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There’s a strong connection between sleep and mental health. A recent study found that people who slept an average of six hours or less per night were almost three times as likely to have increased mental distress.
A Providence clinical psychologist explains how a lack of sleep makes us more vulnerable to negative emotional reactions and decreases positive emotions.
There are several ways to improve sleep, including learning and practicing healthy sleep habits and avoiding screens while in bed.
The importance of sleep and its connection to mental health
It’s no secret that sleep is essential. A lack of sleep can impact how we think, feel and go about our day. There’s also a strong connection between sleep and mental health. A recent study from the Centers for Disease Control and Prevention (CDC) found that people who slept an average of six hours or less per night were almost three times as likely to have increased mental distress.
The CDC, American Academy of Sleep Medicine and National Sleep Foundation say that adults should sleep seven or more hours each night. But what happens to our brains when we don’t get enough sleep? And how are our hours of sleep tied to our mental health? To learn more this National Sleep Awareness Week, we asked Annelise Manns, Psy.D., a clinical psychologist at Providence.
Why is quality sleep important in terms of mental health and well-being?
Sleep and mental health are closely connected and have a significant impact on one another.
There are several ways that insufficient sleep affects mood and how the brain works.
When someone is not getting enough sleep, they are more vulnerable to having negative emotional reactions to stress and a decrease in positive emotions. For people with mental health concerns, insomnia (a common sleep disorder that interferes with sleep) can worsen symptoms of anxiety and depression. It can even contribute to an increase in suicidal thoughts. A lack of sleep can both lead to the onset of these concerns or worsen pre-existing concerns. In addition, often those with mental health diagnoses are more likely to have poor sleep.
Sleep also plays an important role, beyond mood, in cognitive skills like attention, short-term memory and learning. A lack of sleep can have a negative impact on a person’s ability to function at work or in school, which can then, of course, cause added stress. You can see how quickly you can get stuck in a cycle of poor sleep habits and increased distress.
What happens in the brain while we sleep — especially related to our mental health?
Sleep impacts several functions in the brain. During sleep, we consolidate memories in the hippocampus part of the brain. Then we store them in our long-term memory in the prefrontal cortex. As a result, when someone doesn’t get enough sleep, they may have greater difficulty with forgetfulness.
Sleep also affects the amygdala, which is the emotion center of the brain. When we are deprived of sleep, the amygdala can become hyperactive, which increases emotional distress. It also can suppress our prefrontal cortex, which helps us regulate our emotions.
You can think of sleep as plugging in your brain to recharge — the way you would charge a device’s battery that has been drained throughout the day. Like a battery, if your brain can’t refresh and reset with a good night’s sleep, it has a more difficult time functioning.
Do a lot of the patients you see as a clinical psychologist struggle with sleep?
A large portion of patients who are referred to me struggle with healthy sleep. In fact, some folks are referred to a clinical psychologist with insomnia as their primary concern.
Research through the CDC has found that more than one-third of the U.S. population does not get adequate sleep. This finding is consistent with the level of sleep concerns I see in primary care. I’ve also seen sleep concerns worsen since the COVID-19 pandemic, related to increased stress and changes to daily routines. Studies show that for many Americans, sleep has been negatively impacted over the past few years.
What, if any, mental disorders make sleep more challenging and why?
Research has established that mental health concerns and inadequate sleep can occur at the same time, or one can lead to the other. Sleep seems to be a factor for nearly every patient with mental health concerns I work with. For example:
- Attention deficit/hyperactivity disorder (ADHD) — Patients with ADHD often experience hyperactivity, restlessness and a busy mind, which can make relaxing and falling asleep difficult. Then, the lack of sleep often worsens concerns with inattention and concentration.
- Anxiety — Racing thoughts and difficulty relaxing, which are associated with anxiety, can make it difficult for folks to reach the drowsy state that’s needed prior to falling asleep.
- Depression — People with depression can struggle with a lack of sleep or also increased fatigue and a desire to oversleep. They may begin spending 10+ hours a day sleeping, with disrupted sleep patterns.
- Mood disorders — Mood disorders like bipolar disorder significantly impact sleep, especially during times of mania or hypomania (when mood and activity often increase to clinically elevated levels). People will often feel a decreased need for sleep and get minimal sleep for several days on end.
- Psychosis — A prolonged lack of sleep can contribute to the onset of psychosis. Psychosis can make it hard to determine what's real and what’s not.
Research shows that mental health problems can make it harder to sleep, and poor sleep can lead to or worsen mental health problems. How do we break that cycle?
The evidence-based method to better sleep is through cognitive behavioral therapy for insomnia. This treatment includes learning and practicing healthy sleep habits, which involves:
- Going to bed and waking up at consistent times
- Having a quiet, dark and comfortable sleep environment
- Limiting screen time before or in bed
In addition, it can be helpful to learn calming and relaxation skills as part of your sleep routine, which can help reach a drowsy state and enter sleep. Other methods include sleep restriction and stimulus control. Both are processes that support developing clear associations around sleep. There is a free app that teaches many of these skills called CBT-I Coach.
It can also be helpful to discuss sleep concerns with your primary care provider, a behavioral health provider or a sleep psychologist. And when needed, it is important to be evaluated via a sleep study for other concerns. Sleep disorders, such as sleep apnea, may contribute to sleep problems and require proper treatment.
Do you have any other tips for getting a better night’s sleep?
Be careful with technology. One important factor in our modern era that is having an impact on our sleep is technology use. I’ve observed that patients who scroll or use their devices in bed tend to delay sleep longer and have poorer sleep. Research supports this — a higher overall use of social media is associated with poorer sleep. The light from screens can impact our circadian rhythms and mental alertness, making falling asleep more challenging. Limiting phone or device use in bed and within an hour of bedtime can be important for improving sleep.
Annelise M. Manns, Psy.D, Clackamas, OR.
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