness, impulsiveness, and hyperactivity. 

Sleep Conditions Associated With ADHD 

The symptoms of ADHD, a mental health disorder, and the medication used to treat it can cause disrupted sleep, resulting in sleep disorders. People with ADHD are often prone to the following sleep disorders: 

A. Insomnia 

Insomnia can be seen in around 75% of people who have ADHD. Some researchers believe that it may be due to the delayed circadian rhythm, which causes the individual to tire much later in the day. Apart from having trouble falling asleep, people with ADHD can also show fragmented sleep patterns. 

B. Excessive Daytime Sleepiness 

Excessive daytime sleepiness is the most common sleep disorder symptom. It causes the individual to be tired during the day, which can alter their quality of life. Due to sleep-related problems, people with ADHD are more likely to be tired during the day. This psychiatric illness also occurs even when the individual has gotten sufficient sleep, contrary to what their non-ADHD peers experience. 

C. Sleep Apnea 

Sleep apnea is much more common in people with ADHD, who are more prone to breathing difficulties during sleep. This sleep apnea causes them to stop breathing momentarily while sleeping. Sleep apnea is more common in adults with ADHD than children.

D. Periodic Limb Movement Disorder (PLMD) And Restless Leg Syndrome (RLS) 

Both these conditions are more prevalent in children with ADHD. PLMD is a condition where there is a tendency to kick or move the legs during non-REM sleep. These constant movements disrupt sleep and result in sleep problems such as fragmented sleep cycles. 

On the other hand, RLS (restless legs syndrome) is a condition where people with ADHD experience an uncomfortable tingling feeling, especially in the supine position. They deal with this discomfort by constantly moving their legs, making falling asleep much more complicated. 

Treatment 

Similar to antidepressants, the medication used to treat ADHD can result in sleep problems. Prolonged use of ADHD medications can have a more significant impact on one's sleep. It is imperative that people with ADHD inform their physicians about any sleep difficulties they may be facing. This allows the doctor to form a detailed treatment plan that caters to the patient's needs.

CBT-I is yet another therapy method recommended for treating people with ADHD. Therapists focus on ways to improve sleep using muscle relaxation and stimulus control, which calms the body and mind that would otherwise be hyperactive. 

To combat sleep-related problems in people with ADHD, sleep restriction therapy is often used. This involves the therapist setting a structured sleep schedule for the patient, which has to be religiously followed. This prompts the patient to only spend time in bed when they have to sleep and keeps them from taking daytime naps. Additionally, light therapy can also be beneficial to reset their circadian rhythm. 

In terms of accessories, using a weighted blanket can be helpful for people with RLS problems. The ideal weight for the blanket should be 10% of your body weight plus one additional pound. 

4. Schizophrenia 

Schizophrenic Disorder is present in around 1% of Americans. This chronic mental illness causes trouble with their perception of reality, emotional regulation, and communication ability. The most common symptoms of schizophrenia or related psychiatric disorders are hallucinations and psychosis. 

Sleep Conditions Associated With Schizophrenia

Around 30 to 80% of people with schizophrenia and psychiatric disorders have sleep problems. Common sleep disorders associated with schizophrenia include: 

A. Abnormal Or Irregular Sleep Patterns 

People with schizophrenia fail to sleep at a stretch, instead sleeping at random times during the day or night. Based on research conducted on mice with defects in the SNAP25 gene (a gene that is linked to schizophrenia), it was found that irregular sleep patterns were a result of delayed melatonin and shifted circadian rhythm. 

People with schizophrenia experience delayed melatonin release, owing to which they only fall asleep late at night. This keeps going until there is no circadian rhythm at all. 

B. Inconsistent Sleep Volume

Apart from sleeping at random hours, people with schizophrenia often don't get enough sleep per day. Certain times, they experience insomnia, whereas other times, it's hypersomnia. Some people can reach extremes of both conditions either due to their medication or symptoms like hallucinations. 

