Sleep is vital to physical and mental health, allowing time each day for the body to rest and heal. Sleep contributes to positive mental health, which helps people develop meaningful relationships and grow in the face of challenges.
Historically, sleep problems have been viewed as a symptom of mental illness. Modern research suggests a more nuanced relationship, demonstrating that the links between mental health and sleep may be complex and bidirectional.
Understanding the relationship between sleep and mental health can help people harness the power of sleep to improve their well-being and support people living with mental illness to better manage their conditions.
Impact of Sleep on Mental Health
Sleep supports positive mental health by boosting a person’s mood and improving their ability to focus and make decisions. Quality sleep also allows the body to recover from daily stress and helps people feel more optimistic, alert, and better able to navigate relationships.
Insufficient and poor quality sleep are risk factors for developing mental health conditions. Sleep deprivation can also make it difficult to focus and remember information, and it can lead to a bad mood, irritability, and poor decision making.
Poor sleep may also exacerbate the symptoms of mental health conditions. Changes in sleep patterns can trigger the symptoms of mental health conditions such as depression, anxiety, bipolar disorder, and schizophrenia. Even for those without mental health conditions, getting fewer than six hours of sleep each night can increase mental distress.
How Mental Health Affects Sleep
Mental health affects a person’s thoughts, feelings, and actions. Positive mental health means being able to experience a range of emotions and having the resilience to recover from difficulties.
Strategies for improving mental health often involve practicing self-care. While self-care looks different for everyone, it often includes staying connected to loved ones, setting goals, and taking care of physical wellness with exercise, healthy eating, and quality sleep.
Having sleep troubles may be an early warning sign for mental health conditions. Many mental health conditions — including anxiety, depression, attention-deficit/hyperactivity disorder, and post-traumatic stress disorder — can make it more challenging to fall asleep and get the right amount of rest. In fact, sleep issues are one of the criteria that health professionals take into account when diagnosing mental health conditions.
Certain medications used to treat mental health conditions can also negatively affect a person’s sleep patterns.
Sleep and Mental Health Conditions
Sleep and mental health affect one another in ways that researchers are just beginning to understand, but studies consistently show that sleep issues are present in nearly all mental health conditions.
Anxiety Disorders
Anxiety is a common reaction to stress. An anxiety disorder describes fear and anxiety that are out of proportion to the trigger and affect a person’s ability to function at work, school, or in relationships. Around 30% of people experience an anxiety disorder at some point in their life, making this the most common mental health condition in the United States.
Anxiety and sleep issues often exist in a negative feedback loop, with sleep issues leading to increased anxiety and anxiety exacerbating sleep issues. People with anxiety are more prone to having trouble sleeping when under stress and many experience frequent nightmares.
Obsessive-Compulsive Disorder
Obsessive-compulsive disorder (OCD) is a chronic mental health condition that involves repeated thoughts or urges that cause anxiety and lead to repetitive behaviors. This condition affects nearly 2.3% of adults and can significantly disrupt a person’s life.
People with OCD tend to have a harder time falling asleep and lower sleep quality than people without this condition, and severe symptoms of OCD are associated with more significant sleep issues. Sleep deprivation may also increase the amount of intrusive thoughts, even in people without OCD.
Depression
Depression is a term often used to describe sadness, discouragement, or a low mood. While feelings of sadness are usually temporary, sometimes they last for a long time or begin to interfere with a person’s life. In these cases a person may be diagnosed with a depressive disorder.
Sleep difficulties are a common symptom of depression and a potential cause of depressive episodes. Most people with depression have trouble falling asleep and wake up often during the night, and many sleep longer than usual. Subtypes of depression also tend to affect sleep.
- Seasonal Affective Disorder: Seasonal affective disorder is a type of recurrent depression that is tied to seasonal changes. Each year, people with this condition may exhibit symptoms like social withdrawal, weight gain, and sleeping longer than usual. Many researchers believe that this condition is triggered by disruptions in a person’s internal clock, called their circadian rhythm.
- Postpartum Depression: It is common to have some symptoms of depression for a few weeks after giving birth, but mood changes lasting more than two weeks may be diagnosed as postpartum depression. Sleep issues can be both a contributing factor for postpartum depression and a symptom of the condition.
