Sleep and Mental Health

You’ve likely noticed the impact that your mental and emotional state can have on your sleep. If you’ve been feeling stressed or anxious throughout the day, it can often be difficult to relax at bedtime and get a good night’s sleep. And the opposite is also true: sleep deprivation can impact your mood and mental health. It can make it more difficult to deal with stressful events throughout the day and contribute to conditions such as depression and anxiety. If you’re currently dealing with a mental health issue, this can create a vicious circle where your symptoms make it difficult to sleep, and the resulting lack of sleep makes your symptoms worse.

Sleep is critical for your body to regulate itself, so a lack of sleep can cause issues with emotional balance and cognitive functions. If you’re sleep-deprived, you may have more difficulty managing your emotions, staying focused, recalling information, and making decisions.

If you are already experiencing stress, anxiety, or a mood disorder, a lack of quality sleep can further exacerbate your symptoms. In particular, sleep deprivation has been associated with an increase in negative emotions and can make it harder to cope with daily stressors. Sleep disorders also tend to be more common in people with mental health conditions.

While worrying about getting enough sleep can make getting quality sleep even more difficult, there are ways to set your mind at rest. Knowing how sleep can affect your mental health can help you gain a better understanding of your emotional state and help you take actionable steps to improve your sleep at night.

Common sleep disorders that can impact your mental health include:

Insomnia affects approximately one in three adults. Some people experience short-term insomnia, caused by a stressful event or travel, for example, which typically resolves in a few weeks. Others experience long-term insomnia, meaning that you have trouble sleeping for a period that lasts longer than three months.

Having insomnia can cause you difficulty falling asleep initially, or you may wake up in the middle of the night and have difficulty getting back to sleep. You might also wake up too early and not be able to get back to sleep. This can lead to you feeling tired throughout the day and can even cause mental health symptoms like feeling anxious, depressed, or in a bad mood.

Sleep apnea repeatedly interrupts your breathing during sleep and can be serious if left untreated. Symptoms of sleep apnea include loud snoring, gasping for breath or choking, stopping breathing for over ten seconds during sleep, and restlessness. During the day, you might experience symptoms like crankiness, depression, anxiety, and difficulty concentrating.

If your doctor suspects that you have sleep apnea, they’ll likely order a sleep study. Depending on the severity of your sleep apnea, lifestyle changes may be effective in managing symptoms or your doctor might recommend using a sleep apnea machine.

Restless legs syndrome (RLS) can cause an uncomfortable feeling in the legs and an urge to move, which can make it difficult to sleep. If you suspect you have RLS, your doctor will likely perform a physical exam to check for any other causes of your symptoms.

Sometimes, this condition can be treated by addressing associated conditions, like iron deficiency. Other times, your doctor may prescribe a medication to help.

If you have narcolepsy, your brain has trouble controlling and managing your sleep-wake cycles. This can mean that you feel excessively sleepy throughout the day and can even fall asleep in the middle of important activities, like driving or working. This condition is particularly associated with depression.

If your doctor suspects you have narcolepsy, they’ll typically want to send you to a sleep clinic for specialized testing. Lifestyle changes and certain medications can help to manage the symptoms of narcolepsy.

Parasomnias are a group of disorders that are characterized by abnormal behaviors during sleep. For example, you might talk, walk, move, or eat during your sleep. People with certain types of parasomnia might also suffer from nightmares or night terrors.

Sleep studies are often used to diagnose these types of disorders and they can be treated with lifestyle changes and medication.

Common mental health conditions that can impact your sleep include:

Although depression is common in people who have difficulty sleeping, the opposite is also true: depression symptoms can make it more difficult to sleep.

If you have depression, you might find that you have trouble falling asleep or are waking up in the middle of the night more frequently. Another common symptom of depression is fatigue, which may or may not be related to the quality of sleep that you’re getting.

In addition to depression contributing to insomnia, a lack of good-quality sleep can also worsen your symptoms, which can make it even more challenging to sleep. The good news is that treating sleep issues may help to ease or prevent depression symptoms recurring.

Sleep issues are also common with anxiety disorders, as worrisome thoughts and feelings of fear or trepidation can make it harder to fall asleep. If you’re in an anxious state, you might also be more prone to experiencing nightmares once you do fall asleep.

Sleep issues are particularly common in those with generalized anxiety disorder and obsessive-compulsive disorder (OCD). When you have trouble sleeping, it can cause additional anxiety around bedtime, which in turn can affect your sleep.

