Monday, May 20

How sleep affects your mood: The link between insomnia and mental health

It started with mild anxiety.

Emily, who asked to be identified only by her first name because she was speaking about her mental health, had just moved to New York after graduate school to start a marketing job at a large law firm.

She knew it was normal to feel a little nervous. But she wasn’t prepared for what came next: chronic insomnia.

Operating on only three or four hours of sleep, it didn’t take long for her anxiety to increase: At 25, she was “damn nervous all the time. A disaster.”

When a lawyer at her firm scolded her one day, she had the first of many panic attacks. At a doctor’s suggestion, she tried taking a sleeping pill, hoping it would “reset” her sleep cycle and improve her mood. It did not work.

Americans are chronically sleep deprived: One-third of adults in the United States say they sleep less than 7 hours a night. Teens fare even worse: About 70 percent of high school students don’t get enough sleep on school nights.

And it’s having a profound effect on mental health.

An analysis of 19 studies found that although sleep deprivation worsened a person’s ability to think clearly or perform certain tasks, it had a greater negative effect on mood. And when the National Sleep Foundation conducted a survey in 2022, half of those who said they slept less than 7 hours each weekday also reported having depressive symptoms. Some research even indicates that addressing insomnia can help prevent postpartum depression and anxiety.

Clearly, sleep is important. But despite the evidence, there continues to be a shortage of psychiatrists or other doctors specializing in sleep medicine, leaving many to educate themselves.

So what happens to our mental health if we don’t get enough sleep and what can be done about it?

When people have trouble sleeping, the way they experience stress and negative emotions changes, said Aric Prather, a sleep researcher at the University of California, San Francisco, who treats patients with insomnia. “And for some, this can have a feed-forward effect: feeling bad, feeling ruminated, feeling stressed can bleed into our nights,” he said.

Carly Demler, 40, a stay-at-home mother from North Carolina, said she went in bed one night and never fell asleep. From then on he got up at least once a week until 3 or 4 in the morning. This continued for more than a year.

She became irritable, less patient and much more anxious.

Hormone blood tests and a sleep study at a university lab offered her no answers. Even after taking Ambien, she stayed up most of the night. “It was like my anxiety was a fire that somehow climbed over the fence and somehow ended up spreading into my nights,” she said. “I just felt like I had no control.”

Ultimately, it was cognitive behavioral therapy for insomnia, or CBT-I, that brought Ms. Demler the most relief. Studies have found that CBT-I. It’s more effective than long-term sleep medications: As many as 80% of people who try it see improvements in their sleep.

Mrs. Demler has learned not to “lay in bed and freak out.” Instead, she gets up and reads so as not to associate her bedroom with anxiety, then she goes back to bed when she’s tired.

“The feeling of gratitude I feel every morning, when I wake up and feel refreshed, I don’t think will ever go away,” she said. “It was an unexpected silver lining.”

According to the Centers for Disease Control and Prevention, adults need between 7 and 9 hours of sleep per night. Teenagers and young children need even more.

It’s not just a question of quantity. Sleep quality is also important. If it takes longer than 30 minutes to fall asleep, for example, or if you regularly wake up in the middle of the night, it’s harder to feel rested, regardless of the number of hours you spend in bed.

But some people “have a tendency to think they function well even if they are sleepy during the day or have trouble concentrating,” said Lynn Bufka, a clinical psychologist and spokeswoman for the American Psychological Association.

Ask yourself how you feel during the day: do you find yourself more impatient or easy to get angry? Do you have more negative thoughts or feel more anxious or depressed? Do you find it harder to deal with stress? Do you find it difficult to do your job efficiently?

If so, it’s time to act.

We’ve all heard how important it is to practice good sleep hygiene, adopting daily habits that promote healthy sleep. And it’s important to talk to your doctor, to rule out any physical problems that need to be addressed, such as a thyroid disorder or restless legs syndrome.

But this is only part of the solution.

Conditions such as anxiety, post-traumatic stress disorder, and bipolar disorder can make it more difficult to sleep, which can then exacerbate symptoms of mental illness, which in turn makes it more difficult to sleep well.

“It becomes very difficult to break the cycle,” Dr. Bufka said.

Some medications, including psychiatric drugs such as antidepressants, can also cause insomnia. If one drug is to blame, talk to your doctor about switching to another, taking it earlier in the day or reducing the dose, said Dr. Ramaswamy Viswanathan, a professor of psychiatry and behavioral sciences at State University of New York Downstate Health. Sciences University and the incoming president of the American Psychiatric Association.

The cycle can afflict even those without mental health disorders, when worries worsen sleep and lack of sleep worsens mood.

Emily, who worked at the large law firm, was so worried about her inability to sleep that she didn’t even want to go to bed.

“You really start to believe, ‘I’ll never sleep,’” he said. “The adrenaline is so high you absolutely can’t cope.”

She finally came across “Say Goodnight to Insomnia” by Gregg D. Jacobs. The book, which uses CBT-I. techniques, helped Emily reframe the way she thought about sleep. She started writing her negative thoughts in a diary and then turning them into positive ones. For example: “What if I can never fall asleep again?” it would become “Your body is made for sleep”. If you don’t get enough rest one night, eventually you will. These exercises helped her stop being catastrophic.

Once she went back to sleep, she felt “much happier.”

Now, at 43, nearly 20 years after moving to New York, she still relies on the techniques she learned and takes the book with her whenever she travels. If she doesn’t sleep well away from home, “I catch up on sleep for a few days if necessary,” she says. “I’m much more relaxed about it.”