It sounds like the beginning of a corny joke: Sleep, a circadian rhythm, and a mood disorder enter a brain …
But this is actually quite serious: Their relationship to one another is complicated. If one is out of balance with the others, your mental health may suffer.
Consider this 2019 study in mice, which revealed that sleep is a sensitive and early marker of the brain’s ability to respond to challenges faced during wakefulness. Rapid eye movement (REM) sleep—the state in which we dream—may help to regulate our emotions and consolidate our memories, and possibly plays an important role in the brain’s response to stress.
“REM sleep may be helping us prepare our brains to deal with the outside world,” says Ruth Benca, MD, PhD, Chair of Psychiatry and Human Behavior at the University of California Irvine, and a member of Genomind’s Scientific Advisory Board. “There's also probably the fact that certain kinds of instinctual behaviors may get rehearsed in REM sleep.” For instance, how we deal with stress.
Sleep, Mental Health, and Their Complicated Relationship
First of all, you should know that REM sleep is a more activated brain stage. “Sleep seems to be important for brain plasticity—some of the functions probably include putting memories into longer term storage and solidifying memories,” Dr. Benca says. Certain kinds of instinctual behaviors may get rehearsed during this sleep stage. Early in development, REM sleep is a much larger chunk of our sleeping time, and it may be essential for the brain to wire itself properly, and therefore, aid in its development.
So while researchers are just starting to understand sleep functions, it appears that REM sleep is a critical component. And here is where the relationship between sleep and mental wellbeing isn’t well-defined.
For instance, in various types of dementia, particularly in Alzheimer’s disease, there is a loss of REM sleep. Whether it is the lack of REM sleep that contributes to the disease and its symptoms, or whether the disease causes the deficiency in REM sleep, is not known. The question of which comes first is also a question when looking at the relationship between sleep and mental health conditions.
On the other hand, NREM (non-REM) sleep, which makes up the majority of sleep time in adults (75-80%) includes two important sleep EEG oscillations: slow waves and sleep spindles. Both have been implicated in learning and memory, and one of the important functions of NREM sleep, and slow waves in particular, is to help reset or normalize brain synapses. During wakefulness, brain synaptic strength increases, and during sleep, some synapses are eliminated, which allows for brain plasticity through renormalization of overall synaptic strength.
Sleep and Psychiatric Disorders
“There's a lot of epidemiologic evidence that insomnia, in particular, often precedes new onset or exacerbation of psychiatric disorders, particularly mood disorders,” Dr. Benca says. People who have chronic insomnia are more likely to develop depression than people who don't have any sleep problems, and excessively sleepy individuals may also be at greater risk for developing a psychiatric illness.
“Sleep problems are often but not always a leading edge of psychiatric disorders. And on the other hand, when people are acutely psychiatrically ill, that can contribute to their sleep problems,” she says.
How Better Sleep Can Improve Symptoms
When talking about sleep and mental health issues, the quantity, quality, and timing are important. Sleep is governed by timing, or circadian rhythms, which helps determine retire and wake behavior.
“We want to think not just about insomnia or sleep amount, but understand that there is a timing component as well,” Dr. Benca says. Dysregulation of sleep and rhythms are common in mental health conditions. For example, people with mood disorders tend to have a more delayed sleep phase—they are night owls, sometimes in the extreme, so it isn’t just that they have insomnia and cannot sleep, but that they can’t sleep during the right time of the day. Furthermore, many psychiatric disorders have been associated with alterations in circadian clock genes.
For some mental health conditions, addressing these social rhythms through therapy could help diminish symptoms. There is data surrounding bipolar disease and depression that shows this is the case. Improving sleep—the quantity, quality, and timing—may help mental wellbeing.
“Patients with psychiatric illnesses also have high rates of primary sleep disorders,” says Dr. Benca. Sleep apnea and restless leg syndrome are some of the common ones. People with insomnia tend to also have restless leg syndrome because, as Dr. Benca explains: “There’s a genetic overlap that one of the key genes associated with restless legs is also associated with insomnia.”
Herein lies the catch-22 of sleep and mental health: Sleep deprivation affects how you think and feel, and mental health issues can cause insomnia or other sleep disorders. Sleep problems are common with anxiety, depression, bipolar disorder, and attention deficit hyperactivity disorder (ADHD).
5 Ways to Sleep Better
Researchers are still trying to get to the root of the relationship between mental illness and slumber. “Unfortunately, we don't have strong evidence that preventing a sleep problem will prevent an episode of illness, cure an illness, or cause an illness to remit just by treating sleep. But certainly, treating sleep often can help,” says Dr. Benca.
In the meantime, use the tips below to improve the quality and quantity of your sleep. “Without sleep, no matter what medication we give the patient, they may be treatment resistant,” says Rupali Chadha, M.D., chief of medical staff at Metropolitan State Hospital in Norwalk, California, and a general and forensics psychiatric physician.
- Talk to your doctor about your medications. Dr. Chadha suggests using medications that are sedating at bedtime, because they can both treat the illness and help patients sleep. Many antipsychotic medications can hamper sleep. Talk to your doctor about the best time to take medicines to reduce the impact on your sleep.
- Keep a sleep schedule. Dr. Chadha emphasizes waking up at the same time every day, no matter what time you fall asleep. “It prevents the patient from sleeping during the day or not getting restful sleep at night,” she says.
Eventually, your body will start to produce sleep hormones at the same time each night, making you feel tired. As a result, it may help you to fall asleep at the same time each night, thereby achieving a regular sleep schedule and helping address any timing or rhythm issues that you’re experiencing.
- Participate in self-care. Making sure you are taking care of yourself can help you reduce everyday stress. Dr. Chadha tells her patients to exercise, do yoga, or participate in any other enjoyable activity.
- Move more, preferably early. People sleep significantly better when they exercise an average of 20 minutes a day, says a study published in Mental Health and Physical Activity.
When researchers sampled more than 3,000 men and women ages 18 to 85, they found that those who participated in 150 minutes of moderate to vigorous activity a week experienced a 65% improvement in sleep quality.
Bonus: Physical activity may improve your mental wellness; sedentary people may be more likely to suffer from anxiety and depression, suggests a study published in Sleep and Breathing.
Try to exercise in the morning or early afternoon, because intense exercise can release adrenaline that hampers sleep.
- Consider CBT. Cognitive Behavior Therapy, or CBT, for insomnia could go a long way. Dr. Benca suggests that “we need to make stronger efforts with cognitive behavioral therapies for insomnia, because these treatments are effective, safe, and focus on the overall behavioral activity rhythms of our patients.”
This is where social rhythms therapy may be helpful to many psychiatric patients, since it covers more than just sleep, by helping train the circadian rhythms through adding more structure to their day. This is something that many psychiatric patients—particularly those that are more severely ill—often don't have, especially if they're disabled.
Recreating the structure of when you go to sleep and get up, when you eat, when you get exposed to outdoor light, when you exercise, and when you interact with people, are all components of therapy that are helpful for both sleep and rhythms, Dr. Benca says.
What’s more: Recent studies show that when people experiencing depression and insomnia are treated with CBT—either for depression or for insomnia—the ones who got CBT for insomnia not only had a similar response to those who received CBT for their depression, but they had a better response for their sleep. So overall, CBT for insomnia may be a better treatment than CBT for just depression alone.
Science is still unraveling the relationship between sleep and mental health conditions. In the meantime, do the best you can (with some professional help if necessary) to get a good night’s rest.