Treating anxiety as well as practicing good sleep habits can help to combat this issue.

When you’re stressed, racing thoughts or jitteriness can often make it more difficult to relax and sleep. When you’re not able to get enough good quality sleep, it can make you more susceptible to the negative effects of stress which, in turn, make it more difficult to get the sleep you need.

Practicing good sleep hygiene and incorporating stress reduction methods can help make it easier for you to get the sleep you need and feel more balanced.

Bipolar disorder can affect your sleep in several ways. When you experience symptoms of depression, you may experience hypersomnia, meaning that you sleep more than you do typically. When you’re experiencing mania—or approaching a cycle of mania—you may have more difficulty sleeping and experience insomnia or more vivid dreams.

Bipolar disorder can also make you more prone to developing certain sleep conditions like sleep apnea, circadian rhythm disorders, and a reduced need for sleep. Creating a sleep diary can help you understand how bipolar affects your sleep so that you can create a plan with your doctor.

Sleep issues are common with post-traumatic stress disorder (PTSD). If you have PTSD, you might experience increased stress during the day and restlessness, which makes it more difficult to go to sleep initially. You might also experience nightmares that replay the traumatic event, which can disrupt sleep and make it more difficult to go back to sleep.

A special type of therapy called cognitive behavior therapy for insomnia has been found to be effective in reducing stressful nightmares in people with PTSD.

Because ADHD impacts your brain’s ability to regulate, it can have a direct impact on your sleep. Having ADHD means you’re more likely to experience difficulty with getting to and staying asleep, have periods where you require less sleep, and are more likely to experience a sleep disorder.

The type of ADHD that you experience can also impact your sleep in different ways. With the inattentive form of ADHD, you may prefer a later bedtime, which can make it difficult to get enough sleep. With the hyperactive and impulsive type of ADHD, you may be more likely to experience insomnia.

Practicing a good sleep routine and establishing a set bedtime can be helpful.

Sleep hygiene refers to practicing good sleep habits that can have been shown to help improve sleep quality and overcome mild to moderate insomnia. It involves lifestyle habits and creating a better sleep environment.

You’ll find that you sleep best in an environment that is cool, dark, and comfortable.

You can start by ensuring that your bed is comfortable, with a suitable mattress and pillow that works for your body type and sleep position, and doesn’t leave you waking up with a sore back or neck.

You can also choose sheets that keep you at a comfortable temperature, as well as ensuring that you have enough blankets to stay warm.

Some people find that it is helpful to sleep with a fan, as this keeps their room at a cool temperature and also helps to block outside noise. You may also find that a white noise machine is helpful.

To create a dark environment, blackout curtains or an eye mask are options.

When you do settle into bed, you might consider turning your clock away from you. This can prevent clock watching, which can lead to stress over how many hours of sleep you might get, which makes it more difficult to sleep.

Although you might think of preparing for sleep as something that just needs to be done in the evening, there are plenty of things that you can do during the day to set yourself up for a good night’s sleep.

Incorporate exercise into your daily routine. Try to get about 30 minutes of moderate aerobic exercise on most days. However, you might need to experiment to learn when the best time of day is to exercise for your body. Some people find that exercising too close to bedtime can keep them awake.

Manage your stress during the day can help you to feel calmer overall, which is helpful for quality sleep. Meditation, deep breathing, journaling, and yoga or tai chi are some examples of relaxation techniques to incorporate.

Reserve your bed for sleep. Although it can be tempting to work or study in the comfort of your bed, this can make it more difficult for your body to recognize that your bed is a place of sleep. Instead, try to limit your bed for just sleep and sex.

Your body relies on light to manage your circadian rhythm or sleep-wake cycle. In the darkness of night, your body produces more melatonin to help you feel sleepy. The blue light from your television, computer, tablet, and phone can have the opposite effect, priming your body to stay awake.

Setting up your devices to use a blue light filter after sundown can help, but the best idea is to put your electronics away an hour or so before bed.

If it’s safe to do so, turning off as many lights as possible and dimming the lights that need to stay on can be helpful. Instead of screen time, you might try listening to relaxing music or an audiobook, or reading with a soft light.

While your daily cup of coffee might help boost your energy in the morning, too much caffeine close to bedtime can keep you awake.

Try to avoid caffeine within a six-hour window before bedtime. If you’re more sensitive to caffeine, you might need longer.

Remember that caffeine isn’t just in coffee; it can also be found in tea, chocolate, and some sodas.

