The Interplay Between Sleep Disorders and Mental Health

Having trouble sleeping can significantly affect mental health and lead to a variety of complications. In addition to feeling less than your best, getting insufficient or non-restful sleep can disrupt normal physical, mental, social, and emotional functioning, which can profoundly affect overall well-being [5]. If you suspect you or a loved one suffers from a sleep disorder, speaking to your healthcare provider is important to prevent worsening mental health issues [5]. Sleep disorders can increase the risk of accidents and serious health problems, and effectively managing them can significantly improve overall mental well-being and reduce the risk of accompanying mental health conditions [5]. This article explores the complex relationship between sleep disorders and mental health. It covers different sleep disorders, how they affect mental well-being, and the various treatment options.

Chronic Insomnia and its Impact on Mental Health

Chronic insomnia is a common sleep problem that can significantly impact an individual’s overall health and academic performance. It refers to difficulty falling or staying asleep, causing problems during the day, and can lead to medical issues like heart disease, chronic pain syndrome, and psychiatric disorders like depression, anxiety, and post-traumatic stress disorder [6].

Chronic insomnia can also lead to other medical issues, such as restless legs syndrome, chronic pain, and respiratory issues, further worsening one’s mental well-being. The relationship between chronic insomnia and psychiatric conditions is complex, as each can worsen the symptoms of the other. For instance, chronic insomnia can make depression symptoms worse, while depression can make it harder to sleep. Additionally, chronic insomnia can lead to increased stress levels, irritability, and decreased overall quality of life, making it difficult for an individual to cope with stress and maintain emotional well-being. [6].

The Link Between Sleep Disorders and Psychiatric Conditions

Studies have shown a significant link between sleep disorders and mood and anxiety disorders. This suggests that sleep disorders could potentially contribute to developing anxiety and depression. Furthermore, sleep deprivation caused by these mental disorders can result in the formation of false memories and a decline in cognitive function. This highlights the complex relationship between sleep and mental well-being [5].

Anxiety disorders: Anxiety is a mental health condition that can be triggered by factors such as disrupted sleep patterns, abnormal circadian rhythm, negative thinking patterns, and autonomic arousal. Research has also shown that melatonin, a hormone that regulates sleep, may play a role in treating anxiety and related disorders. This is particularly relevant for adults with bipolar disorder, who often have abnormal melatonin secretion patterns [3].

Depression: One of the main features of depression is poor sleep, which can happen at the beginning or the end of an episode. Having trouble sleeping can make depression worse and increase the chances of it returning. It can also cause fatigue, physical problems, difficulty concentrating, and thoughts of suicide. Poor sleep quality, amount of sleep, and sleep patterns can predict when depression might happen again. Insomnia can also contribute to mental health problems later in life [3].

Bipolar Disorder: Sleep problems are common among people with bipolar disorder and can affect both depressive and manic symptoms. Adolescents with bipolar disorder may experience more severe symptoms, impacting their school and social life. Common sleep difficulties experienced by individuals with bipolar disorder include difficulty falling asleep, difficulty staying asleep, oversleeping, and struggling to wake up in the morning. When treating bipolar disorder, especially in young people, it’s essential to be careful with psychotropic medication, as it can affect sleep and potentially worsen mood symptoms [3].

Types of Sleep Disorders and Sleep Disturbances

In addition to insomnia, which we just discussed, there are several other common sleep disorders that people may experience, each with their own symptoms or specific criteria. These disorders affect sleep quality and can have far-reaching consequences for mental health.

