Sleep disorders and mental illness go hand in hand


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Imran S. Khawaja, M.D.
An early day at the office. Late nights checking email on our laptops or smartphones. Watching our favorite TV shows late into the night. And then we get up early the next morning, feeling exhausted as we do it again.

We are so busy with our everyday lives that sleep may feel like a luxury – something we push off until the weekend or the next vacation to try to “catch up.” Unfortunately, sleep doesn’t work like that.

A March 2017 New York Times article highlighted a very real danger of disruptions to our sleeping patterns: an increased risk of mental illness. Though we’ve known for some time that sleep disorders and mental illness are linked, we shouldn’t jump to the conclusion that one simply causes the other. In fact, both of these problems often are different aspects of the same treatable condition.

The relationship between sleep disorders and mental illnesses

When I give talks to my colleagues in psychiatry, I ask them, “How many of you have patients who are struggling with mental health and don’t have any sleep troubles?” Almost none of them raise their hands. But they all raise their hands when I flip the question and ask, “How many of you have patients who have mental health issues and trouble with sleep?”

Changes in natural sleep patterns can lead to several types of sleep disorders. And as we’ve seen in numerous studies, sleep disorders are highly likely to appear in several forms of mental illness. It’s a circular relationship that can make treatment challenging – but not impossible.

My colleagues help patients who are having trouble sleeping, who have some form of mental illness, or both. Request an appointment with a sleep specialist, or call 214-645-8300 for more information.

Related reading: A look at how ‘sleep genes’ may affect our circadian rhythms

Depression and insomnia

Insomnia, or difficulty falling asleep or staying asleep, is among the most common sleep disorders. In one study, 40 percent of participants with insomnia had a mental illness. Just 16.4 percent of people in that study had no sleep disorder paired with their mental illness.

We recognize insomnia as a risk factor for both depression and major depressive disorder. In fact, people with insomnia are twice as likely to develop depression as people who don’t have sleep disorders. We used to think depression caused insomnia, but we now know that the relationship is more circular than causal. Insomnia gives us a clue that a person is at high risk for becoming depressed. If we can treat the insomnia, we may be able to prevent a patient from becoming depressed.

Schizophrenia and sleep disorders

Schizophrenia is a severe psychiatric condition in which people interpret reality abnormally. It often result in some combination of hallucinations, delusions, and extremely disordered thinking and behavior that impairs daily functioning. Disturbances in sleep patterns are present in as many as 80 percent of people with schizophrenia.

Common sleep problems in people with schizophrenia include:
  • Circadian rhythm problems, or misalignment of their biological rhythms with the time zone they live in
  • Increased sleep latency, or taking longer to fall asleep
  • Not getting enough sleep
  • Waking frequently during sleep
  • Sleep apnea

Bipolar disorder and sleep disorders

If I’m seeing a bipolar patient in my clinic, and the patient tells me he’s not sleeping well or waking up multiple times at night, that’s a red flag for me. In fact, up to 80 to 90 percent of people with bipolar disorder have some type of sleep disturbance or insomnia before a manic episode.

Many patients who are experiencing a manic episode don’t feel like they need to sleep. They don’t complain about this because they feel energized and don’t think they need to rest. But without proper treatment for the sleep disorder, that patient is going to have a manic episode or a psychotic break sooner or later.

Post-traumatic stress disorder and sleep disorders

There has been a great deal of study on post-traumatic stress disorder, or PTSD, and how it affects sleep patterns. A colleague of mine, Dr. Erin Koffel at the University of Minnesota, took part in a study of National Guard members who were screened for sleep disturbances a few months before they were deployed to Iraq.

A year later, they came back from Iraq and were tested for PTSD. The researchers in this study found that soldiers who had sleep disorders before they were deployed were more likely to have PTSD afterward. People who have trouble sleeping are more likely to develop PTSD – as well as other mental illnesses, potentially – when they’re placed in stressful situations, such as military deployment in a combat zone.

Light therapy to improve sleep and mental health

Treating sleep disorders involves getting a detailed sleep history from patients. That means delineating what’s happening at night as well as what they’re doing during the day. Do they drink a lot of caffeinated beverages? Do they drink alcohol? How stressed are they? What time do they have to go to work or school? Once we’ve established a patient’s normal routine and what we think is going wrong, we can talk about solutions.

Light exposure plays a huge role in regulating our sleep patterns. I use bright light therapy for patients who have delayed sleep phase syndrome or “night owl syndrome.” This involves exposure to bright light early in the day. This reinforces the signals to the brain that it’s time to be awake and active during the daytime.

It is also helpful to minimize patient’s exposure to light in the evenings. This helps signal to the brain that it’s time to start winding down and prepare for sleep. What we’ve found is that light in the blue area of the visible light spectrum has the most negative effect on sleep patterns. This could be because blue light is some of the brightest light. It also could be related to the blue color of the daytime sky.

Blue light also happens to be the type of light given off by our TVs, computers, smartphones, and tablets. With our evening work habits, as well as evenings spent watching TV or using computers, we’re exposed to more blue light later in the day than ever before. That’s why we recommend that people reduce or eliminate their exposure to sources of blue light in the evening and nighttime hours so they don’t accidentally delay their brains’ natural sleep cycles.

Many devices include settings or third-party apps that can block the blue wavelength of light to reduce their effects on their natural sleep cycles, or circadian rhythms. Some eyewear manufacturers also are producing glasses or goggles that filter blue light.

Supplements and medications for better sleep

Some patients find relief from sleep disorders by taking a melatonin supplement in the evening to jump-start the brain’s release of the chemical melatonin, which prepares the body for sleep. However, it’s important for patients to take the supplement according to their normal sleep patterns. Taking melatonin too early or too late can throw sleep patterns further out of alignment.

Some patients do well with antidepressant medications that also are sedatives that help them fall asleep at night. Other patients need help staying awake during the day, so we can give them stimulant medications if needed.

But medications alone are not always the answer. For example, some depression medications can cause weight gain. If a patient has gained weight and is snoring during sleep, we will examine the patient for sleep apnea and potentially treat that condition. If we don’t address a patient’s sleep apnea, the patient likely is going to stay sleepy and continue to have problems with depression.

Sleep’s powerful effects on our mental health can’t be ignored. But with the right treatment plan, we can help patients find peace of mind – along with a peaceful night’s sleep.