How Does Mental Health Affect Your Sleep?
Contributed By: Rose MacDowell, Sleepopolis
Expert Verified By: Dr. Nicole Moshfegh, Psy.D.
The term mental health describes emotional, cognitive, and social well-being. Mental health is important at every stage of life, from childhood and adolescence through adulthood. Mental health affects not just how we feel, but how we think and behave. Our psychological condition determines how we handle stress, relate to others, and make choices.
There are more than 200 types of mental illness, which is defined by the American Psychiatric Association as “a health condition involving changes in emotion, thinking, and behavior.” Mental illness is based in the brain and can have a significant impact on relationships and quality of life.
Note: The content on Sleepopolis is meant to be informative in nature, but it shouldn’t take the place of medical advice and supervision from a trained professional. If you feel you may be suffering from any sleep disorder or medical condition, please see your healthcare provider immediately.
Mental Illness: Causes and Symptoms
Mental health problems can affect self-esteem, happiness, and basic functions, such as eating and sleeping. (1) Social and financial success is strongly influenced by psychological wellness, including self-awareness and our ability to exercise self-control.
Many factors contribute to mental health issues, including:
Genes and brain chemistry
Family history of mental health problems
Life experiences, such as trauma or abuse
Mental health issues run the gamut from minor difficulty with daily living to full-blown psychosis. Treatment can have a significant impact on the course and outlook of psychological issues, making early detection crucial.
Mental illness can appear in early childhood or not until adulthood. (2) Some psychological issues may not emerge until later in life and can be influenced by certain drugs and medical conditions. There are numerous warning signs of mental health issues. These vary depending on the nature of the condition, and may include:
Eating or sleeping too much or too little
Withdrawing from relationships and usual activities
Having low or no energy
Feeling numb
Experiencing unexplained aches and pains
Feeling helpless or hopeless
FAQ
Q: What is the most common mental illness?A: Depression, a mood disorder that affects 300 million people worldwide, is the single most common mental illness. Anxiety disorders are more prevalent overall.
Psychological difficulties increase the risk of troubled relationships with family and friends. (3) Interpersonal conflict can be caused by irritability and mood swings, or feelings such as fear and anger. Other cognitive signs associated with mental health issues include worry, confusion, memory loss, and intrusive thoughts.
More serious mental disorders may cause hallucinations, including hearing voices or believing things that are not true. Suicidal behavior or thoughts of harming another person are also common signs of psychological issues. A person suffering from mental illness may experience paranoia, imagined physical ailments, or the need to abuse drugs or alcohol.
Types of Mental Health Disorders
Each type of mood disorder is characterized by unique signs and symptoms and may co-occur with other disorders. For example, anxiety might occur along with substance abuse, physical complaints, or a sleep disorder like insomnia.
The following are some of the most common mental health disorders:
Anxiety Disorders. People with anxiety disorders respond to certain objects or situations with fear and dread. Anxiety disorders can include panic disorders, generalized anxiety disorder, and phobias. (4) Symptoms of anxiety include:
Fatigue
Feelings of restlessness or irritability
Difficulty focusing or learning new concepts
Chronic pain or muscle tension
Trouble controlling feelings of worry
Problems sleeping, including the inability to sleep, unsatisfying sleep, or excessive sleeping
Psychiatric Disorders in Children. Common psychiatric disorders in children include attention deficit hyperactivity disorder (ADHD) a neurodevelopmental disorder that usually persists into adulthood. Symptoms include impulsiveness, trouble focusing on tasks or conversations, restlessness, and feeling easily frustrated. Oppositional defiant disorder is part of a spectrum known as disruptive, impulse-control, and conduct disorders. Symptoms of oppositional defiant disorder include hostility toward and lack of cooperation with teachers, parents, and other authority figures. (5)
Eating Disorders. Eating disorders involve extreme emotions, attitudes, and behaviors related to weight and food. Common eating disorders include anorexia, bulimia, and binge eating.
Substance Use Disorders. Mental health problems and substance abuse disorders often occur together. (6) Substance abuse can be a cause or a result of psychiatric issues, and may be an attempt by some patients to self-medicate or reduce symptoms.
