National Sleep Foundation

Chapter 1: Normal Sleep

The Physiology of Sleep – Mental Health

Sleep and mood have a bidirectional relationship: Mental health is both impacted by and impacts how well a person sleeps. Lack of sleep can be caused by other mental health (i.e., psychiatric) conditions that a person is experiencing, and can, in turn, impact those conditions. Sleep disturbance is, in fact, a diagnostic criteria for some mental health disorders, including depression76.

A variety of mental health conditions involve insomnia, including substance abuse; eating disorders; and mood, anxiety, and psychotic disorders. It is not known precisely why insomnia is such a common symptom among these illnesses77.  Possible mechanisms include neurotransmitter (brain chemical) imbalance; circadian phase advance; hypothalamic-pituitaryadrenal axis dysregulation; and decreased activity levels of the frontal, parietal, and temporal cortex compared to healthy individuals78.

Sleep and mental health disorders may cause or contribute to the other, or may both be symptoms of an underlying problem79 For example, patients with persistent, untreated insomnia have up to a ten-fold higher risk of depression compared to people who sleep well. Depressed people may suffer from a range of insomnia symptoms, including difficulty falling asleep and/or staying asleep, unrefreshing sleep, and excessive daytime sleepiness80 81.,  There is also evidence that insomnia is a risk factor for the development and/or recurrence of anxiety disorders, bipolar disorders, and substance abuse82. Post-traumatic Stress Disorder (PTSD) is frequently characterized by nightmares that lead to disturbed sleep 83.

Individuals with mental health disorders may benefit from targeted insomnia treatment, particularly when treatment for a co-occurring mental health disorder interferes with sleep. As with pain treatment, patients experience better outcomes when insomnia and depression are treated concurrently from the start (compared to initially treating of depression and then subsequently addressing the insomnia if it has not been resolved).

References

76. Institute of Medicine (IOM) Committee on Sleep Medicine and Research, Colten HR and Altevogt BM (ed.), Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem, Washington, DC: National Academy of Sciences, 2006.

77. National Sleep Foundation, Sleep Hygiene, Insomnia and Mental Health, Arlington, VA: NSF, no date. Available at: http://www.sleepfoundation.org/ask-the-expert/sleep-hygiene-insomnia-and-mental-health.

78. Institute of Medicine (IOM) Committee on Sleep Medicine and Research, Colten HR and Altevogt BM (ed.), Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem, Washington, DC:

79. Institute of Medicine (IOM) Committee on Sleep Medicine and Research, Colten HR and Altevogt BM (ed.), Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem, Washington, DC: National Academy of Sciences, 2006.

80. National Sleep Foundation, Sleep Hygiene, Insomnia and Mental Health, Arlington, VA: NSF, no date. Available at: http://www.sleepfoundation.org/ask-the-expert/sleep-hygiene-insomnia-and-mental-health.

81. National Sleep Foundation, Sleep and Depression, Arlington VA; NSF, 2001. Available at: http://www.sleepfoundation.org/ask-the-expert/sleep-and-depression

82. National Sleep Foundation, Sleep Hygiene, Insomnia and Mental Health, Arlington, VA: NSF, 2004. Available at: http://www.sleepfoundation.org/ask-the-expert/sleep-hygiene-insomnia-and-mental-health.

83. National Sleep Foundation, Sleep Hygiene, Insomnia and Mental Health, Arlington, VA: NSF, 2004. Available at: http://www.sleepfoundation.org/ask-the-expert/sleep-hygiene-insomnia-and-mental-health.