Does Insomnia Indicate Severe Mental Illness?
An early day at the office. A late night checking emails on your laptops or smartphones. We stayed up late watching our favourite TV shows. Then we wake up early the next morning, exhausted.
We are so busy with our everyday lives that sleep may feel like a rare thing – something we push until the weekend to catch up. Unfortunately, sleep doesn’t work like that.
A 2017 article highlighted a very real danger of disruptions to our sleeping patterns: an increased risk of mental illness. Though we’ve known for some time that sleep disorders and mental illness are linked, we can’t jump to the conclusion that one simply causes the other. In fact, both of these problems often are different aspects of the same condition
The relationship between sleep disorders and mental illnesses
When I discuss with my colleagues I ask them, “How many of you have patients who are struggling with mental health and don’t have any sleep troubles?” Almost none of them raise their hands. But when I ask, "How many of you have patients who have mental health issues and sleep problems?" they all raise their hands. Changes in natural sleep patterns can result in a variety of sleep disorders. And, as numerous studies have shown, sleep disorders are highly likely to appear in a variety of mental illnesses. It's a vicious circle that can make treatment difficult. We help patients who are having trouble sleeping, who have some form of mental illness, or both
Depression and insomnia
One of the most common sleep disorders is insomnia, or difficulty falling or staying asleep. In one study, 40 per cent of those suffering from insomnia had a mental illness. Only 16.4 per cent of those in the study had no sleep disorder in addition to their mental illness.
Insomnia is recognised as a risk factor for depression and major depressive disorder. In fact, people who suffer from insomnia are twice as likely as those who do not suffer from sleep disorders to develop depression. We used to believe that insomnia was caused by depression, but we now know that the relationship is more circular than causal.
Schizophrenia and sleep disorders
Schizophrenia is a severe psychiatric disorder in which people have an abnormal interpretation of reality. It frequently results in a mix of hallucinations, delusions, and extremely disordered thinking and behaviour that impairs daily functioning. Sleep disturbances are present in as many as 80 per cent of people with schizophrenia.
The following are examples of common sleep problems in people with schizophrenia:
• Circadian rhythm issues, or biological rhythm misalignment
• Increased sleep latency, or difficulty falling asleep
• Not getting enough sleep
• Waking frequently during sleep
• Sleep apnea
Bipolar disorder and sleep disorders
If I’m seeing a bipolar patient in my clinic, and the patient tells me he’s not sleeping well or waking up multiple times at night, my ears go up.
In fact, up to 80% to 90% of people with bipolar disorder experience some form of sleep disturbance or insomnia prior to a manic episode.
Many patients who are going through a manic episode do not feel the need to sleep. They don't complain because they are energized and don't believe they need to rest. However, if the sleep disorder is not treated properly, the patient will experience a manic episode or a psychotic break sooner or later.
Post-traumatic stress disorder and sleep disorders
There has been a lot of research into post-traumatic stress disorder (PTSD) and how it affects sleep patterns.
Some patients with sleep disorders find relief by taking a melatonin supplement in the evening to kick-start the brain's release of the chemical melatonin, which prepares the body for sleep. However, it’s important for patients to take the supplement as per their normal sleep patterns. Taking melatonin too early or too late can further disrupt sleep patterns.
Some patients respond well to antidepressant medications that also act as sedatives, allowing them to sleep at night. Other patients require assistance staying awake during the day, so we can administer stimulant medications if necessary.
However, medications alone are not always the solution.
Some antidepressant medications, for example, can cause weight gain.
If a patient has gained weight and is snoring while sleeping, we will examine him or her for sleep apnea and possibly treat it. If we do not treat a patient's sleep apnea, the patient will most likely remain sleepy and suffer from depression.
Sleep’s powerful effects on our mental health can’t be ignored. But with the right treatment plan, we can help patients find peace of mind – along with a peaceful night’s sleep.