Bipolar Disorder
Bipolar disorder involves drastic changes in a person’s mood, behavior, and ability to function. Periods of elevated or irritable moods, called manic or hypomanic episodes, alternate with depressive episodes. Manic, hypomanic, or depressive episodes can last for days or weeks at a time.
As many as 70% of individuals with bipolar disorder experience sleep problems. People with bipolar disorder frequently sleep less during manic episodes. During depressive episodes, people may have difficulties falling asleep, staying asleep, or sleeping too much. Sleep issues can also trigger symptoms of bipolar disorders.
Eating Disorders
Eating disorders impact a person’s thoughts, feelings, and behaviors related to eating. People with eating disorders are often preoccupied with food as well as their body’s weight and shape. Some of the most common eating disorders are anorexia nervosa, bulimia nervosa, and binge-eating disorder. Eating disorders often develop in adolescence and affect around 5% of people in the United States.
The development of an eating disorder is influenced by genetics and biology as well as behavioral, psychological, and social factors. Irregular eating patterns may also be linked to sleep issues. Research shows that eating habits can impact sleep patterns and people who do not get enough sleep are more likely to binge eat.
Schizophrenia
Schizophrenia is a chronic mental health condition that affects less than 1% of the population. It can cause hallucinations, delusions, and other difficulties with thinking, speech, and motivation. If left untreated, schizophrenia can make it challenging for people to function in their daily lives.
Research shows a two-way relationship between sleep issues and schizophrenia. Symptoms of schizophrenia can disrupt sleep, while sleep difficulties can trigger symptoms. Studies also suggest that sleep problems can contribute to the development and persistence of schizophrenia. As many as 50% of people with schizophrenia experience insomnia, and trouble sleeping is a warning sign that a person may be experiencing a relapse of symptoms.
Dissociative Disorders
Dissociation describes a disconnection between a person’s consciousness, memory, and identity. Some amount of dissociation is normal when a person is daydreaming, driving, or focusing on a book or television show. More severe symptoms of dissociation may be diagnosed as a dissociative disorder.
Research has shown an association between sleep issues and dissociative symptoms. Some researchers propose that dissociative symptoms could be caused by issues in the sleep-wake cycle that affect thinking and cause dreamlike mental activity during wakefulness. This connection is exemplified in sleep disorders called parasomnias, like sleepwalking, sleep talking, and sleep paralysis, which involve altered states of consciousness somewhere between wakefulness and sleep.
Post-Traumatic Stress Disorder
Post-traumatic stress disorder (PTSD) is a mental health condition that can develop after experiencing or witnessing a traumatic event. While irritability, troubling memories, sleep issues, and other symptoms are normal after a stressful event, a person may be diagnosed with PTSD if symptoms last longer than a month and lead to distress or interfere with their ability to function.
Studies suggest that sleep issues contribute to the development of PTSD and can alter the effectiveness of treatment. Sleep issues before or soon after a traumatic event increases a person’s risk of developing PTSD. People diagnosed with PTSD often feel alert, on edge, or hyperaware of danger, which can make it difficult to fall and stay asleep. Around 75% of people with PTSD also relive traumatic experiences in frequent nightmares.
Prolonged Grief Disorder
Grief is a natural response to loss. Prolonged grief disorder is a mental health condition that develops when a person experiences severe grief that impairs their ability to function normally. Research suggests that around 10% of adults who lose a loved one are at risk of developing prolonged grief disorder.
People with prolonged grief disorder may have trouble sleeping because of thoughts about the deceased person before bed or dreams about their loved one during sleep. Disrupted sleep can then make it more challenging to regulate emotions, learn new things, and benefit from treatment.
Dementia
Dementia is a condition that involves the loss of cognitive functioning, often with severe changes in memory, language, and the ability to carry out everyday tasks. Around 33% of adults over 85 years of age may experience some form of dementia. The most common forms of dementia include Alzheimer’s disease and Lewy body dementia.
Sleep issues earlier in the lifespan may increase the risk of developing dementia later in life. People with dementia also tend to have more sleep problems. Dementia can disrupt circadian rhythms, leading many people with Alzheimer’s disease to become more active, agitated, or upset later in the day.
