Connection Between Sleep, Depression, & Anxiety (Mental Health & Sleep)
Connection Between Sleep, Depression, & Anxiety (Mental Health & Sleep)
Throughout this post (and my website), I use the following terms rather interchangeably: Mental health issues, mental health conditions, mental health disorders, mental illness, and mental health diagnosis.
Are you having trouble with falling asleep or staying asleep?
Are you setting multiple alarms and still struggle to wake up?
Have you been stressed for days or weeks because of an ongoing work project, family issue, health concern, or a looming deadline?
Is your mind flooding with thoughts and worries instead of being able to fall asleep?
Sleep quality typically signals how well a person is handling stress or changes in overall health.
Improving sleep quality improves mental health and physical health; this is relevant for people with or without a mental health condition (Scott et al., 2021).
Quality of sleep is often a criterion in diagnosing depression, PTSD, anxiety, suicidal ideations, eating disorders, and other mental health disorders.
We all know that sleep is important to health, yet a lot of us are not getting enough good quality sleep:
Almost 30% of the general population report symptoms of insomnia (Scott et al.).
Researchers have noticed a decrease (roughly more than 1 hour each night) in the total amount of reported sleep among people in the United States today compared to the 1960’s (Spiegel, Knutson, Leproult, Tasali, & Van Cauter, 2005).
Lack of restful sleep is a public health concern in the United States (McAlpine et al., 2022).
Signs and Symptoms
Not getting enough good quality sleep can manifest as:
Chronically feeling tired; Fatigue
Getting sick more than “average”
Lack of alertness throughout the day
Poor reactions to situations (irritability)
Difficulty falling or staying asleep
Difficulty waking up
Falling asleep during inopportune situations
Sleeping too much
Trouble focusing in conversations, reading, or impaired attention
Feeling stressed or worried about getting enough sleep
Taking more (or longer) naps
Increase in appetite; drinking more coffee or energy drinks than “average”
No memories of dreaming
Sleeping too little
People May Struggle Getting Enough Restful Sleep for Reasons Including:
Working long, unpredictable or variable shifts
Increase screen use
Terrible cliché, I know
Experiencing high stress (from school, parenting, finances, relationships)
Being a parent or caregiver to dependent children
Having been recently diagnosed with a chronic disease or disability
Checking the clock frequently during the night
Nightmares or night terrors which disrupt sleep
Childhood adversity
When Should I Talk to my Healthcare Provider About Sleep?
As always: If you notice changes in your sleep patterns, are feeling more tired than normal, or having general difficulties or concern related to your sleep: consult with your primary healthcare provider for healthcare advice.
This information is NOT medical advice or suitable to replace your own healthcare provider and medical treatment.
This information is provided as general knowledge.
If you have any concerns similar to the signs & symptoms listed in the previous section for 3 or more nights each week for at least one month, you may wish to consult with your healthcare provider(s).
Sleep-wake disorders are diagnosed by a diagnostician (AKA, a qualified healthcare provider) upon conducting a thorough interview assessing symptoms, level of impairment, over a specified period of time.
Common Sleep Disorders:
Insomnia
Hypersomnolence
Narcolepsy
Breathing-related sleep disorders (e.g., sleep apnea)
Restless Leg Syndrome
Substance or medication induced sleep disorders
More information:
As a pre-licensed psychotherapist, I ask each client during our first appointment about their sleep quality.
Sleep is often an indicator of well-being, environmental factors, and lifestyle habits (such as stress management) which impact psychological health.
This process in psychotherapy can support people developing insights about their sleep and health.
By re-evaluating sleep habits, influences from daytime activities, paying more attention to sleep-related thoughts (or worry/ anxiety), can give us a targeted goal during treatment.
Mental health clinicians often support people struggling with sleep issues (American Psychological Association, 2022).
Sleep & Stress: Who is at Risk?
Surprising to no one, parents or caregivers of dependent children carry higher burdens of stress than adults without dependent children (Merrill).
Women are at a higher risk for stress & sleep disorders
This may be due to hormonal changes or that women are more likely to report sleep distress to healthcare providers, than do men (Merrill)
Shift workers: People who work “abnormal” overnight shifts or variable shifts, which disrupt the circadian cycle, are at an increased risk for sleep disorders
People who recently gave birth, or are going through menopause (APA)
First Responders / Healthcare providers
People who experience loneliness; people in relationships experience a lower risk for sleep disorders and stress
ADHD is known to impact circadian rhythm and cause sleep disturbance (Codoñer-Franch, Combert, Martínez-Raga, & Carmen Cenit, 2023), and is a risk factor for sleep disorders
What Makes Sleep Quality “Good”?