Since they have such irregular sleeping patterns and sleep problems, their sleep efficiency is also comparatively low. Due to this, they are often extremely exhausted and unable to cope with their symptoms on a day-to-day basis. 

Treatment 

The first generation of antipsychotics that were used to treat schizophrenia did not have any direct effect on the individual's sleep. However, modern atypical antipsychotics, like clozapine, olanzapine, and quetiapine, were found to have several positive impacts on sleep quality. It was observed that schizophrenic patients who consumed these medications slept longer. 

Some medicines increase the duration of slow-wave sleep, whereas others increase REM latency. These drugs are also similar to the SSRI drugs used to treat depression. 

When sleep problems are treated accurately, it does lower the intensity of psychotic symptoms of schizophrenia. Clinicians recommend changing the CBT-I principles based on the patient and their potential psychosis triggers. 

5. Personality Disorders 

A personality disorder can be defined as a way of feeling, thinking, and behaving contrary to conventional cultural norms and expectations. Personality disorders can be classified into various forms. These include: 

  • Antisocial personality disorder¬†
  • Narcissistic personality disorder¬†
  • Avoidant personality disorder¬†
  • Paranoid personality disorder¬†
  • Borderline personality disorder¬†

Studies have shown that approximately 1.6% of people in the United States have a borderline personality disorder (BPD). BPD symptoms usually include unstable feelings in personal relationships that swing between extremes of love and hate, distorted self-image, the feeling of emptiness, etc. 

Sleep Conditions Associated With Personality Disorders 

The average rate of substance abuse and depression is much higher in those with a personality disorder. This makes researching the link between sleep disorders and personality disorders complicated and confusing. 

Substance abuse and depression can cause sleep disturbances, so the presence of sleep disorders in those with a personality disorder can be linked to these factors. Unfortunately, studies that correlate sleep disorders and personality disorders are minimal, with most studies focusing on either BPD or antisocial personality disorder. 

But on average, the below-mentioned sleeping problems were commonly identified in people with personality disorders. 

A. Insomnia 

Insomnia is directly linked to BPD and antisocial personality disorder. The main insomnia symptoms include difficulty falling asleep, fragmented sleep due to sleep disturbances, waking up early, and lack of sleep quality. This results in daytime sleepiness or fatigue which affects an individual’s ability to function normally. 

B. Shortened REM Latency 

Shortened REM latency is commonly seen in people with personality disorders. This essentially means that the individual spends significantly less time in the REM stage of sleep. 

The REM stage of sleep is usually associated with cognitive and emotional recovery, which allows you to maintain your mood and make proper decisions when awake. When there is limited REM sleep, it can cause the pre-existing symptoms of these conditions to be adverse. 

C. Nightmares 

Nightmares and dream anxiety are quite prominent in people who have personality disorders. Both these factors have been shown to contribute to low sleep quality and decreased sleep duration. 

Treatment 

Cognitive Behavioural Therapy (CBT) and Dialectical Behavior Therapy (DBT) are the most effective treatments for personality disorders. DBT mainly involves having the patient experiment with new skills that allows them to deal with emotions and feelings rationally. 

Ideally, DBT consists of 4 areas: mindfulness, distress tolerance towards negative emotions, emotional regulation, and interpersonal effectiveness to strengthen personal relationships. Bright light therapy is yet another way to improve sleep and overall circadian rhythm, resulting in increased daytime alertness. 

Final Words 

Sleep disorders are usually the most common symptom in almost all psychiatric disorders as well as side effects of medications. It is considered quite rare to have a mental health disorder that does not affect one's sleep habits. 

However, it is ironic that poor sleep can lead to heightened mental health symptoms, ultimately leading to sleep disorders. This condition keeps going around in loops and causes immense stress to people suffering from mental illnesses. 

Fortunately, there are several ways to cope with these problems and find practical solutions in the long run. Treatments such as CBT, DBT, light therapy, medications, etc., help you deal with these issues in a healthy way and regulate your natural circadian rhythm.