The Real Link Between Mental Health and Sleep

Your mental health influences how well you sleep, and the quality of your slumber can also alter your psychological state. Whether your heart rate jumps because you feel anxious, or depression makes you feel sleepy all day long, your overall state of mental well-being affects the rest of your body and its systems, including sleep. When you treat one area, the other often improves as well, almost like they are linked by a tether, pulling each other in the same direction.^1,2 

Note: The content on Sleepopolis is meant to be informative in nature, but it shouldn’t take the place of medical advice and supervision from a trained professional. If you feel you may be suffering from any sleep disorder or medical condition, please see your healthcare provider immediately.

Mental Health and Sleep

Have you laid down for bed and closed your eyes, exhausted and ready for sleep to come over you like a calming fog, only to have your brain decide to run through your to-do list at breakneck speed? Or remember that awkward conversation you had with the pharmacist that morning? Likewise, if you’ve ever dragged yourself out of bed after a long night of not sleeping, you may have noticed your mental health was a little down that day.

“We often talk about the ‘chicken or egg’ phenomenon when it comes to anxiety or depression and poor sleep,” Dr. Daniel Rifkin, sleep medicine physician in Buffalo, NY, tells Sleepopolis. “However, most sleep and psychiatry professionals believe the effects are bidirectional.” Meaning, your mental health woes could cause your lack of sleep, or your sleeplessness can cause or worsen your mental health, each pulling the other around in a circular dance.

One study published in 2019 in Nature Human Behavior found that lack of sleep can cause anxiety or make it worse if you already have it.³ Most people experience occasional trouble falling asleep, but mental health conditions like anxiety, depression, and just plain old stress can disrupt your slumber so much that your body starts to complain. After all, your brain needs sleep to rest and process the day, while your body’s cells use the time you sleep to repair themselves and save energy. Essentially, if you don’t get the sleep you need, your brain is going to feel it.

Mental Health Disorders and Sleep

While anyone can have trouble sleeping every so often, some people cope with diagnosed mental health disorders that can disrupt sleep over a long period of time. From depression to schizophrenia, mental health and sleep are linked.

Anxiety Disorder 

People with anxiety disorders respond to certain objects or situations with fear and dread. Anxiety disorders can include panic disorders, generalized anxiety disorder, and phobias.⁴ Symptoms of anxiety include:

• Chronic pain or muscle tension
• Difficulty focusing or learning new concepts
• Fatigue
• Feelings of restlessness or irritability
• Problems sleeping, including the inability to sleep, unsatisfying sleep, or excessive sleeping
• Trouble controlling feelings of worry

Anxiety stops sleep by putting your central nervous system into overdrive, which releases stress hormones like adrenaline and cortisol. Bad sleep can also cause anxiety. Studies show a strong association between a history of insomnia and anxiety disorder, panic disorder, and social anxiety disorder.^5,6

Depression

According to the World Health Organization, 280 million people across the world report having depression. Depression is characterized by sadness and lack of usual enjoyment that continues for two weeks or longer.⁷ Grief and sadness related to a change in life circumstances are different from depression, which doesn’t improve in response to external events.

Clinical depression often comes with persistent insomnia, which means you have had trouble sleeping at least three days a week for more than three months. Hypersomnia, or excessive drowsiness, can be a sign of depression, as well.⁸ Studies suggest when you treat your insomnia, depression also improves.^1,9

Bipolar Disorder

Bipolar disorder is characterized by severe fluctuations in mood, behavior, and thought patterns. Fluctuations can last from a few hours to several months, and may be affected by seasonal and light changes.¹⁰

Bipolar disorder is strongly associated with the inability to fall asleep, stay asleep, fall back to sleep, or all three. People in the manic phase of bipolar disorder often have difficulty sleeping, whereas those in the depressive phase may sleep much more than usual.¹⁰

Sometimes a change in sleep quality can predict an oncoming mood swing. Sleep is especially important for people coping with bipolar disorder because keeping a stable circadian rhythm is vital to keeping your mood stable.¹¹

Borderline Personality Disorder 

Borderline personality disorder (BPD) can also cause intense mood swings and cause you to see situations in extremes. People with borderline personality disorder have trouble regulating their emotions. They tend to act impulsively, resulting in career and relationship difficulties.

