How Poor Sleep and Mental Health Feed Each Other

How are sleep and mental health connected?

The American Psychiatric Association puts it plainly: sleep problems can exacerbate depression or anxiety, and depression or anxiety can lead to sleep problems. A sleep problem can be a symptom of a mental health condition, and it can also contribute to one. It often does not matter which came first, because both may need attention.

Short sleep also changes how the next day goes. The same source lists fatigue, irritability and problems focusing as consequences of poor sleep, and says your mood and your ability to make decisions can be affected too. When anxiety or low mood is already making those things harder, a bad stretch can start to feed itself.

What do sleep problems look like with each condition?

The pattern can differ from one condition to the next. This table is a general guide for noticing and describing what is happening. It is not a way to diagnose yourself, and these patterns can overlap.

How is needing less sleep different from not being able to sleep?

What habits can help me sleep better?

These steps from the National Heart, Lung, and Blood Institute (NHLBI) can make it easier to fall asleep and stay asleep. Try a few at a time, and give them a fair chance before judging them. They will not fix every sleep problem, but they are a reasonable place to start.

• Go to sleep and wake up around the same time each day, including weekends.
• Keep your bedroom cool, quiet and dark, and avoid watching TV or looking at electronic devices at bedtime.
• Avoid caffeine, nicotine and alcohol close to bedtime. Alcohol can make sleep lighter and make you more likely to wake during the night.
• Get regular physical activity during the day, at least 5 to 6 hours before bed.
• Avoid naps, especially in the afternoon.
• Eat meals on a regular schedule, avoid late dinners, and limit how much you drink close to bedtime.
• Follow a wind-down routine, such as reading a book, soothing music or a hot bath.

What is cognitive behavioral therapy for insomnia?

Cognitive behavioral therapy for insomnia, or CBT-I, is a structured treatment, not just a list of sleep tips. NHLBI describes it as a 6- to 8-week plan that is usually recommended as the first treatment option for long-term insomnia. It can be done by a doctor, nurse or therapist, in person, by telephone or online. The VA National Center for PTSD says sleep hygiene is often part of CBT-I but is not the same thing.

NHLBI lists these parts. If you would like to know whether CBT-I can be part of your care with us, ask us, because a referral may be the right step.

• Cognitive therapy, to feel less nervous about not being able to sleep
• Relaxation or meditation training, to wind down and fall asleep faster
• Sleep education, to learn good sleep habits
• Sleep restriction, which sets a specific amount of time in bed and increases it as sleep gets better
• Stimulus control, which means going to bed only when sleepy, getting up if you cannot sleep, and keeping the bed for sleep and sex

What about sleep medicines and supplements?

The VA National Center for PTSD says sleep medication usually gives quick, temporary relief, is often recommended only for short-term use, and tends to become less helpful over time without addressing the core cause. NHLBI says research has not proven melatonin to be an effective treatment for insomnia, and that antihistamine sleep aids can be unsafe for some people. Tell your provider about anything you take for sleep, including over-the-counter products.

Some medicines can also disturb sleep, so ask before changing anything. Do not start, stop or change a medication on your own. Medication decisions here come after an evaluation, not every medication can be prescribed at every kind of visit, some may require an in-person appointment, and we explain what applies to you and how medication management works.

When should I talk with primary care or a sleep medicine provider?

The American Psychiatric Association says to seek evaluation if sleep problems persist or get in the way of how you feel or function during the day. Insomnia disorder involves trouble at least three nights a week for at least three months, along with real distress or problems at work, school or elsewhere.

Some sleep problems need a medical workup. Our clinic does not do sleep studies or treat sleep apnea, so raise these with your primary care provider or a sleep medicine provider:

• Loud snoring, gasping or pauses in breathing, which a bed partner often notices first
• Feeling tired or needing to sleep during the day even after a full night in bed
• An urge to move your legs at night, or episodes of acting out dreams or sleepwalking
• Suddenly falling asleep during the day

How does sleep fit into care at this clinic?

Sleep is part of the conversation at a first evaluation, which takes about 60 minutes with Victor Onodjacha, MSN, PMHNP-BC, in person in Sugar Land or by secure video if you are physically in Texas, Idaho, Arizona or Maryland. Our pages on sleep problems, anxiety and depression explain how care works for each. A short sleep diary can help. If nightmares follow a frightening event, our guide on when to get help after trauma may also be useful.

You can request an appointment and read about coverage on our insurance page. If you are in crisis, call or text 988, or call 911 if there is immediate danger. DanShalom Behavioral Clinic is not an emergency service.