Mood Disorders. Almost one in ten people aged eighteen or older have a mood disorder. Mood disorders involve persistent feelings of sadness, or feelings that fluctuate between extreme happiness and extreme sadness. Mood disorders include:
Depression. Approximately 17.3 million people in the US — 7.1% of adults — suffered from one or more major depressive episodes in the last year. Depression is characterized by sadness and lack of usual enjoyment that continue for two weeks or longer. Grief and sadness related to a change in life circumstances are different from depression, which doesn’t improve in response to external events
Bipolar disorder. Bipolar disorder affects approximately six million adults in the US, and impacts men and women equally. The disorder is characterized by severe fluctuations in mood, behavior, and thought patterns. Fluctuations can last from a few hours to several months, and may be affected seasonal and light changes
Personality Disorders. People with personality disorders have inflexible personality traits that are distressing to the sufferer and may cause problems in work, school, or social relationships. (7) These disorders are highly resistant to treatment, and include the following:
Antisocial personality disorder, or APD. People with antisocial personality disorder exploit, manipulate, and disregard the feelings of others. APD describes the behavior of sociopaths and psychopaths. Psychopaths do not have a conscience, whereas sociopaths have a conscience that is severely disordered
Narcissistic personality disorder, or NPD. Approximately 1% of people are afflicted with NPD. The disorder is associated with lack of empathy, feelings of superiority, and a need for admiration. Narcissists tend to be easily hurt and are unable to tolerate criticism. Treatment is generally ineffective because people with NPD don’t believe they have a mental health issue
Borderline personality disorder, or BPD. People with borderline personality disorder have trouble regulating their emotions. They tend to act impulsively, resulting in career and relationship difficulties. Of the 1.4% of the population with BPD, 75% are women, though this number may represent misdiagnosis in many men with the disorder
Psychotic Disorders. Psychotic disorders are characterized by abnormal perceptions such as hallucinations and delusions. Hallucinations are false perceptions that involve hearing or seeing things that don’t exist. Delusions are false beliefs, such as being pursued by authorities or people wishing to do the sufferer harm. The most common psychotic disorder is schizophrenia, which typically appears in the mid to late twenties. Possible causes of schizophrenia include genetic and environmental factors, disordered brain circuitry, trauma, and drug abuse.
Psychosis
Psychosis describes mental conditions that involve loss of contact with reality.
Mental Health and Sleep
One common sign of mental health difficulty is trouble sleeping. (8) The sleep disorder most closely associated with psychiatric disturbances is chronic insomnia. Some common mental illnesses and their effect on sleep include the following:
Depression. Clinical depression often presents with persistent insomnia, or the inability to sleep. (9) Hypersomnia, or excessive drowsiness, can be a sign of depression, as well. Sleep disorders are associated so strongly with depression that some medical practitioners advise caution in diagnosing depression in patients without symptoms of a sleep disorder. Up to 75% of people diagnosed with depression also suffer from insomnia.
Bipolar Disorder. Bipolar disorder is strongly associated with the inability to fall asleep, stay asleep, fall back to sleep, or all three. People in the manic phase of bipolar disorder often have difficulty sleeping, whereas those in the depressive phase may sleep much more than usual. Studies show that sleep deprivation can aggravate the struggles with emotional regulation that are common in people who are bipolar. (10) For many sufferers, trouble sleeping can be an indication of an approaching manic phase.
Anxiety Disorder. Anxiety is a principal cause of chronic insomnia. Even common anxiety related to work and life circumstances may trigger insomnia. A primary cause of chronic insomnia is conditioned anxiety related to sleep and the bedtime routine. Anxiety’s impact on the body includes hyperactivity of the central nervous system and excessive release of stress hormones, such as adrenaline and cortisol. Studies show a strong association between a history of insomnia and anxiety disorder, panic disorder, and social anxiety disorder. (11)
Borderline Personality Disorder. BPD sufferers with insomnia typically experience the daytime consequences of sleep loss, including sleepiness, difficulty concentrating, and irritability. Symptoms of BPD can be worsened by insomnia, leading to a vicious cycle of sleeplessness and behavioral issues.
