If you’ve ever struggled with your mental health, most likely you’ve also dealt with sleep issues. An estimated 50 to 80 percent of patients in a typical psychiatrist’s office wrestle with sleep, versus just 10 to 18 percent of the general population. Like nutrition and exercise, sleep is one of the pillars of well-being.
Sleep does more for your health than just give you energy. While you’re sleeping, the brain is busy sorting and storing memories, cleaning out junk you don’t need and balancing hormones that have a direct impact on emotions and mood. Sleep is like nightly housecleaning to keep your body in tip-top shape. Without good sleep, our body clock gets thrown out of whack (think jet lag), which is both disorienting, miserable and trouble for your mental health.
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Sleep and Mental Illness
The sleep-mental illness connection is well established. Sleep trouble is even a symptom of many mental illnesses. It’s in the diagnostic criteria for everything from generalized anxiety disorder to post-traumatic stress disorder (PTSD), schizoaffective disorder and others. A decreased need for sleep is a hallmark of impending mania in bipolar disorder. Sleep issues often occur before a psychotic episode. If you regularly wake up too early in the morning, it could be a sign of depression.
Living with mental illness also takes a lot of energy, so sheer fatigue might be part of your norm. “Going ‘out’ for me is like a person who isn’t struggling with mental illness running a marathon,” described Mighty community member Jennifer B. in the article, “What You May Not Realize About Your Friend Who ‘Sleeps Too Much‘.” Even your mental health treatment may be part of the problem. Many psychiatric drugs cause sleep-related side effects like insomnia or fatigue and drowsiness, sometimes at the same time.
Wish people knew how much mental illness interferes with your life. Finding the energy to do simple things is hard. You feel constantly tired. You isolate yourself but feel lonely at the same time. Leaving the house is difficult. It can be hard to even work. It’s exhausting.
— hattie gladwell (@hatttiegladwell) September 12, 2018
To add insult to injury, if your sleep schedule is off, there’s an increased risk of having a mental health episode. One research review found that if you sleep either too little or too much, you have 10 times the chance of having a major depressive episode compared to those who got good sleep. Insomnia or sleep deprivation can also lead to anxiety, doubling your risk compared to those without sleep trouble. And dysregulated sleep has a strong link to an increased suicide risk. More than 30 studies, which covered everyone from children to older adults, “have identified that sleep disturbance is linked to suicidal ideation or completed suicide.”
Trying to maintain a sleep schedule with a mental illness — the recommended seven to nine hours of sleep every 24 hours for adults — is no small task. But it’s important, so let’s take a closer look at how your sleep schedule might be affecting your mental health.
Getting Too Little Sleep
Getting too little sleep — whether it’s not sleeping enough, having trouble falling or staying asleep or waking up too early in the morning — makes life with a mental illness more difficult. Without enough sleep, you’re more vulnerable to every stressor that pops up in your life, even the little things.
“When we don’t get enough sleep, we’re running a little bit more ragged,” Debra Kissen, Ph.D., clinical director of Light On Anxiety Treatment Center and chair of the Anxiety and Depression Association of America public education committee, told The Mighty. “When life gets hard and challenging, we are more impacted by those moments.”
Studies have shown without adequate sleep you’re also more likely to experience worse mental health symptoms. It’s a bit of a catch 22. Around 40 percent of people diagnosed with a psychiatric disorder struggle with insomnia because of their mental health. At the same time, insomnia also makes your mental illness worse. Part of the reason for this is likely the stress-related responses common in conditions like anxiety and PTSD. The brain can’t be both in hhyper-alertanxious mode and deep in sleep at the same time.
When you don’t get enough sleep, there’s evidence that mental health treatment might not be as helpful either. If you regulate your sleep schedule while in clinical care — whether that includes therapy and/or psychiatric medications — your recovery outcomes improve. A small 2008 study published in the journal Sleep discovered that participants with depression who received cognitive behavioral therapy for insomnia in addition to antidepressants had a 62 percent remission rate versus 33 percent of those who didn’t receive the extra sleep therapy.
What Happens When You Sleep Too Much
It may seem counterintuitive, but it’s just as bad if you sleep too much. Sometimes mental illness sends you signals to sleep all day, even if it’s not satisfying. “It’s not the enjoyable, refreshing kind of sleep,” Mighty community member Kaitlin R. shared. “I wake up sleepier, which makes me want to sleep again. It’s a vicious cycle of exhaustion that feels impossible to break.”
Hypersomnia — excessive sleepiness — doesn’t help your brain any more than insomnia. Like insomnia, too much sleep is “associated with [the] persistence of depression/anxiety.” In other words, it’ll take longer to recover. Oversleeping also increases your risk for physical issues like stroke, migraine or heart disease. Not to mention, when you sleep longer than your internal body clock needs, you’re likely to wake up feeling lethargic and unmotivated. More sleep doesn’t equal better energy, quite the opposite.