• Sleep-disordered breathing: This category includes a spectrum of disorders affecting the respiratory system during sleep. It has conditions such as:
  • Obstructive Sleep Apnea (OSA): OSA is a sleep disorder characterized by repetitive airway blockage, leading to pauses in breathing during sleep, resulting in reduced oxygen levels. This condition can be caused by various factors such as obesity, aging, and muscle relaxation of the throat. When left untreated, OSA can increase the risk of cardiovascular issues [5].
  • Central Sleep Apnea (CSA): CSA results from the central nervous system’s failure to send signals to the muscles that control breathing [10]. Problems with the central nervous system often cause central sleep apnea. [5]
• Central disorders of hypersomnolence: The conditions causing these disorders stem from irregularities in the central nervous system, which result in feeling excessively sleepy during the day [5]. They Include:
• Narcolepsy: Narcolepsy is a neurological disorder that affects the ability to regulate sleep and wakefulness. 
• Idiopathic Hypersomnia: Individuals with idiopathic hypersomnia experience extended episodes of sleep and find it challenging to wake up.
• Circadian rhythm sleep-wake disorders (CRSD): CRSDs manifest as disruptions in the body’s internal clock, leading to irregular sleep-wake patterns; these include shift work disorder, jet lag, and delayed sleep phase syndrome [5]:
• Shift Work Disorder: Shift work disorder is a condition that arises due to irregular or rotational shifts in one’s work schedule. This can disrupt the natural sleep-wake cycle and result in difficulty falling asleep or staying asleep during the day or night which may result in excessive daytime sleepiness.
•  Jet Lag: Jet lag occurs when a person travels rapidly across multiple time zones, disturbing the body’s internal clock. This can cause various symptoms, such as fatigue, insomnia, and cognitive impairment.
• Delayed Sleep Phase Syndrome: Delayed sleep phase syndrome is a disorder that slows the typical sleep-wake cycle. This means that a person’s natural sleep pattern is delayed by a few hours, causing them to fall asleep and wake up later than usual. This can lead to difficulty maintaining a regular sleep schedule and significantly impact a person’s daily routine and overall well-being [5].
• Sleep-related movement disorders: Some movements can occur during sleep, which is normal. However, there can also be abnormal movements during sleep. These movements can happen due to problems with controlling muscles while sleeping. Restless legs syndrome (RLS) is one example of these abnormal movements, and it can be caused by iron deficiency or be inherited. Other sleep-related movement disorders can involve complex movements and behaviors, which may be associated with parasomnias [5].
• Parasomnias: During sleep, parasomnias can cause abnormal behaviors, movements, or experiences, such as sleepwalking, night terrors, and sleep-related eating disorders. Genetics, environmental factors, or a combination of the two may be factors in who experiences parasomnias [5].

Sleep Disorder Treatments        

There are a number of different ways to treat sleep disorders and manage their symptoms, each targeting different aspects of sleep problems. These treatment options include various psychiatric medications, behavioral therapies, and alternative methods. Let’s look at the specific types of treatments commonly used to address sleep-related issues.

Sedatives and Hypnotics:

Sedatives and hypnotics are medications used to treat insomnia. Older drugs like chloral hydrate and barbiturates were risky due to potential abuse and overdose. Newer benzodiazepine-like agents, such as zolpidem and zaleplon, have fewer side effects and better efficacy. Along with medication, non-pharmacological therapies like cognitive and sleep hygiene practices have also proven effective in improving overall sleep quality [8].

Cognitive Behavioral Therapy for Insomnia (CBT-i):

Cognitive Behavioral Therapy for Insomnia (CBT-i) is a type of psychotherapy designed to help people with trouble sleeping. It involves changing negative thoughts and behaviors that contribute to sleep problems. CBT-i includes techniques like education about sleep, improving sleep habits, limiting time in bed, controlling stimuli, relaxation exercises, and changing the way you think about sleep [9].

Research has shown that Cognitive Behavioral Therapy for Insomnia (CBT-i) can significantly improve sleep quality by reducing the time it takes to fall asleep, minimizing wakefulness during the night, and enhancing overall sleep efficiency [1]. Some studies suggest integrating mindfulness meditation, Tai Chi, or herbal treatments with CBT-i may amplify its effectiveness. However, further research is necessary to substantiate these findings [1].

One study demonstrated that practical strategies such as sleep consolidation, stimulus control, and cognitive restructuring could help to re-establish the body’s natural sleep mechanism. It emphasizes the significance of adhering to a consistent sleep schedule, avoiding stimulants before bedtime, and creating a soothing pre-sleep routine as integral components of cognitive-behavioral therapy for insomnia (CBT-i). The study concludes that this comprehensive approach has shown promising results in improving sleep patterns and overall well-being for individuals struggling with insomnia [9].

Transcranial Magnetic Stimulation (TMS):

Transcranial Magnetic Stimulation (TMS) is a non-invasive procedure that uses magnetic fields to stimulate nerve cells in the brain. It has been explored for its therapeutic potential in various neurological and psychiatric conditions, including insomnia [7]. Recent studies indicate that TMS can effectively improve multiple sleep parameters, suggesting its potential as an effective treatment for individuals with insomnia. Although reported as safe, further research is necessary to establish optimal treatment protocols and long-term effects [7].

TMS has shown promise in helping people with Major Depressive Disorder (MDD) who have trouble sleeping [2]. When rTMS is applied to a specific area of the brain called the dorsolateral prefrontal cortex (DLPFC), it can improve certain sleep problems such as difficulty falling asleep, waking up during the night, and waking up too early [2].

