Sleep and Mental Health

A two-way relationship

For a long time, sleep problems were seen mainly as symptoms of mental health conditions. Research now shows the relationship runs both ways. A 2011 meta-analysis in the Journal of Affective Disorders found that people with insomnia had about twice the risk of developing depression later compared with people without sleep problems. Sleep loss also makes emotions harder to regulate, increasing irritability and stress reactivity.

Depression

Most people with depression experience sleep changes: trouble falling or staying asleep, early morning waking, or sleeping much more than usual. Insomnia that persists after other depressive symptoms improve increases the chance of relapse. Treating insomnia with CBT-I alongside depression treatment can improve both sleep and mood.

Anxiety and PTSD

Anxiety makes it harder to switch off at night, and short sleep increases anxiety the next day. People with post-traumatic stress disorder often have insomnia and nightmares. Effective treatments exist for trauma-related nightmares, including imagery rehearsal therapy, which a sleep specialist or therapist can provide.

Bipolar disorder

Sleep is especially important for people with bipolar disorder. Reduced need for sleep can be an early warning sign of mania, and sleep loss can help trigger episodes. Regular sleep and wake times are a core part of management. Some insomnia techniques, notably sleep restriction, should only be used with a clinician's guidance in bipolar disorder.

Other conditions

ADHD is commonly associated with a delayed body clock and difficulty falling asleep. Substance use, including alcohol and cannabis, often disrupts sleep, and sleep problems can make relapse more likely. Some psychiatric medications affect sleep, so mention sleep changes to your prescriber.

What helps

• Keep a regular wake time and get morning light.
• Use CBT-I for persistent insomnia; it is effective in people with depression and anxiety.
• Stay active and connected with others during the day.
• Limit alcohol and other substances.
• Ask a doctor to check for sleep apnea, which is more common than many people realise and can worsen mood.

When to seek urgent help

If you are having thoughts of suicide or self-harm, seek help right away. In the US, call or text 988 to reach the Suicide and Crisis Lifeline, or call your local emergency number. Severe insomnia combined with hopelessness should always be taken seriously.