Personality Disorders. Some personality disorders may be associated with disturbed sleep patterns. (12) One study revealed that people with circadian rhythm disorder are more likely to have a personality disorder than people with normal sleep and wake cycles.
Psychotic Disorders. Psychotic disorders such as schizophrenia can have a profound impact on sleep. Sleep disturbances are often an early sign of schizophrenia and can precede psychiatric symptoms by months or years. Schizophrenia patients are more likely to suffer from other sleep disorders, as well, including:
Obstructive sleep apnea
Restless legs syndrome
Periodic limb movement disorder
Circadian rhythm dysfunction
FAQ
Q: What is circadian rhythm dysfunction?A: Circadian rhythm dysfunction is caused by a loss of synchronization between sleep-wake cycles and natural light and darkness signals. Symptoms include the inability to fall or stay asleep, cognitive dysfunction, and trouble maintaining a traditional sleep schedule.
Does Depression Cause Insomnia, or Vice Versa?
It was once thought that insomnia symptoms resulted from psychiatric disorders and depression, not the other way around. Now the evidence isn’t so clear. Sleep problems may not just be the result of emotional disturbances, they may increase the likelihood of suffering from them, as well.
Medications to treat psychiatric disturbances may also cause insomnia. Psychotropic medications can have stimulating effects that contribute to interrupted sleep. Restless leg syndrome and periodic limb movements may be triggered or exacerbated by antidepressants and other drugs used to treat mood disorders.
An analysis of major studies revealed that volunteers who suffered from insomnia symptoms were twice as likely to be diagnosed with depression as those without sleep difficulties. Why? Though the connection between mood disorders and insomnia isn’t entirely understood, it is well-known that hormones and neurotransmitters are affected by poor sleep. Sleep is a restorative activity that reduces stress in the body and areas of the brain, especially the axis between the hypothalamus and adrenal and pituitary glands. Excess secretion of cortisol — also known as “the stress hormone” — may play a role, as well.
Lack of sleep and the resulting physiological stress may predispose insomnia sufferers to major mood disturbances, making early treatment of sleep disorders essential, especially in people with a family history of mental health issues. (13)
Depression and Other Sleep Disorders
Insomnia is not the only sleep disorder associated with depression and anxiety. (14) Sleep apnea is a common cause of depression, as is hypersomnia. Sleep apnea is characterized by blockage of the airway and repeated awakenings during the night. Chronic sleep apnea can result in weight gain, increased risk of heart attack and stroke, and memory problems.
Hypersomnia is associated with excessive time spent sleeping and daytime sleepiness. The disorder can be caused by medical conditions, certain drugs, and immune system dysfunction. Though most people need between seven and nine hours of sleep each night, the need for significantly more can indicate a mood disorder. Like sleep apnea, hypersomnia is related to a greater likelihood of heart attack and stroke.
Hypersomnia
A sleep disorder associated with excessive sleeping. Hypersomnia includes narcolepsy, an autoimmune disease that can cause extreme sleepiness and muscle weakness.
Psychiatric Medications and Sleep
Medications to treat psychological disturbances can have a positive or negative impact on sleep. (15) Most antidepressant medications influence the neurotransmitters dopamine, serotonin, and norepinephrine, all of which help to regulate sleep and wake cycles. Some can have stimulating effects that contribute to insomnia.
Restless legs syndrome and periodic limb movements can be triggered or exacerbated by antidepressants and other drugs used to treat mood disorders. (16) These medications can be helpful in patients without movement-related sleep disorders who suffer from hypersomnia.
Other medications such as older tricyclic drugs can help establish healthy sleep patterns in depressed patients with insomnia. Once a depressed patient starts taking medication, insomnia may be the last symptom to improve. Newer antidepressants such as selective serotonin reuptake inhibitors can suppress the REM stage of sleep, as well as the vivid dreaming that occurs during REM sleep.
Antipsychotic medications can help with insomnia, a common issue for schizophrenia sufferers. Some of these drugs can also cause daytime sleepiness, which may be preferable to insomnia. (17) Hypnotic medications are often prescribed along with antipsychotics, and may initially help with insomnia due to their sedative effects. However, many patients become tolerant of hypnotics or develop a rebound response, which can limit their usefulness for insomnia over the long-term.