Alcohol prior to bed can also lead to tossing and turning. Although it might initially make you feel sleepy, it can lead to frequent night waking and poor-quality sleep that can leave you feeling tired the next day.

If you decide to drink alcohol, aim to stop at least three hours before bedtime.

What you eat can also impact your sleep.

Eating heavy, spicy meals before bed can make it difficult to sleep and can cause indigestion and heartburn. Typically, it’s helpful to eat dinner at least two hours before bed.

If you are hungry before bed, a snack that has protein with some healthy fats is ideal to help keep you satiated throughout the night. Examples include Greek yogurt or apple slices with a tablespoon of peanut butter.

There are also some particular food options that can help increase your body’s production of melatonin, like tart cherries, milk, and bananas.

You might also opt for complex carbs, which can help your body to produce serotonin and encourage sleep. Examples include whole-wheat toast or oatmeal.

Creating a relaxing bedtime routine can help you wind down before bed, releasing any worrisome thoughts or tension from your day.

Relaxation techniques, such as deep breathing or meditation, can help you relax before bed.

You can also practice some gentle stretching or yoga to help relax your muscles.

There’s evidence that your body temperature drops before sleep, so taking a warm shower or bath an hour or two before bed can help to create this temperature drop and make you feel sleepy.

You may also consider using a sleep app, which can guide you through meditations for sleep or provide you with calming music.

If you’re having trouble falling asleep, rather than tossing and turning, get up and do a relaxing activity for 20 minutes. Then go back to bed when you’re feeling sleepy again.

Whatever routine you decide on, practicing this routine at the same time each evening can help you get on a schedule that can help to set your body’s internal clock so that it’s easier for you to fall asleep when you want to.

Since mental health issues and sleep problems are so intertwined, it’s important to treat them together. Using a multifaceted approach involving lifestyle changes, therapy, and medication can often be the most effective in treating symptoms and making lasting improvements.

Cognitive behavior therapy (CBT) can be effective in helping to treat both sleep issues and common mental health problems, such as anxiety or depression. A specialized type of CBT for sleep, cognitive behavior therapy for insomnia (CBT-I), can help you recognize and change the negative thought patterns that make it difficult for you to sleep.

On the behavior side, creating a sleep diary can help you understand the daytime choices that may be making it difficult for you to sleep, and work to make lifestyle changes.

For people who find it difficult to commit to in-person therapy for sleep, online therapy options can also be helpful.

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Cognitive and behavior changes are considered to be the most effective for addressing long-term sleep issues. However, for short-term sleep problems, such as those caused by temporary stressful situations, grief, or long-haul travel, medication can be an option.

Before trying sleeping pills or sleep aids, it’s important to rule out a sleep disorder, such as sleep apnea or RLS, that may be behind your sleep difficulties.

As with any prescription medication, sleeping pills can have side effects such as next-day drowsiness, withdrawal symptoms, and “rebound insomnia”, where your sleep problems become worse once you stop taking the medication. Some may even cause serious side-effects.

If a depression or anxiety diagnosis is impacting your ability to sleep, some antidepressants can also have a sedating effect. However, it’s important to note that this is an off-label use, as the FDA has not approved antidepressants for sleep disorders.

There are certain dietary supplements that can be helpful for aiding sleep, depending on your situation. However, before trying any supplements, it’s important to discuss it with your healthcare provider to ensure it’s safe to take alongside any other medical condition or medications you’re taking.

Melatonin can help to regulate sleep-wake cycles. It’s most effective for people who have trouble falling asleep or are experiencing jet lag and can also be helpful for people with ADHD.

Magnesium. Magnesium can help to improve both sleep quantity and quality and has been shown to be especially helpful in managing insomnia for older adults.

L-theanine. L-theanine is a compound that is found in tea and can help to improve the quality of sleep while promoting relaxation.

Chamomile. Although more research is needed, there is some evidence that chamomile can help to promote relaxation and improve sleep.

Sleep is an important factor in how you feel. When you don’t get enough sleep you can be more prone to developing symptoms of anxiety, depression, and irritability. Likewise, mental health conditions can directly contribute to making it more difficult to get good quality sleep.

Practicing good sleep hygiene, like creating an ideal sleeping environment and following a relaxing sleep routine, can help you to feel more calm at bedtime and get a better night’s sleep.

If you’re dealing with difficulty sleeping alongside mental health issues, there are a number of treatments available to help you feel better. Prioritizing your sleep is an important component of both physical and mental self-care.

Last updated or reviewed on November 13, 2024