Sleeping issues often go hand in hand with BPD. People with BPD and insomnia typically experience the daytime consequences of sleep loss, including sleepiness, difficulty concentrating, and irritability. Symptoms of BPD can be worsened by insomnia, leading to a vicious cycle of sleeplessness and behavioral issues. A study published in Nature and Science of Sleep reported the diagnosis and treatment of a sleep disorder with BPD could improve symptoms for both.^12,13

Schizophrenia

Psychotic disorders such as schizophrenia can have a profound impact on sleep. Sleep disturbances are often an early sign of schizophrenia and can precede psychiatric symptoms by months or years.¹⁴ This disorder is characterized by abnormal perceptions, such as hallucinations and delusions.

Those symptoms, as you may easily imagine, can be very detrimental to good sleep. Treatment options include cognitive-behavioral therapy (CBT), antipsychotic medications, and non-invasive brain stimulation, although CBT has shown to be the most effective by far.¹⁵ 

ADHD

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that usually starts in childhood and persists into adulthood. Symptoms include impulsiveness, trouble focusing on tasks or conversations, restlessness, and feeling easily frustrated. 

People with ADHD often have trouble sleeping, which can worsen symptoms during the day.¹⁶ ADHD often comes with other disorders like restless leg syndrome and narcolepsy, which also add to sleep disturbances. Treatment for poor sleep associated with ADHD will vary widely depending on your particular situation — let your healthcare provider know about your symptoms, and together you can make a plan for better sleep.¹⁷

Seasonal Affective Disorder

Seasonal Affective Disorder (SAD) is a mental health disorder that changes with the seasons. Some people cope with a period of depression during winter, for example. SAD symptoms look similar to depression and include poor sleep, excess sleepiness, low energy, and loss of interest in hobbies.¹⁸

Treatments for SAD can include light therapy, psychotherapy, and short-term antidepressant medications.¹⁹ Research on SAD treatment and sleep improvement have been few and far between, but future studies may be able to better pinpoint the best treatment for SAD and sleep troubles.^20,21

Autism Spectrum Disorder

Autism Spectrum Disorder (ASD) is a neurological and developmental disorder with symptoms that can range from mild to severe. People with ASD may find it difficult to communicate with others, display repetitive behaviors, have few interests, and have trouble sleeping.²²

Treating poor sleep associated with ASD usually involves treating the ASD symptoms themselves. Researchers have found some success using cognitive and behavioral therapies. Additionally, deep pressure therapy offers relief to some people living with ASD,³⁷ and other studies suggest medications like melatonin and serotonin could be the best aid.²³

Eating Disorders

Eating disorders like anorexia and bulimia involve extreme emotions, attitudes, and behaviors related to weight and food.²⁴ Some people with eating disorders feel compelled to eat in the middle of the night. Others experienced a disturbed circadian rhythm, and so find it hard to fall asleep or stay asleep.

Treating poor sleep from an eating disorder, like many other psychiatric disorders, is often grouped together with treating the condition itself. The two are so linked, that any improvement in one can prompt improvement in the other.²⁵

Substance Abuse Disorders

Mental health problems and substance abuse disorders often occur together. Substance abuse can be a cause or a result of psychiatric issues, and may be an attempt by some patients to self-medicate or reduce symptoms. To treat insomnia from substance abuse, you must first address the substance abuse.²⁵

Does Depression Cause Insomnia, or Vice Versa?

It was once thought that insomnia symptoms resulted from psychiatric disorders and depression, not the other way around. But more recent evidence shows this relationship goes both ways. A large study review published in Dialogues in Clinical Neuroscience found that if you have insomnia, you are four times more likely to develop depression.²⁵

Though the connection between mood disorders and insomnia isn’t fully clear, experts agree that hormones and neurotransmitters are affected by poor sleep.²⁷ Sleep is a restorative activity that lowers stress in the body and the brain, especially areas of the brain that manage your response to stress or trauma.³⁸ When you feel stressed from a long day, or get surprised or frightened, your body releases a hormone called cortisol to put you on guard. And too much cortisol can stop you from sleeping well.²⁶

Lack of sleep and the resulting stress on the body may predispose those with insomnia to major mood disturbances, making early treatment of sleep disorders essential, especially if you have a family history of mental health issues.²⁵

Medication and Sleep

Medications to treat psychiatric disturbances may also cause trouble sleeping. Psychotropic medications can have stimulating side effects that keep you up. Restless leg syndrome and periodic limb movements may be triggered or worsened by antidepressants and other drugs used to treat mood disorders.^17,25

Antidepressants

Most antidepressant medications influence the neurotransmitters dopamine, serotonin, and norepinephrine, all of which help to regulate sleep and wake cycles. Some can have stimulating effects that contribute to insomnia.