Suicidal Behavior and Sleep
Suicidal behavior is a common feature of certain psychiatric conditions, including bipolar disorder and depression. Suicidal thoughts and actions can also occur in the absence of a psychiatric condition. Suicide is the second leading cause of death in people between 15 and 24. Suicide is more likely to be completed by people with access to guns.
Signs of suicidal thoughts and behavior may include the following:
Speaking about suicide or the desire to die
Feeling or talking about feeling hopeless
Researching ways to commit suicide
Appearing anxious or depressed
Excessive use of alcohol, or use of drugs
Exhibiting unusual behavior, such as rage, mood swings, or agitation
Suicidal behavior is often caused by psychiatric conditions, but may also be triggered by difficult life events, stress, loss of a loved one, or past trauma such as emotional, physical, or sexual abuse. Suicidal behavior is also more common in people suffering from post-traumatic stress disorder or chronic pain.
Recent research reveals that suicidal behavior and lack of sufficient sleep are related in adolescents and adults. (18) People who completed their suicidal actions were more likely to have suffered from insomnia, hypersomnia, or another sleep disturbance. Though further research is needed to better understand this link, existing studies reveal a strong association between mental health and sleep.
FAQ
Q: What is suicidal ideation?A: Suicidal ideation involves thinking about, planning, or considering suicide.
Last Word From Sleepopolis
Mental health is critically important to happiness and well-being. Research reveals a connection between mental illness and disturbed sleep, an association that may exist months or years before psychiatric symptoms appear.
Medications and other mental health treatments can help regulate sleep patterns, but may also cause or worsen insomnia, hypersomnia, and other sleep difficulties. Adjustment of medications or separate treatment of sleep issues can help establish healthy sleep patterns and improve quality of life for people suffering from mental health disorders.
References
Amy C. Watson, Self-Stigma in People With Mental Illness, Schizophrenia Bulletin, January 25, 2007
William Copeland Ph.D., Cumulative Prevalence of Psychiatric Disorders by Young Adulthood: A Prospective Cohort Analysis From the Great Smoky Mountains Study, Journal of the American Academy of Child & Adolescent Psychiatry, March 2011
Alan R. Teo, Social Relationships and Depression: Ten-Year Follow-Up from a Nationally Representative Study, Plos One, April 30, 2013
Peter J. Norton, Transdiagnostic models of anxiety disorder: Theoretical and empirical underpinnings, Clinical Psychology Review, August 2017
Martin B. Keller, MD, The Disruptive Behavioral Disorder in Children and Adolescents: Comorbidity and Clinical Course, Journal of the American Academy of Child & Adolescent Psychiatry, March 1992
Robert E Drake, et al. A systematic review of psychosocial research on psychosocial interventions for people with co-occurring severe mental and substance use disorders, Journal of Substance Abuse Treatment, January 2008
Tyrer P, Mulder R, Crawford M, Newton-Howes G, Simonsen E, Ndetei D, Koldobsky N, Fossati A, Mbatia J, Barrett B., Personality disorder: a new global perspective, World Psychiatry, February 2010
Krahn LE., Psychiatric disorders associated with disturbed sleep, Seminars in Neurology, March 25, 2005
Chiara Baglioni et al., Insomnia as a predictor of depression: A meta-analytic evaluation of longitudinal epidemiological studies, Journal of Affective Disorders, December 2011
Harvey AG, Talbot LS, Gershon A, Sleep Disturbance in Bipolar Disorder Across the Lifespan, Clinical Psychology, New York State Psychiatric Institute, April 8, 2012
Heidemarie Blumenthal, et al., The Links Between Social Anxiety Disorder, Insomnia Symptoms, and Alcohol Use Disorders: Findings From a Large Sample of Adolescents in the United States, Behavior Therapy, January 2019
Yaron Dagan, High prevalence of personality disorders among Circadian Rhythm Sleep Disorders (CRSD) patients, Journal of Psychosomatic Research, October 1996
Liu X, Buysse DJ, Gentzler AL, Kiss E, Mayer L, Kapornai K, Vetró A, Kovacs M., Insomnia and hypersomnia associated with depressive phenomenology and comorbidity in childhood depression, Sleep, January 30, 2007
Nutt D, Wilson S, Paterson L., Sleep disorders as core symptoms of depression, Dialogues in Clinical Neuroscience, September 2008
DeMartinis NA, Winokur A., Effects of psychiatric medications on sleep and sleep disorders, CNS and Neurological Disorders Drug Targets, February 6, 2007
Staner L., Sleep disturbances, psychiatric disorders, and psychotropic drugs, Dialogues in Clincal Neuroscience, December 7, 2005
