The Impact of Sleep on Mental Health

Facts & Mysteries About Sleep

Sleep plays a foundational role in physical health, mood, daytime energy levels, and cognitive functioning. During a normal full night of sleep, a person cycles through several sleep stages that involve periods of lighter and deeper sleep. Each part of the cycle seems to have a different function which some experts believe include detoxing the body and brain, rebalancing brain chemistry, consolidating memory and information, and even renewing the body at a cellular level.^4,10

The functioning of this cycle, the amount of time spent in each stage, and the body and brain demonstrating the normal responses in each cycle seems to be essential to the restorative benefits of sleep. What this means is that it is not just how long you sleep that matters, but also, the overall quality of sleep as measured by the time and activity in each part of the cycle.^4,5,10

Deeper sleep involves slow-wave brain activity that seems to have a restorative effect on the body and brain and helps people wake up refreshed. Lighter sleep and REM sleep are especially mysterious, as the activity of the brain and body mirrors that of when the body is awake. REM sleep is where the majority of dreams occur. Interestingly, the arms and legs are paralyzed in REM sleep, which prevents people from physically acting out their dreams, but electrical brain activity, heart rate, and respiration all increase to near-waking levels. REM sleep is believed to be highly influential in cognition, learning, memory, and also emotion regulation.^4,10

The Mental Health & Sleep Connection

When it comes to mental illnesses like depression, anxiety, bipolar disorder, and even schizophrenia, sleep problems have a complicated two-way relationship.^3,6 For example, hypersomnia (sleeping too much) and insomnia (not sleeping enough) are often symptoms of mental illnesses, suggesting they are caused by these conditions—but the reverse is true as well. Research has also shown that people with sleep problems are more likely to develop these conditions, and also that these conditions can worsen someone’s symptoms.^4,6,10,8

The relationship between mental health conditions and sleep is bidirectional, meaning that sleep problems can be caused and worsened by these conditions and may also cause or worsen these conditions. People who have mental illnesses like depression and who also struggle with sleep problems are less receptive to treatment and are more likely to experience more severe symptoms.^4,6,8

Aside from the increased rate of mental illnesses, a lack of adequate, quality sleep also affects the mental health of all people, even those without these conditions. When people don’t get enough sleep, they become more moody, irritable, stressed out, and have more trouble regulating their emotions. This leads to more impulsive decision making and less careful consideration and planning. Sleep deprivation also causes people to feel sluggish, exhausted, and less able to focus and be productive.^4,9,10

Because of the many ways that sleep deprivation or poor sleep affect people’s mental health, it is not surprising that sleep issues are also correlated to overall higher levels of stress and lower levels of life satisfaction. People who don’t get enough sleep are more likely to think negatively, be more self-critical, and struggle more with confidence and self-esteem issues, potentially leading to a cycle of revenge bedtime procrastination.⁷ They have more difficulties in work, school, and social relationships, and are also more susceptible to injuries, accidents, and chronic health problems.⁴

Sleep & Mood Disorders

The strongest link between sleep and mental health is its link to depression. Research has shown that up to 90% of people diagnosed with major depressive disorder struggle with sleep difficulties.^3,6 People with depression also demonstrate abnormalities in REM sleep by spending more time in REM than non-depressed people and exhibiting more rapid and intense eye movements in REM.⁶

The link between sleep problems and mood extends to other mood disorders like Bipolar Disorder, where hypersomnia is common during depressive episodes and insomnia is common in the vast majority of manic episodes.^4,6

Sleep & Suicide

There is a troubling link between sleep problems and higher levels of suicidal thoughts, attempts, and completed suicides.^1,11 People who struggle with nightmares have been found to struggle with more suicidal thoughts and urges. This connection is so strong that SAMHSA has listed sleep as one of the 10 warnings signs for suicide.¹

Sleep & Stress or Anxiety

There is also a link between lack of sleep and anxiety, and stress. Sleep deprivation is linked to an increase in stress hormones like cortisol, which are known to be present in people who are more stressed or anxious. Researchers estimate that about half of people diagnosed with generalized anxiety disorder struggle with sleep problems, with the majority reporting insomnia or poor sleep quality. Research has shown that people with anxiety and stress have more problems falling asleep and staying asleep, and also tend to sleep more lightly, meaning spending minimal time in deep stages and REM stages of sleep.⁶

Sleep & Psychosis

There is also a link between sleep deprivation and psychosis, and extreme sleep deprivation can even cause paranoid thoughts and hallucinations in healthy people. Sleep disruptions are often reported leading up to psychotic episodes in people with schizophrenia. People with schizophrenia are also more likely to have reversed sleep schedules where they stay up at night and sleep during the day.^3,6

