The Mind, Body, Brain, Sleep Connection
Jessica Chang, MHC-LP
Since the pandemic, as seen in a study of 22,330 adults from 13 countries published in Sleep Medicine, rates of those who meet the criteria for insomnia disorder have more than doubled as of November 2021 (Morin et al., 2021). Anxiety and depression rates have also spiked in comparison to pre-pandemic levels. Four in ten people have reported at least one mental health symptom during the pandemic, with triple the number of people with symptoms of anxiety and quadruple the number with symptoms of depression compared with 2019 (Fry and Singh, 2023). Further, these occurrences are likely not happening completely separate from each other. Not only are sleep problems a common symptom of psychiatric disorders, but sleep disturbances have been linked to higher levels of psychological distress.
Before getting into the bidirectional relationship between sleep problems and mental health issues, it is important to understand how sleep directly affects one’s mental health. Sleep is important to a plethora of brain and body functions necessary in processing daily events. This includes sleep as integral in regulating emotions and behaviors, maintaining cognitive skills (i.e. attention, learning, memory), building tolerance and utilizing coping skills, and perceiving the world accurately. More research is needed to fully understand the mechanisms underlying the sleep and mental health connection, but it is clear that sleep is imperative in physical and mental functioning.
Bidirectional Relationship between Sleep and Mental Health Issues
A bidirectional correlation exists between poor sleep and poor mental health such that each tends to feed into the other, and often becomes a cyclical pattern. Poor sleep quality or insufficient hours of sleep can increase risk for mental health disorders. As mentioned earlier, issues with sleep is both a symptom of psychiatric disorders such as anxiety and depression and contributes towards the onset or worsening of various mental health problems such as anxiety, depression, and suicidal ideation. Even in those who are considered healthy, anxiety and stress levels often increase upon lack of sleep. Those with mental health disorders, who are more likely to experience chronic sleep problems, face exacerbation of psychiatric symptoms and increased risk of suicide. More details on the bidirectional nature of sleep and specific mental health disorders including, but not limited to bipolar disorder, schizophrenia, and ADHD can be found here. With many of these mental health issues, treatment for insomnia or regulating sleep behavior may help to reduce psychiatric symptoms.
Cortisol and Melatonin
One relatively well-understood mechanism which helps to explain the interaction between sleep and mental health involves the hormones cortisol and melatonin, which operate inversely of each other. In a typical healthy human, cortisol levels naturally rise in the early morning to energize the body during the day and lower in the evening. Melatonin responds inversely to cortisol, and increased production levels of melatonin prepares one for sleep. Stress is associated with cortisol levels and sleep is associated with melatonin levels such that when a person experiences higher levels of stress, cortisol levels increase, and when cortisol levels remain elevated, melatonin production is disrupted, consequently disrupting one’s sleep cycles and leading to restless sleep. Interestingly, cortisol is released from adrenal glands on top of one’s kidneys, and melatonin is produced by the pineal gland in the brain.
Prolonged Stress and Long-term Effects
Major stressful life events have long-term effects on psychological well being and can create lingering sleep problems, which can lead to additional health issues if left unaddressed. Sleep architecture is one aspect which may be affected by significantly stressful events. This includes decreases in slow-wave sleep, increases in rapid eye movement (REM) sleep, and higher chances of waking up during the night. Related to this process is one’s circadian rhythm, which regulates a host of biological functions (i.e. digestion, appetite, immune response, etc.) and is dependent upon one having a daily routine, thus disrupted with irregular sleep habits. Sleep deprivation and eating behavior are also closely linked. When a person does not get enough restful sleep, it is common for one to experience decreased motivation to exercise and increased appetite for unhealthy foods. This may lead to weight gain, associated with increased risk for sleep disorders and chronic sleep disruption. Long term health consequences include cardiovascular disease, obesity, depression, and stroke, thus highlighting yet again the overlapping interactions of mental and physical health while pertaining to sleep.
Current Relevance
The topic of sleep and mental health remains relevant. COVID-19 illuminated the effects of major stressful life events on psychological well being and impact of dysregulated sleep behavior as people began to take more naps during the day and spend less time sleeping at night, pushing back bedtimes and wake times. “Coronasomnia” is the term that has emerged to describe an increase in sleep problems during the pandemic along with symptoms of anxiety, depression, and stress. Groups of people at especially high risk of insomnia during the pandemic were identified, including young adults, women, and people of color, all of which are already more likely to suffer from anxiety, depression, and chronic sleep problems (Fry and Singh, 2023). As the world continues to experience troubling and dehumanizing times, it is important to be cognizant of how sleep affects mental health and physical health, including short and long term consequences of not getting enough restful sleep, and who is at particularly high risk.
With that in mind, the following section includes tips on improving sleep and mental health:
Better your sleep hygiene. Stick to a regular sleep schedule, avoid long naps, find sunlight, optimize bedroom conditions for sleep (i.e. dark, quiet, cool), minimize alcohol intake, limit caffeine, finish dinner at least a couple of hours before going to bed, etc. - these practices lend towards better sleep!
Establish daily routines. Feeling in control may help to reduce stress and regulate sleep patterns. Focus on what you can control. Try to schedule regular meals and break times, incorporate exercise into your routine, and create separation between work and sleep spaces. Follow a bedtime routine or ritual that feels calming and allows you to unwind from the day.
Monitor your time engaging with news and social media. Consuming news and media and checking on your feed more frequently are both associated with higher levels of anxiety. Especially consuming media at night, close to bedtime, is linked with increased screen time and shorter, less restful sleep. Your brain interprets blue light from screens similarly to sunlight, which keeps cortisol levels high while suppressing melatonin, contributing to feeling more alert and stressed out instead of relaxed and ready for sleep.
Cognitive Behavioral Therapy (CBT-I, for insomnia) - Those with chronic insomnia may benefit from CBT-I, a specific form of cognitive behavioral therapy for insomnia. A professional can help educate people about sleep with the goal of changing sleep-related behaviors and thought processes. Strategies can include stimulus control, sleep restriction, relaxation techniques, and cognitive therapy.
Talk Therapy. As sleep and mental health are so closely intertwined, focusing on and prioritizing one’s mental health may lead to better sleep and lead to a positive cycle of overall improved health and wellbeing.
Sources:
Fry, A. and Singh, A. (2022). Coronasomnia: Definition, Symptoms, and Solutions. Sleep Foundation.
How Sleep Deprivation Impacts Mental Health (2022). Columbia University Department of Psychiatry.
Morin, C., et al. (2021). Insomnia, anxiety, and depression during the COVID-19 pandemic: an international collaborative study. Sleep Medicine, 87, 38-45. https://doi.org/10.1016/j.sleep.2021.07.035
Suni, E., and Dimitriu, A. (2023). Mental Health and Sleep. Sleep Foundation.