Here is a brief video overview on the four sleep stages from YouTube, The SleepDoctor:
Sleep stages: What is REM Sleep?
REM, or Rapid Eye Movement sleep, is vital to a couple of fairly important processes including brain development, building memories, emotion regulation, and more (Hirotsu, Tufik, & Andersen, 2015).
The brain and body have different sleep requirements through life; babies tend to sleep more than middle-aged adults.
Keep reading to learn more about improving sleep quality.
Sleep & Mental Health Conditions
Sleep influences mental health (Merrill).
Mental health encompasses emotional, psychological, and social well-being.
Sleep quality can influence AND can be influenced by a person's ability to handle stress, manage difficult emotions (also called emotional regulation, or coping), mental health disorders, and engage in productive and adaptive activities.
More: Emotional Regulation Skills to Boost Well-Being
Sleep science is continuously evolving as researchers learn new processes about the brain during sleep cycles, further highlighting the significance of each sleep stage, how the immune system functions during sleep versus wake cycles, and technological advancements in science.
Insomnia is linked with Generalized Anxiety Disorder (GAD), OCD (Obsessive Compulsive Disorder), depression, and bipolar disorder (Fang, Tu, Sheng, Shao 2019; Merril).
Over 90% of patients with depression share complaints about insomnia (Fang et al.).
People are also likely to experience sleep-wake disorders around receiving a new chronic health diagnosis or disability, or following childbirth (APA).
It has been believed that mental health and sleep disorders have a bidirectional relationship: suggesting that one may influence the other, and vice versa.
However, a sleep study in 2021 suggested that poor sleep influences mental health conditions; rather than mental health conditions influence sleep disturbance (Scott et al.) More research is needed to confirm this takeaway; though sleep studies consistently link sleep disturbance with mental health conditions (Codoñer-Franch et al.).
Unfortunately, researchers have yet to discover the “one” cause of the connection between sleep disturbance and mental health, though there are highlighted connections between stress, sleep, and mental health disorders (McAlpine et al.; Merrill).
Reserachers are interested in learning more about the Hypothalomic-Pituitary-Adrenal (HPA) axis.
The HPA (hypothalamic-pituitary-adrenal) axis, a neuroendocrine system, is responsible for regulating stress responses (McApline et al.).
A generously boiled down description of the HPA axis: this system informs cells to signal the release of hormones; namely cortisol (Which is linked to the fight-flight-freeze response).
Learn more about the HPA axis here
Long-term impaired HPA axis functioning caused by stress can lead to weaker immune system responses, sleep disorders, mental health disorders, and other adverse health outcomes (McAlpine et al.).
Research suggests that mental health disorders such as depression are associated with increased HPA axis activity; sleepers without mood disorders have lower levels of HPA axis activity.
Overactive HPA axis activity is connected with other mental health diagnoses such as anxiety, bipolar disorder, eating disorders, schizophrenia, and OCD (Hirostu et al.).
Quick read: Habits that Improve Mental Health (At Any Age)
Let’s take a moment to recognize that stress and sleep disturbance are often the body’s natural response!
Not all sleep disturbance will be attributable to mental health issues or cause clinically significant impairment.
Other influences on sleep disturbance include environmental (lights/ brightness, loud noises, lack of access to a comfortable and safe bed), stressors related to low socioeconomic status or financial stress, genetic factors, and short-term responses to stress which may last a few nights (Hirostu et al.; McAlpine et al.).
How Can I Sleep Better?
If you’re wondering, “How much REM sleep do I need?” consider this:
The brain needs to enter the REM cycle for an appropriate amount of time, and the brain enters REM cycles towards the end of what length of time each body finds the most restful.
The 8-9 hours of sleep recommendation is not a 1-size-fits-all approach: it is a guideline.
Try to pay attention to how much sleep you need to feel fully rested.
Some people may feel fully rested with a consistent 6.5 hours of sleep each night, while others may need closer to 9, or 10. Some may find the 8 hour-mark is the sweet spot.
Start a Sleep Journal
Some people may journal their sleep habits each night to help keep track of patterns or changes.
Sleep hygiene is helpful, but is often not enough to address clinically diagnosed sleep-wake disorders (Codoñer-Franch et al.).
(But don’t sleep on sleep hygiene!)
Stress Management
This post has mentioned stress in many forms.
Poor stress management or being exposed to frequent stressful events is an influence on impaired HPA axis functioning, which leads to sleep disturbance and potentially mental health disorders.