Alternative Treatment Options

Several alternative options may be considered in combination with other treatment methods, such as the following:

• Acupuncture: Acupuncture, a traditional Chinese medicine practice, involves the insertion of thin needles into specific points of the body. Studies have indicated that acupuncture can significantly improve sleep quality and reduce insomnia severity [4].
• Mind-Body Exercises: Mind-body exercises combine physical movements, mental focus, and controlled breathing to promote overall well-being. Studies have suggested that mind-body exercises significantly improve sleep quality and reduce insomnia severity [4].
• Exogenous Melatonin: Exogenous melatonin, a synthetic version of the hormone that regulates the sleep-wake cycle, has been associated with reduced sleep onset latency, allowing individuals to fall asleep more quickly [4].
• Light Exposure Therapy: Light exposure therapy involves exposure to specific wavelengths of light to regulate the body’s internal clock and improve sleep patterns [4].
• Valerian: Valerian, an herbal remedy known for its potential sedative and anxiolytic effects, has been used in managing sleep disturbances. However, its efficacy in treating sleep disorders compared to other alternative treatments requires further investigation [4].

These alternatives offer additional avenues for managing sleep disorders and addressing related symptoms. While their effectiveness may vary, they can provide complementary support to conventional treatments, contributing to a more holistic approach to managing sleep-related issues.

Improving Sleep and Mental Health Disorders

In conclusion, addressing sleep disorders is essential for improving mental well-being and overall quality of life. Individuals with chronic insomnia or other sleep disorders can achieve better mental health and lead a more fulfilling life with the proper intervention at the right time.

Neuro Wellness Spa is dedicated to helping individuals with sleep disorders. If you’re experiencing sleep difficulties, fatigue, or disruptions in your sleep patterns, our expert team offers personalized treatment options. Contact us today to take the first step toward better sleep and well-being. Schedule a consultation to explore your mental health treatment options including in-person and online psychiatry for medication management, integrative brief psychotherapy, and alternative treatments like TMS therapy. Don’t let sleep disorders and mental health conditions get in the way, call us today and start your journey to a healthier, more restful life. 

References:

1. Chan, N. Y., Chan, J. W. Y., Li, S. X., & Wing, Y. K. (2021). Non-pharmacological Approaches for Management of Insomnia. Neurotherapeutics: the journal of the American Society for Experimental NeuroTherapeutics, 18(1), 32–43. https://doi.org/10.1007/s13311-021-01029-2
2. Chen, X., Jiang, F., Yang, Q., Zhang, P., Zhu, H., Liu, C., Zhang, T., Li, W., Xu, J., & Shen, H. (2022). Bilateral repetitive transcranial magnetic stimulation ameliorated sleep disorder and hypothalamic-pituitary-adrenal axis dysfunction in subjects with major depression. Frontiers in psychiatry, 13, 951595. https://doi.org/10.3389/fpsyt.2022.951595
3. Comsa, M., Anderson, K. N., Sharma, A., Yadav, V. C., & Watson, S. (2022). The relationship between sleep and depression and bipolar disorder in children and young people. BJPsych open, 8(1), e27. https://doi.org/10.1192/bjo.2021.1076 
4. Ell, J., Schmid, S. R., Benz, F., & Spille, L. (2023). Complementary and alternative treatments for insomnia disorder: a systematic umbrella review. Journal of sleep research, e13979. Advance online publication. https://doi.org/10.1111/jsr.13979
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6. Kaur, H., Spurling, B. C., & Bollu, P. C. (2023). Chronic Insomnia. In StatPearls. StatPearls Publishing.
7. Ma, H., Lin, J., He, J., Lo, D. H. T., & Tsang, H. W. H. (2021). Effectiveness of TES and rTMS for the Treatment of Insomnia: Meta-Analysis and Meta-Regression of Randomized Sham-Controlled Trials. Frontiers in psychiatry, 12, 744475. https://doi.org/10.3389/fpsyt.2021.744475
8. Pagel, J. F., & Parnes, B. L. (2001). Medications for the Treatment of Sleep Disorders: An Overview. Primary care companion to the Journal of clinical psychiatry, 3(3), 118–125. https://doi.org/10.4088/pcc.v03n0303
9. Rossman J. (2019). Cognitive-Behavioral Therapy for Insomnia: An Effective and Underutilized Treatment for Insomnia. American journal of lifestyle medicine, 13(6), 544–547. https://doi.org/10.1177/1559827619867677 
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