Sleep & Addiction

People with sleep problems may turn to drugs or alcohol to either help them get to sleep or to help them wake up and be functional. This can quickly spiral into a pattern of compulsive and addictive behaviors, increasing the likelihood of developing a substance use disorder. Some of these substances (like alcohol) even affect the quality of sleep by suppressing certain sleep cycles, resulting in sleep that is less restorative.⁶

Sleep & Other Mental Illnesses

To a lesser extent, hypersomnia, insomnia and other sleep disruptions are also linked bidirectionally to other mental illnesses like PTSD and ADHD.⁴ For example, people who have experienced something traumatic and report disrupted sleep a month or more after the trauma are more likely to be symptomatic after one year than those who report no sleep issues.⁶

In children diagnosed with ADHD, sleep problems are very common, affecting between 25-50% of all children with the disorder.⁴ Anxious children also report higher levels of sleep problems, and in teens, there is a link between poor sleep, anxiety, depression, and low self-esteem.¹¹

Signs That Sleep Is Affecting Your Mental Health

People who either consistently get less than 7-8 hours of sleep per night, those who sleep more than 9 hours per night, or those who sleep 7-9 hours but wake up unrested may have a sleep disorder that could be affecting their mental health.

In the book Sleep for Success, authors Maas and Robins note that America has an unhealthy culture of “sleep machismo” that normalizes and even glorifies sleep deprivation as being a sign of mental strength, ambition, and dedication.⁹ They argue that most people are so chronically sleep-deprived that they do not recognize the signs of sleep deprivation and even sometimes mistake these as being normal.

Signs that sleep problems are impacting your mental health and ability to function include:^5,9

• Needing an alarm to wake up in the morning
• Trouble waking up or getting out of bed
• Feeling tired throughout the day
• Needing energy drinks, caffeine, or other stimulants to keep you awake
• Having trouble concentrating, focusing, and thinking clearly
• Having trouble with your memory
• Becoming easily irritable, stressed, or overwhelmed
• Feeling moody or emotionally reactive
• Hitting a “wall” in the afternoon and becoming very tired
• Feeling sleepy or falling asleep when sitting or doing a quiet activity
• Making less healthy lifestyle choices
• Relying on sedatives, alcohol, or sleep aids to get to sleep
• Being more impatient or impulsive
• Making more mistakes or not catching simple errors
• Finding it hard to communicate and feel connected to others
• Having no motivation to do things you normally enjoy
• Feeling more anxious, restless, and unable to relax
• Frequently waking up during the night
• Frequently struggling to fall asleep
• Racing, anxious thoughts when trying to sleep

If you struggle with several of the issues listed above, you may be struggling with sleep deprivation or even one of nearly 90 known sleep conditions.^4,10 The more chronic sleep problems become, the worse the impact is on both your physical and mental health. You might not make the connection between the two, but it is possible that feelings of moodiness, exhaustion, lack of motivation, and trouble focusing is a direct consequence of poor sleep.

10 Ways to Improve Sleep

Even though there is still a lot scientists and sleep researchers don’t understand about sleep, the research clearly shows that sleep is an absolute necessity. We cannot be fully happy, healthy, or thriving in life without having a consistent sleep schedule that includes 7-9 dedicated hours per night. In addition to getting the recommended amount of sleep, it is also important to focus on getting quality sleep, meaning ensuring that the sleep you get helps to provide you with consistent energy, focus, and motivation throughout the day.

Here are 10 strategies to improve your sleep:^4,5,8,9,10

1. Cut Out Nighttime Stimuli

One of the first ways to improve sleep is to identify activities you do in the later afternoon or evening that may be keeping you awake. For example, eating a heavy meal or engaging in strenuous exercise in the evening can make it hard to sleep, as can caffeine or nicotine, which both have stimulating effects. Even your cell phone, laptop, or tablet can be contributing to the problem, as these devices emit blue light that mimics caffeine. If there are things you are doing at night that are keeping your body or brain stimulated and energized, consider moving these to earlier in the day.

2. Create a Sleep-Friendly Environment

People tend to sleep better in rooms where there isn’t a lot of light, noise, or heat, and in beds that are comfortable. Make your room more sleep-friendly by getting black-out curtains or blinds, investing in comfortable bedding, turning down the thermostat, and even putting black electrical tape on anything that emits light. Consider ear plugs if you have a snoring partner, dog, or noisy subway interrupting your sleep. Experts also recommend reserving your bed for sleep, and doing other activities in different areas of the home to form an association between your bedroom and sleep.

