Many people experience problems sleeping including not getting enough sleep, not feeling rested and not sleeping well. This problem can lead to difficulties functioning during the daytime and have unpleasant effects on your work, social and family life. Problems sleeping can be secondary to a medical illness such as sleep apnea, or a mental health condition like depression. Sleep issues can be a sign of an impending condition such as bipolar disorder. In addition to affecting sleep itself, many medical and mental health conditions can be worsened by sleep-related problems.
One of the major sleep disorders that people face is insomnia. Insomnia is an inability to get the amount of sleep needed to function efficiently during the daytime. About 1 in 3 people in the U.S. report difficulty sleeping at least one night per week. Insomnia is caused by difficulty falling asleep, difficulty staying asleep or waking up too early in the morning.
Insomnia is rarely an isolated medical or mental illness but rather a symptom of another illness to be investigated by a person and their medical doctors. In other people, insomnia can be a result of a person’s lifestyle or work schedule.
Sometimes insomnia or other sleep problems can be caused by sleep apnea, which is a separate medical condition that affects a person’s ability to breathe while sleeping. A doctor or sleep specialist can diagnose sleep apnea and provide treatment to improve sleep.
Short-term insomnia is very common and has many causes such as stress, travel or other life events. It can generally be relieved by simple sleep hygiene interventions such as exercise, a hot bath, warm milk or changing your bedroom environment. Long-term insomnia lasts for more than three weeks and should be investigated by a physician with a potential referral to a sleep disorder specialist, which includes psychiatrists, neurologists and pulmonologists who have expertise in sleep disorders.
Cause and Effect
Approximately 50% of insomnia cases are related to depression, anxiety or psychological stress. Often the qualities of a person’s insomnia and their other symptoms can be helpful in determining the role of mental illness in a person’s inability to sleep. Early morning wakefulness can be a sign of depression, along with low energy, inability to concentrate, sadness and a change in appetite or weight. On the other hand, a sudden dramatic decrease in sleep which is accompanied by increase in energy, or the lack of need for sleep may be a sign of mania.
Many anxiety disorders are associated with difficulties sleeping. Obsessive-compulsive disorder (OCD) is frequently associated with poor sleep. Panic attacks during sleep may suggest a panic disorder. Poor sleep resulting from nightmares may be associated with posttraumatic stress disorder (PTSD).
Substance use disorders can also cause problems with sleep. While alcohol is sedating in limited quantities, intoxication with alcohol can make you wake up numerous times in the night and disturbs your sleep patterns. Illicit drugs such as LSD and ecstasy are also associated with interruptions in sleep. Some sedative medications may cause sleepiness during intoxication but can disturb sleep and cause serious problems sleeping in people who are misusing or withdrawing from these medications.
Poor sleep has been shown to significantly worsen the symptoms of many mental health issues. Severe sleep problems can decrease the effectiveness of certain treatments. Treatment of sleep disorders has also been studied in relationship to schizophrenia, ADHD and other mental illnesses. All of the scientific data shows the connection between medical and mental illnesses: good sleep is necessary for recovery—or prevention—in both types of conditions.
The first-line treatment for insomnia is good sleeping habits and taking care of any underlying conditions that may be causing the problems with sleeping. But when these are not enough, other treatment options can be considered.
- Good sleeping habits. A first-line treatment for treatment of insomnia, these can include maintaining a regular sleep schedule, avoiding stimulating activities like exercise before bed, and having a comfortable sleep environment.
- Relaxation techniques. Deep breathing, progressive muscle relaxation and mindfulness can help people become aware of their body and decrease anxiety about going to sleep.
- Medication. Many psychiatric drugs are used to promote sleep in people with insomnia. One should be careful regarding the risk of becoming “over-sedated” by using other drugs and alcohol when taking some of these medications. Doctors don't generally recommend staying on medication for more than a few weeks but there are a few medications that have been approved for long term use.
- Herbal remedies. Melatonin and valerian root are two herbal remedies that are available at many pharmacies and other locations. The effectiveness of these treatments has not been proven for most people, and neither treatment has been approved by the FDA.
- Sleep restriction. This is a form of therapy that increases “sleep efficiency” by decreasing the amount of time that a person spends in bed awake. This involves very strict rules regarding the amount of time that a person can lay in bed for at night which gradually increases over time.
- Cognitive behavioral therapy. This therapy can help you control or eliminate negative thoughts and worries that keep you awake.
- Light therapy. Also known as phototherapy, this can be specifically helpful in people with a condition called “delayed sleep phase syndrome.”
- Exercise is associated with improved sleep quality. Talk with your health care provider about the kind of exercise that will work for you.