Waite F, Myers E, Harvey AG, Espie CA, Startup H, Sheaves B, Freeman D., Treating Sleep Problems in Patients with Schizophrenia, Behavioural and Cognitive Psychotherapy, May 2016
Goldstein TR, Bridge JA, Brent DA., Sleep Disturbance Preceding Completed Suicide in Adolescents, Journal of Consulting and Clinical Psychology, February 17, 2010
Original article: https://sleepopolis.com/education/how-does-mental-health-affect-your-sleep/
Rose MacDowell
Rose is the Chief Research Officer at Sleepopolis, which allows her to indulge her twin passions for dense scientific studies and writing about health and wellness. An incurable night owl, she loves discovering the latest information about sleep and how to get (lots) more of it. She is a published novelist who has written everything from an article about cheese factories to clock-in instructions for assembly line workers in Belgium. One of her favorite parts of her job is connecting with the best sleep experts in the industry and utilizing their wealth of knowledge in the pieces she writes. She enjoys creating engaging articles that make a difference in people’s lives. Her writing has been reviewed by The Boston Globe, Cosmopolitan, and the Associated Press, and received a starred review in Publishers Weekly. When she isn’t musing about sleep, she’s usually at the gym, eating extremely spicy food, or wishing she were snowboarding in her native Colorado. Active though she is, she considers staying in bed until noon on Sundays to be important research.
Three types of depression identified
October 31, 2018
Science Daily/Okinawa Institute of Science and Technology (OIST) Graduate University
Scientists have used brain imaging to identify three sub-types of depression -- including one that is unresponsive to commonly prescribed serotonin boosting drugs.
According to the World Health Organization, nearly 300 million people worldwide suffer from depression and these rates are on the rise. Yet, doctors and scientists have a poor understanding of what causes this debilitating condition and for some who experience it, medicines don't help.
Scientists from the Neural Computational Unit at the Okinawa Institute of Science and Technology Graduate University (OIST), in collaboration with their colleagues at Nara Institute of Science and Technology and clinicians at Hiroshima University, have for the first time identified three sub-types of depression. They found that one out of these sub-types seems to be untreatable by Selective Serotonin Reuptake Inhibitors (SSRIs), the most commonly prescribed medicines for the condition. The study was published in the journal Scientific Reports.
Serotonin is a neurotransmitter that influences our moods, interactions with other people, sleep patterns and memory. SSRIs are thought to take effect by boosting the levels of serotonin in the brain. However, these drugs do not have the same effect on everyone, and in some people, depression does not improve even after taking them. "It has always been speculated that different types of depression exist, and they influence the effectiveness of the drug. But there has been no consensus," says Prof. Kenji Doya.
For the study, the scientists collected clinical, biological, and life history data from 134 individuals -- half of whom were newly diagnosed with depression and the other half who had no depression diagnosis- using questionnaires and blood tests. Participants were asked about their sleep patterns, whether or not they had stressful issues, or other mental health conditions.
Researchers also scanned participants' brains using magnetic resonance imaging (MRI) to map brain activity patterns in different regions. The technique they used allowed them to examine 78 regions covering the entire brain, to identify how its activities in different regions are correlated. "This is the first study to identify depression sub-types from life history and MRI data," says Prof. Doya.
With over 3000 measurable features, including whether or not participants had experienced trauma, the scientists were faced with the dilemma of finding a way to analyze such a large data set accurately. "The major challenge in this study was to develop a statistical tool that could extract relevant information for clustering similar subjects together," says Dr. Tomoki Tokuda, a statistician and the lead author of the study. He therefore designed a novel statistical method that would help detect multiple ways of data clustering and the features responsible for it. Using this method, the researchers identified a group of closely-placed data clusters, which consisted of measurable features essential for accessing mental health of an individual. Three out of the five data clusters were found to represent different sub-types of depression.