“Certain neurotransmitter reuptake inhibitors (SSRIs or SNRIs), for example,” says Rifkin, “cause periodic limb movement disorder, which is a movement disorder during sleep associated with nighttime arousals and daytime sleepiness.” He explains nightmares and vivid dreaming are also common side effects, but can be temporary. 

Other medications such as amitriptyline have a sedating effect and can help establish healthy sleep patterns in depressed patients with insomnia. Newer antidepressants such as selective serotonin reuptake inhibitors can suppress the REM stage of sleep, as well as the vivid dreaming that occurs during REM sleep.²⁸

Stimulants

Stimulant medications are most often used for attention-deficit/hyperactivity disorder, or ADHD. They work by increasing certain chemicals in your brain, like dopamine and norepinephrine. This prompts more focus, less impulsive behavior, and lowers hyperactivity.

A common side effect of stimulants, though, is insomnia. Many ADHD medications are now extended-release so they can help you all day. The problem comes in if you take it too late in the morning, or have to take a dose in the afternoon as well.²⁹ However, some people have noticed sleep improvement with stimulants if they take melatonin at night.³⁰

Antipsychotics

Antipsychotic medications can help with insomnia, a common issue for people living with schizophrenia. Some of these drugs can also cause daytime sleepiness, which may be preferable to insomnia. 

Hypnotic medications are often prescribed along with antipsychotics, and may initially help with insomnia due to their sedative effects.¹⁵ In fact, one study published in 2021 suggested patients without a psychiatric need for these medications could still receive benefits relating to insomnia treatment.³¹  

How to Improve Sleep and Mental Health 

If you have mental health issues and are having trouble sleeping, says Rifkin, “the most important advice I could give is to seek professional help. These problems often need to be treated in tandem and often require close follow-up care.” Your healthcare provider can help you make a plan for improved sleep, including lots of non-medication options.

Cognitive Therapy 

A type of psychotherapy, cognitive therapy works to change negative thought patterns and modify behavior, which can lead to better sleep patterns and better sleep. During cognitive therapy, you learn coping mechanisms and new ways of thinking. A study review published in 2019 found this practice can improve sleep after just three months for some.³²

Sleep Hygiene

What you do leading up to bedtime can make a big difference in how you sleep. Good sleep hygiene includes habits that help your body realize it’s time to sleep, says Rifkin, “including a regular sleep-wake schedule, a comfortable sleep environment (cool, dark, and quiet), and regular exercise…” A supportive mattress, cooling sheets and pillows also contribute to a better sleep environment.

It’s also a good idea to avoid snacks, caffeine, and alcohol — and to turn off blue light from screens at least one hour before bed. Habits like these can be hard to get used to, but they will help you improve your snoozing.

Meditation  

Meditation can decrease anxiety for some people, and research suggests it can also help you sleep better.³³ If you live with a chronic mental health condition, meditation can help to improve your overall mental health.³⁴ You can practice meditation in a myriad of different ways. 

Some meditation calls for focus and concentration, while others allow your thoughts to freely flow through your mind. The practice of meditation and mindfulness not only can benefit your mental health and sleep; it can also lower your blood pressure and ease pain.³⁵ 

The Last Word From Sleepopolis 

Mental health is critically important to happiness and well-being. Research reveals a connection between mental illness and disturbed sleep, an association that may exist months or years before psychiatric symptoms appear.

Medications and other mental health treatments can help regulate sleep patterns, but may also cause or worsen insomnia, hypersomnia, and other sleep difficulties. Adjustment of medications or separate treatment of sleep issues can help establish healthy sleep patterns and improve quality of life for people suffering from mental health disorders.

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Abby McCoy

Abby McCoy is an RN of 16 years who has worked with adults and pediatric patients encompassing trauma, orthopedics, home care, transplant, and case management. She has practiced nursing all over the world from San Fransisco, CA to Tharaka, Kenya. Abby loves spending time with her husband, four kids, and their cat named Cat.