Generally, when you sleep, you’ll go through five stages that get progressively deeper — light sleep stages one and two, deep sleep stages three and four and REM, which is where the memory processing happens in the brain. Each of these cycles lasts approximately 60 to 90 minutes. For the average person, it takes about 7.5 hours to go through this process. When you sleep hours longer than your natural cycle, you increase the chances of waking up in the middle of a later sleep stage. This disrupts your body and brain’s rhythms and will make you feel more tired.
Oversleeping can also be a hit to your mood because it prevents you from doing activities that help build motivation. “If you’re sleeping too much, number one, there’s less time to accomplish what you need to accomplish throughout your day,” Kissen told The Mighty. “Excess sleeping and more avoidance could lead to more depression and hopelessness because they are not getting done as much.” Of course with mental health, it’s not usually as easy as “just” getting out of bed.
When trying to navigate your mental health, naps may seem really appealing. This is especially true if you wake up constantly during the night because of racing thoughts, use all your energy just to get dressed or need a safe way to escape overwhelming emotions for a few hours.
“Sleep is my way of escape, if only temporarily. It’s my way of shutting it all out,” Mighty community member Marcel W. said. “Many times, I’m not even physically tired, just weary or out of my element when I am up and around. Being in the world drains me rapidly; it’s like an electromagnetic force pulling me back inside no matter how hard I try to fight it.”
Naps can be an effective go-to coping skill. About a third of U.S. adults take naps on any given day and when they last 60-90 minutes, they have some positive benefits. Stretching naps longer than that gets into tricky territory because you’ll be in the middle of a deep sleep phase when you wake up. These “depression naps,” as they’re currently called in the social media zeitgeist, can contribute to a dysregulated pattern that’s going to affect your ability to sleep at all.
How I feel when I wake up from my 5 hour depression nap pic.twitter.com/IWrjgVQC5t
— ¯_()_/¯ (@jonnoxrevanche) September 7, 2018
“If you take a nap during the day, it might throw off your sleep drive at night, which would make it harder to fall asleep,” Kissen said. “It’s not only about the amount of sleep but also regulated sleep….Otherwise, someone might be napping throughout the day or operating in a state of half-wakefulness.”
How To Get Better Sleep
If any of this sounds like you, there are ways to improve your sleep schedule — and your mental health. Studies show that when you (and your doctor) address underlying sleep issues or disorders alongside your mental illness, you’re less likely to have a mental health relapse after treatment. Here’s how to get better sleep.
1. Track Your Sleep
To get your sleep schedule on track, it’s helpful to know how it went off the rails in the first place. Record your sleep habits using an app or a journal or spreadsheet. Kissen recommends tracking not just the hours you sleep but also “what kind of behaviors are happening around that time in terms of getting themselves ready for bed, where are they in the home, are they sitting in front of the TV, are they sitting in bed, what are they doing? On average what time are they going to bed? On average what time are they waking?” Make note of everything sleep-related for at least a week and see what you discover.
2. Follow a Consistent Schedule
Once you’ve gathered and reviewed your data, create and follow a consistent sleep schedule. Limit naps and try to go to bed and wake up at the same times. Aim to get seven to nine hours of sleep each day. If you start to feel naturally tired around your bedtime, once you’re in this sleep window, let yourself go to bed. Don’t push yourself to stay up later. “Once you miss your sleep window…you’re going to start having some stress hormones that wake you up a little bit more and then it’s a lot harder to go to bed,” Kissen told The Mighty.
3. Limit Technology
You’ve probably heard it many times before, but limit your use of technology before bed. The light from all the screens can activate the brain, which doesn’t always help you sleep. Reading on your phone or using a relaxing app may be helpful to calm your mind. Stimulating video games or binge-watching a high stakes TV show on Netflix may not be as helpful. Pay attention to what helps your sleep patterns when you’re engaging with technology and experiment to find what works best.
4. Address Medication Side Effects
Antidepressants and other psychiatric drugs aren’t always helpful for your sleep. They can be too stimulating and keep you wide awake, or on the other hand, like many antipsychotics, knock you out into zombie mode. Neither option is productive when want to get on a sleep schedule. Talk with your doctor to find out what side effects your meds may have and how you can deal with them. You might want to try an alternative drug that’s better for your sleep or add additional remedies.
5. Talk To Your Therapist About Sleep
Don’t forget to loop in your counselor too. Talk about your sleep in therapy. Kissen asks clients about their sleep patterns during the initial therapy intake interview so they can discuss how to address any sleep issues that might hurt treatment when the time is right. Some therapies, like a special version of cognitive-behavioral therapy for insomnia (CBT-I), may be helpful if you’re not getting enough sleep.
Your therapist can also help you develop supportive sleep habits. For example, they might work with you to plan how to calm racing thoughts at night, address anxiety about falling asleep, develop a self-soothing kit if you wake up with a flashback, or brainstorm ways to get out of bed and moving if you have depression. They may also recommend self-help books or calming practices like mindfulness based on your condition.
It’s hard to underestimate how much your sleep impacts your mental health. Whether you’re sleeping too little or too much, working to get on a regular, consistent sleep schedule may help you feel better, make treatment easier and, eventually, kick some (or all) of those mental illness symptoms to the curb.
Looking for more ways to improve your sleep? Check out this list of six things Mighty editors tried to sleep better.