The three distinct sub-types of depression were characterized by two main factors: functional connectivity patterns synchronized between different regions of the brain and childhood trauma experience. They found that the brain's functional connectivity in regions that involved the angular gyrus -- a brain region associated with processing language and numbers, spatial cognition, attention, and other aspects of cognition -- played a large role in determining whether SSRIs were effective in treating depression.
Patients with increased functional connectivity between the brain's different regions who had also experienced childhood trauma had a sub-type of depression that is unresponsive to treatment by SSRIs drugs, the researchers found. On the other hand, the other two subtypes -- where the participants' brains did not show increased connectivity among its different regions or where participants had not experienced childhood trauma -- tended to respond positively to treatments using SSRIs drugs.
This study not only identifies sub-types of depression for the first time, but also identifies some underlying factors and points to the need to explore new treatment techniques. "It provides scientists studying neurobiological aspects of depression a promising direction in which to pursue their research," says Prof. Doya. In time, he and his research team hope that these results will help psychiatrists and therapists improve diagnoses and treat their patients more effectively.
https://www.sciencedaily.com/releases/2018/10/181031093337.htm
Mindfulness-based therapy helps prevent depression relapse
December 9, 2010
Science Daily/JAMA and Archives Journals
Mindfulness-based cognitive therapy appears to be similar to maintenance antidepressant medication for preventing relapse or recurrence among patients successfully treated for depression, according to a new study.
"Relapse and recurrence after recovery from major depressive disorder are common and debilitating outcomes that carry enormous personal, familial and societal costs," the authors write as background information in the article. The current standard for preventing relapse is maintenance therapy with a single antidepressant. This regimen is generally effective if patients take their medications, but as many as 40 percent of them do not. "Alternatives to long-term antidepressant monotherapy, especially those that address mood outcomes in a broader context of well-being, may appeal to patients wary of continued intervention."
Zindel V. Segal, Ph.D., of the Centre for Addiction and Mental Health, Toronto, Ontario, Canada, and colleagues studied 160 patients age 18 to 65 who met criteria for major depressive disorder and had experienced at least two episodes of depression. After eight months of treatment, 84 (52.5 percent) achieved remission. Patients in remission were then randomly assigned to one of three treatment groups: 28 continued taking their medication; 30 had their medication slowly replaced by placebo; and 26 tapered their medication and then received mindfulness-based cognitive behavioral therapy.
In this therapy, patients learn to monitor and observe their thinking patterns when they feel sad, changing automatic reactions associated with depression (such as rumination and avoidance) into opportunities for useful reflection. "This is accomplished through daily homework exercises featuring (1) guided (taped) awareness exercises directed at increasing moment-by-moment nonjudgmental awareness of bodily sensations, thoughts, and feelings; (2) accepting difficulties with a stance of self-compassion; and (3) developing an 'action plan' composed of strategies for responding to early warning signs of relapse/recurrence," the authors write.
During the 18-month follow-up period, relapse occurred among 38 percent of those in the cognitive behavioral therapy group, 46 percent of those in the maintenance medication group and 60 percent of those in the placebo group, making both medication and behavioral therapy effective at preventing relapse.
About half (51 percent) of patients were classified as unstable remitters, defined as individuals who had symptom "flurries" or intermittently higher scores on depression rating scales despite having a low enough average score to qualify for remission. The other half (49 percent) were stable remitters with consistently low scores. Among unstable remitters, those taking maintenance medication or undergoing cognitive behavioral therapy were about 73 percent less likely to relapse than those taking placebo. Among stable remitters, there were no differences between the three groups.
"Our data highlight the importance of maintaining at least one active long-term treatment in recurrently depressed patients whose remission is unstable," the authors write. "For those unwilling or unable to tolerate maintenance antidepressant treatment, mindfulness-based cognitive therapy offers equal protection from relapse during an 18-month period." It is unclear exactly how mindfulness-based therapy works, but it may change neural pathways to support patterns that lead to recovery instead of to deeper depression, they note.
http://www.sciencedaily.com/releases/2010/12/101206161734.htm