Neurodevelopmental Disorders
Neurodevelopmental disorders are conditions in which a person does not reach developmental milestones related to cognition, emotions, or motor skills. Sleep issues are associated with several neurodevelopmental disorders, including attention-deficit/hyperactivity disorder and autism spectrum disorder.
- Attention-Deficit/Hyperactivity Disorder (ADHD): ADHD is a condition in which inattention, hyperactivity, or impulsivity affects a person’s functioning or development. Around 5% of children and teenagers are diagnosed with ADHD, and about 70% of children diagnosed with ADHD experience sleep problems. Sleep issues can also exacerbate symptoms of ADHD.
- Autism Spectrum Disorder (ASD): ASD affects how people learn, behave, and relate to others. Research suggests that 40% to 80% of people with ASD have sleep issues. In people with ASD, sleep issues can contribute to challenges in relationships and schoolwork.
Improving Your Mental Health
People with mental health conditions benefit from treatment. Treatment can help some people recover completely and support others in managing their mental health conditions and improving their quality of life. Treatment for a mental health condition is based on an individual’s needs and may include therapy, medication, or a combination of the two.
Your mental health is not defined solely by whether you have a mental health condition. Positive mental health can help you reach your full potential, make meaningful connections, and adapt to change. There are several strategies that may help you experience the benefits of positive mental health.
- Practice Self-Care: Spend time doing things that improve your physical and mental health, like getting regular exercise, eating a balanced diet, and prioritizing sleep.
- Cultivate Healthy Relationships: Healthy relationships are one of the best ways to improve your sense of well-being. Research shows that a strong connection to others improves physical and emotional health and may even help you live longer.
- Practice Coping Skills: Coping skills help people deal with stress in a healthy way. Find strategies that work for you, like exercise, deep breathing, connecting with your community, and avoiding drugs and alcohol.
- Find a Sense of Purpose: Whether it is related to your spirituality, career, or helping others, developing a sense of meaning in your life can improve your mental health and offer comfort during challenging times.
Knowing when to ask for help is one of the most important aspects of maintaining positive mental health. If you’re experiencing mental health challenges and need support, start by contacting your doctor or a mental health professional.
Improving Your Sleep Hygiene
Whether you are trying to practice self-care, improve your mental health, or manage a mental health condition, improving your sleep habits is a great place to start. Consider incorporating bedtime tips to improve your sleep health.
- Stick to a Schedule: For better sleep, keep a consistent bedtime routine and go to bed at the same time every night.
- Avoid Late Meals: Reduce sleep disturbances by avoiding caffeine, alcohol, large meals, and excessive liquids in the evening before bedtime.
- Lower the Lights: Avoid bright lights that can keep you awake, starting a few hours before bed, including light from electronics like TVs, laptops, and smartphones.
- Enhance Your Sleep Environment: For an optimal sleep environment, keep your bedroom dark, quiet, and cool. Do not use your bed for anything other than sleeping and sex.
- Don’t Lay in Bed Awake: If you lay awake for longer than 20 minutes or feel anxious or worried about sleep, get out of bed and find a relaxing activity until you feel tired, like stretching or meditating.
- Develop Healthy Daytime Habits: Practice self-care during the day by eating a healthy diet, exercising on a regular basis, and avoiding evening naps after 3 p.m.
Most importantly, communicate with your doctor if you are having difficulty sleeping or suspect that a mental health condition or medication is making it difficult to get the rest you need.
References
About The Author
Clinical Psychologist, Sleep Medicine Expert
Michael Breus, Ph.D is a Diplomate of the American Board of Sleep Medicine and a Fellow of The American Academy of Sleep Medicine and one of only 168 psychologists to pass the Sleep Medical Specialty Board without going to medical school. He holds a BA in Psychology from Skidmore College, and PhD in Clinical Psychology from The University of Georgia. Dr. Breus has been in private practice as a sleep doctor for nearly 25 years. Dr. Breus is a sought after lecturer and his knowledge is shared daily in major national media worldwide including Today, Dr. Oz, Oprah, and for fourteen years as the sleep expert on WebMD. Dr. Breus is also the bestselling author of The Power of When, The Sleep Doctor’s Diet Plan, Good Night!, and Energize!
- POSITION: Combination Sleeper
- TEMPERATURE: Hot Sleeper
- CHRONOTYPE: Wolf
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