3. Create a Relaxing Nighttime Ritual

In the hour or so leading up to bed, consider forming a nightly ritual that helps you relax, unwind, and prepare your body and brain for sleep. Include things that help you de-stress and relax, including herbal tea, a warm shower or bath, specific kinds of music, or reading or writing. The specific activities you choose to make a part of your ritual are less important than their effects on your mood, stress, and energy levels, so experiment freely until you find the ones that work best for you. Once you have a routine, try to be consistent in making it a priority every night.

4. Create an Energizing Morning Routine

Just like there are activities and environments that are more conducive to sleep, there are also ones that can help you feel awake and alert. For example, consider getting outside for a quick morning walk, which will help cue your brain to wake up and get your heart and respiration rate up. Consider putting on some upbeat music while you get ready for work, and steer clear of sugary breakfasts in favor of whole foods and protein, which provides a more consistent supply of energy. Drinking water in the morning can also help improve energy, as the body becomes dehydrated during sleep.

5. Clear Your Mind Through Journaling or Meditation Practice

If your thoughts are keeping you up at night, there are several things you can try. One is to keep a notepad close to your bed where you can jot down thoughts, ideas, or tasks you need to do that you are worried you might forget. You can also try using guided meditation or mindfulness techniques to help you notice your thoughts without getting overly involved with them. This skill requires practice, but pays its dividends in many ways, helping you feel more relaxed, happy, and helping you get a good night’s sleep.

6. Focus on Your Body & Breath as You Fall Asleep

Switching your focus away from thoughts and instead towards your body can be an excellent way to relax and get to sleep. You can try to focus on your breath, while working to have deep and slow exhales and continuously following the rhythm of your breath to relax. You can also try progressive muscle relaxation, a technique that involves tensing and releasing each muscle, which can help you become more aware of letting any tension or stress in your body go.

7. Get Up if You Can’t Sleep

Most people have had the maddening experience of tossing and turning, checking the clock, and becoming increasingly stressed out about how little sleep they will get that night. This can lead to a vicious cycle of stress and anxiety which can feed into insomnia, making it worse.

Break free from this frustrating cycle by getting up and doing something when you can’t fall asleep after 10-20 minutes. Sit in a chair and read or do something else before returning to bed to try again. This will keep you from becoming frustrated and anxious when sleep isn’t happening naturally.

8. Reset Your Body’s Clock

People with chronic sleep problems often describe being sleepy during the day and wide awake at night, signaling a disruption in the circadian rhythm. Your circadian rhythm is your body’s natural clock, which tells your body when to sleep and when to wake, adjusting your brain chemistry to facilitate this cycle. You can reset your body’s clock by enforcing your wake schedule by getting up early, not allowing yourself to sleep in, and not taking naps during the day. After a few days, many people find that this helps them reset their clock and results in them feeling tired at the “right” time.

9. Turn Your Brain on Early in the Morning

Research shows that people are more creative in the morning, and also suggests that they might be better able to think clearly, solve problems, and make better decisions. As your sleep schedule improves and your sleep debt shrinks, challenge yourself with more mentally stimulating activities in the morning. Set earlier meetings at work, make time for journaling or something creative, and frontload your more challenging tasks. It’s possible that there is a morning person inside each of us that is waiting to be put to good use.

10. Balance Your Routine

There is a paradoxical nature to energy where doing either too much or too little in a day can leave you feeling drained and exhausted. It’s important to strike a balance between being active and finding ways to relax, and many people have trouble finding this middle ground. If you find yourself constantly racing, rushing, and going non-stop during the week and then turning into a blob every weekend, consider making some changes. Work on spreading out your tasks a little more evenly, alternating between tasks that you find difficult or boring and those that you enjoy.

Treatment for Sleep Disorders

Some people who struggle with sleep issues have more chronic sleep problems, and may be suffering from a sleep disorder. Luckily, therapy, medication, or a combination of the two can be helpful to those struggling with a sleep disorder, and can also help reduce people who are having more temporary sleep interruptions.

Therapy

Because of the close relationship between sleep and mental health, behavioral and psychological treatments have been found to be highly effective for many people struggling with sleep problems. For example, CBT for insomnia (sometimes called CBT-I) is highly evidence-based, and counselors who use relaxation, mindfulness, or biofeedback can also help people with sleep problems.^3,4,8 Find a therapist by conducting an online search, using a therapist directory, or going through your insurance company.

Medication

Medication is sometimes necessary to address chronic sleep disorders.⁸ All medications have some risk for adverse effects, so it is important to talk with your prescriber about these before starting any medication. Sleeping medication is sometimes prescribed by primary care doctors, psychiatrists, or other specialists who treat sleep problems. Many people first go to their primary care doctor for help with sleep problems to discuss their options, and either get a prescription or are referred to a specialist.