Having a sleep disorder is a risk factor for developing a mental illness.
Sleep disorders and mental health conditions are preventable AND treatable.
Like the advice we've all been given before, try to handle stress as adaptively ("healthy") as possible.
Habits that Improve Mental Health
May is Mental Health Awareness Month (2024)
Chronic Disease (Disability) & Spoon Theory
Get Help
Whether from a primary care physician, sleep specialist, mental health therapist, psychologist, or psychiatrist: sleep disturbance is a health concern from which to seek relief.
CBTI (Cognitive Behavioral Therapy for Insomnia) is an evidence-based treatment for insomnia (Miller, Brownlow, & Gehrman, 2020).
CBTI can be used as an evidence-based practice for PTSD related insomnia and/or nightmares (Miller, Brownlow, & Gehrman).
Medication is an option for sleep-wake disorder treatment, though ensure you seek the advice from your own medical providers to know about your specific healthcare needs.
Sleep Hygiene Reminders and Tips:
Certain activities, scents, or behaviors can help inspire sleep:
A drop or two of lavender oil on a pillow may be relaxing
Avoid using a screen well before desired sleep time
Listen to peaceful music or nature sounds
Go to bed with clean sheets
Fluff up your pillow
Have a pre-sleep stretch or routine (for bedtime hygiene: brush your teeth in the dark, or using as little light as possible)
Bright bathroom lights can often be disruptive immediately before sleep
Avoid drinking lots of water before going to bed
Do enjoy and finish caffeine earlier in the morning (or your “morning” equivalent)
Use your bed for only sleeping or sex
Many of us already know at least a couple of these things, but a refresher never hurts (I often appreciate reminders about monitoring caffeine use during the day!)
Resource: Additional Health Links
Remember, improving sleep quality has benefits for people with or without a mental health condition!
This post provides educational content and offers general self-improvement strategies. Stellar Insight Counseling and blog authors are not providing medical advice or treatment; always consult with your own healthcare team regarding changes or concerns to your specific health status.
See the rest of Stellar Insight Counseling Blog Disclaimer here.
If you live in Alaska and are seeking a mental health therapist for sleep related concerns, I am accepting new telehealth clients: Learn more here.
About the Author:
Hello, my name is Nicole!
I am a pre-licensed psychotherapist working under the supervision of Psychologist Dr. Ekstrom (#196093, #125200) pursuing professional licensure in Alaska. I hold a master's degree in Clinical Psychology from the University of Alaska, Anchorage.
In my free time I like to hike, read, camp, play music, garden, and spend time with my pets.
Learn more about my therapeutic approach and online counseling services here.
References:
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed TR.). https://doi.org/10.1176/appi.books.9780890425596
Codoñer-Franch, P., Gombert, M., Martínez-Raga, J., & Carmen Cenit, M. (2023). Circadian disruption and mental health: The chronotherapeutic potential of microbiome-based and dietary strategies. International Journal of Molecular Sciences 24(8). https://doi.org/10.3390/ijms24087579
Fang H, Tu S, Sheng J, Shao A. (2019). Depression in sleep disturbance: A review on a bidirectional relationship, mechanisms and treatment. J Cell Mol Med.
Hirotsu, C., Tufik, S., Andersen, M. L. (2015). Interactions between sleep, stress, and metabolism: From physiological to pathological conditions. Sleep Science, 8(3). https://doi.org/10.1016/j.slsci.2015.09.002.
McAlpine et al., (2022). Sleep exerts lasting effects on hematopoietic stem cell function and diversity. Journal of Experimental Medicine, Hematology, 219(11). https://doi.org/10.1084/jem.20220081
Miller, K. E., Brownlow, J. A., Gehrman, P. R. (2020). Sleep in PTSD: Treatment approaches and outcomes. Current Opinion in Psychology, 34. https://doi.org/10.1016/j.copsyc.2019.08.017.
Merrill, Ray M. 2022. "Mental health conditions according to stress and sleep disorders" International Journal of Environmental Research and Public Health 19(13). https://doi.org/10.3390/ijerph19137957
Scott, A. J., Webb, T. L., Martyn-St James, M., Rowse, G., Weich, S. (2021). Improving sleep quality leads to better mental health: A meta-analysis of randomised controlled trials. Sleep Medicine Reviews, (60). https://doi.org/10.1016/j.smrv.2021.101556.
Spiegel, K., Knutson, K., Leproult, R., Tasali, E. Van Cauter, E. (2005). Sleep loss: a novel risk factor for insulin resistance and type 2 diabetes. Journal of Applied Physiology, 99(5)