Poor Sleep & Mental Health

Treatment and support for sleep problems via telehealth with Epsychiatry

The amount of sleep we need varies from person to person and most of us will have periods of poor sleep at some point in our lives. Sleep difficulties become a problem when they are recurrent, night after night, and persist for a prolonged period of time. Similarly, prolonged poor sleep is problematic if it causes you distress and significantly impacts your ability to function well in life.

The quality of our sleep can be a good indicator of our health, both physical and mental, and overall wellbeing. It is therefore important to seek help if your sleep problems persist or worsen. Sleep problems can contribute to a deterioration in your health, relationships, performance and overall quality of life.

 

What are some signs, symptoms and impacts of sleep problems?

Sleep problems can have a severe and debilitating effect on people. It is therefore helpful to be aware of the warning signs for these conditions. Some common signs and symptoms of sleep problems are listed below:

  • Difficulty falling asleep or staying asleep at night
  • Waking during the night or too early in the morning
  • Feeling unrested upon waking
  • Excessive tiredness or sleepiness during the day
  • Need for stimulants (e.g. energy drinks, coffee) to get through the day
  • Irritability/agitation, low mood or increased anxiety
  • Lower tolerance for frustration, which may result in uncharacteristic anger outbursts
  • Problems with attention, concentration and memory
  • Increased forgetfulness, oversights or mistakes (e.g. at work, when driving, or keeping commitments)
  • Ongoing worries and anxiety about sleep (e.g. worrying about not being able to sleep, clock watching, or stressing about the impact of poor sleep on your future performance)
  • Appetite and weight changes, most commonly weight gain

These factors can have a significant impact on the way you cope at work/school, in your relationships and in other important aspects of life (e.g. hobbies and personal care). You may find your motivation and performance drops at work, or that your relationships suffer as a result of you being tired or irritable all the time. You may find you lose interest in activities you used to enjoy or that you let yourself go in terms of self-care.

 

How do mental health impact sleep and vice versa?

Sleep and mental health are intricately linked. Our sleep impacts our mental health and our mental health can greatly influence the quality and nature of our sleep. In fact, many mental health diagnoses list sleep disturbance as a core feature of the disorder (e.g. depression or bipolar disorder). Below, we list some of the ways in which mental health can impact sleep:

  • Research has shown that people with mental health problems are more likely to suffer from a diagnosable sleep disorder, such as insomnia. For example, estimates suggest up to 90% of people with depression also have insomnia.
  • Some of the psychiatric medications prescribed for other mental health conditions can interfere with sleep. For example, certain types of antidepressants and the medications prescribed to treat ADHD can be stimulating and act to keep you awake. In addition, ceasing certain nighttime psychiatric medication after taking it for a while can make your sleep worse.
  • Anxiety is a common feature in many mental health problems and can interfere with sleep in many ways. Physical tension and hyperarousal in the body may make it hard for you to wind down and relax enough to fall asleep. Anxiety is also associated with an overactive mind, which can interfere with your sleep. You may be fearful of going to sleep, worrying about the future, or anxious about what might happen whilst you’re asleep. You may also wake up early and be unable to get back to sleep due to the many anxious thoughts whirring around in your head.
  • Depression can cause you to sleep more or less than normal. People who are depressed often struggle with motivation and fatigue, which can lead them to sleep for longer and struggle to wake up. Similarly, people with depression can also experience restlessness and an inability to fall and stay asleep. Early morning awakening is a common feature of some types of depression – this is where the person wakes hours before the intended wake time (e.g. 3-4 am)  and is unable to go back to sleep. 
  • Bipolar symptoms are closely related to sleep. During a manic episode, a person is likely to require less sleep than usual. You may go days or even weeks without the need for much sleep at all. Over time, irregular and poor sleep patterns take a toll on the body and your overall wellbeing.
  • Other mental health conditions, for example, ADHD and trauma-related disorders (e.g. PTSD) can also impact sleep and may experience difficulty falling or staying asleep, night waking, or nightmares.

In each of the above examples, poor sleep can become a maintaining factor for the primary mental health problem. For example, poor sleep can make you feel even more anxious or depressed and less able to cope with challenges the following day. Sleep problems are therefore very important to address.

 

What are the different types of sleep disorders?

There are many different types of sleep disorders. We have listed some of the common types below:

  • Insomnias involve difficulty falling asleep or staying asleep​ (e.g. insomnia)
  • Hypersomnias involve excessive sleepiness, which causes people to fall asleep at inconvenient, or even dangerous, times (e.g. narcolepsy)
  • Parasomnias involve unwanted experiences that occur when falling asleep, during sleep or when waking up (e.g. sleepwalking, night terrors)
  • Sleep-related breathing disorders involve problems with breathing during sleep (e.g. obstructive sleep apnea) 
  • Circadian rhythm related sleep-wake disorders relate to when a person’s sleep times are out of sync with their surroundings
  • Sleep movement disorders involve movement difficulties that interfere with sleep (e.g. restless leg syndrome).

To be diagnosed with a sleep disorder, you must meet certain diagnostic criteria and your symptoms cannot be explained by another mental disorder, medical condition or the effects of a substance (e.g. illicit drug or medication).

 

How can we treat sleep problems?

Treatment for sleep problems starts by seeing a health professional and receiving an accurate diagnosis. Your GP is a good first person to speak to about your sleep difficulties. Sleep troubles are common. Your doctor is likely to have had prior experience in managing insomnia and other sleep difficulties in other patients. You can be referred by your GP to another health professional for more specialised care.

Treatment for sleep disorders may involve one or more of the following components:

 

Lifestyle changes and sleep hygiene

Lifestyle and simple strategies to promote better sleep can have a significant effect on the quality of your sleep. Your doctor, psychologist or psychiatrist will be able to guide you in this. They may recommend things like

1) dietary improvement

2) regular exercise

3) reduced caffeine intake

4) implementing a regular sleep-wake routine

5) strategies to address underlying stress and anxiety

 

Psychotherapy

Talking therapy can help to address sleep problems and is often the first-line recommendation. The reason is it does not carry a risk of side effects. Cognitive Behaviour Therapy for Insomnia (CBT-I) is one form of evidence-based treatment designed specifically to help with sleep. In CBT-I, you will learn to recognise and challenge patterns that are getting in the way of your sleep and implement behavioural strategies to promote better sleep. The behavioural component of the therapy includes techniques like stimulus control therapy, sleep restriction and progressive muscle relaxation. 

 

Medications

Medications, such as sedatives or melatonin supplements, are sometimes prescribed as a short-term option for severe sleep problems. Medication is not recommended as a long term treatment strategy. Because it can foster dependence and often fails to address the true underlying cause of the condition.

 

Specialised sleep clinics and other equipment

Sleep clinics provide perhaps the most specialised and intensive care for sleep disorders. Sleep clinics often involve a multi-disciplinary team of health professionals. Such as psychiatrists, psychologists, respiratory doctors etc. Also the use of specialised equipment to monitor your sleep overnight. With advances in technology, now you can take some forms of sleep monitoring equipment home. At times, you may indicate other treatment devices, such as the use of a CPAP machine for sleep apnea. 

There are many effective treatments for sleep. So if you struggle with sleep problems we strongly encourage you to seek help! If you would like to see a psychologist or psychiatrist regarding poor sleep, speak with your GP about getting a referral. You can also contact our friendly support team for more information and to book an appointment.