New chicken-egg for you: Which comes first—the insomnia or the mental health disorder?
“Traditionally, sleep difficulties, including lack of sleep, are viewed as a consequence of mental health problems,” says Alexander Scott, Ph.D., a health psychology researcher at Keele University in the UK specializing in the role sleep plays in mental health. But the link can also go the other way: Scott’s research shows that sleep struggles can lead to mental health problems.
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Said another way: If you’ve got problems sleeping, you’re at higher risk of developing a mental health disorder, even if you don’t have one now. This is especially pertinent now, as a November 2021 study of over 20,000 people found that a full third had symptoms of clinical insomnia—which showed up stronger in women and young people.
Before you start counting eeps instead of sheep, consider that “this actually raises an exciting question,” says Scott. “Which is: Can you improve your mental health by getting better sleep? From everything we’ve seen, that answer is usually yes.”
The Sleep-Mental Health Connection
You don’t need scientists to confirm how craptastic the next day can be when you haven’t slept well, but of course they have: A 2019 study in the Journal of Experimental Psychology found that restricted sleep resulted in “universally intensified anger” in participants. (Grrr…)
And according to a study in the journal Sleep, people who got about five hours of sleep, versus their typical seven to nine, every night for a week had much higher levels of mental exhaustion, sadness, and anger.
Now, add in a mental health issue, and lack of ZZZs becomes an even bigger mood suck. Take ADHD, which research links to common slumber issues like sleep apnea and difficulty falling asleep and waking in the morning. Or bipolar disorder: Per Sleep Medicine Reviews, there are direct ties between “sleep-wake disturbances” and people who have bipolar. In another study, people with insomnia were five times more likely to develop depression and 20 times more likely to develop panic disorder.
No matter what the mental disorder, a new study review published in Translational Psychiatry suggests that circadian rhythm disruption is “an underlying factor that bridges across mental health disorders,” including bipolar, anxiety, depression, OCD, and ADHD.
Sleep Tips That Don’t Suck
Go online, and you’ll find approximately one zillion suggestions on how to get better sleep. The problem: contradictory info, advice that saps the joy out of life, or tips that essentially suggest you start your bedtime routine at 4 p.m. in order to get enough winks later on.
Some of this common “wisdom” includes:
- Turn off all screens for at least an hour before bed (no Candy for you!)
- Take a warm (not hot) bath, but not a shower
- Drink calming tea, but not too close to bedtime so you can…
- Empty your bladder
- Never drink alcohol
- Go to bed at the exact same time every night
- Wake up at the same time every day
- Yes, even on the weekends
Are these tips legit? Sure, they can help. But they’re way too structured for most people to follow consistently. (What is life without sleep-in Saturdays?) Worse, an attempt to be this relaxed can make you feel so much overwhelm and pressure, it can actually make falling asleep harder, says neurologist and sleep medicine doctor W. Christopher Winter, M.D., president of Charlottesville Neurology and Sleep Medicine and author of The Sleep Solution.
“When it comes to sleep suggestions, more is not always better if it’s making you feel anxious, because that will have the opposite effect,” says Dr. Winter. “Everyone should have their own plan for ways to fall asleep easily, stay asleep, and wake up refreshed.”
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The first step, he suggests, is simply noticing what’s going on. Start connecting mental health symptoms to sleep quality from the night before. Building awareness can be powerful, because it’s an indication that you may need to start tweaking your habits.
Emphasis on the word “tweak.” If you change too much at once, you won’t be sure which tactic is working, explains Dr. Winter. Instead, try one thing for a week, like going to bed at the same time every night, and see if it makes a difference. Plus, smaller changes—like not checking your phone for 30 minutes vs an hour before bed—can feel more doable.
If you’re still struggling after a month, talk to a doctor, ideally a sleep specialist. You may have a condition like sleep apnea that’s interfering with sleep quality and ramping up your health risks—including your mental health.