Sleeplessness and Mental Disorders

What is the Relationship: Insomnia and Mental Disorders

Insomnia is a symptom, not a stand-alone disorder. It is a common symptom of mental illnesses, including anxiety, depression, schizophrenia, bipolar disorder, and attention deficit hyperactivity disorder (ADHD). It can disrupt adequate quality or quantity of sleep, and if left untreated, can increase the risk of developing psychiatric conditions later in life.

Why is Sleep Important?

Although the length of time spent in normal sleep cycles vary, a normal cycle occurs every 90 minutes. During “quiet” sleep, a sleep cycle progresses through four stages of increasingly deep sleep. Body temperature drops, muscles relax and heart rate and breathing slow down. The deepest stage of this produces physiological changes that help boost immune system functions.

The second type of sleep, REM (rapid eye movement) sleep, occurs when people dream. Body temperature drops while blood pressure, heart rate, and breathing increase. This category of sleep contributes to emotional health – in complex ways.

When sleep quality and quantity is disrupted, it affects levels of neurotransmitters and stress hormones. Not only does it wreak havoc in the brain, it impairs thinking and emotional regulation. As a result, insomnia may amplify the effects of psychiatric disorders, and vice versa.

Insomnia and Depression

Patients with depression experience low mood and/or a lack of interest in activities previously found to be enjoyable.  This condition affects one’s appetite, concentration, energy level, and motivation. Most commonly, people with depression report feelings of helplessness, hopelessness, worthlessness, and experience suicidal thoughts. The majority experience symptoms of insomnia, which includes difficulty in falling asleep, difficulty in staying asleep, early morning awakenings, and/or prolonged sleep.

Patients with depression also demonstrate prolonged sleep latency (time to fall asleep), lack of deep sleep, reduced REM sleep latency (time to REM sleep from sleep onset), and increased amount of REM sleep.

Insomnia and Bipolar Disorder

In addition to major depression, insomnia commonly occurs with bipolar disorder during depressive and manic episodes. Manic patients experience an inability to sleep, while others have a decreased need for sleep. The onset or progression of manic episodes in patients with bipolar disorder are more likely to occur during sleep loss from any reason, including jet lag and work schedules.

Insomnia and Anxiety

Insomnia is particularly problematic for patients with anxiety disorder, including those with panic disorder and post-traumatic stress disorder. Patients with anxiety and panic disorder will experience distressing panic episodes that awaken them from sleep, which may lead to anticipatory anxiety about going to sleep. As a result, patients with anxiety may have insufficient sleep. Patients with post-traumatic stress disorder, on the other hand, experience poor sleep quality due to vivid nightmares.

How to Treat Insomnia

Treatment of insomnia is inclusive of both non-medical and medical aspects. Simple steps can be taken to improve a patient’s sleep quality and quantity.

  • Exercise regularly, at least 20 minutes daily; ideally 4 – 5 hours before bedtime
  • Keep a regular sleep and wake up schedule
  • Do not drink caffeinated beverages later than the early afternoon (cut off by 3pm)
  • Do not smoke, especially in the evening
  • Avoid taking long naps in the daytime

Medically, there are numerous possible medications to treat insomnia. It is usually advised that they should not be used as the only therapy and that treatment is more successful if combined with non-medical therapies. Medical treatment includes:

  • Benzodiazepine sedatives: Six of these sedative drugs are used to treat insomnia, which includes temazepam (Restoril), flurazepam (Dalmane), triazolam (Halcion), estazolam (ProSom, Eurodin), lorazepam (Ativan), and clonazepam (Klonopin).
  • Nonbenzodiazepine sedatives: These include eszopiclone (Lunesta), zaleplon (Sonata), and zolpidem (Ambien).
  • Antihistamines with sedative properties are used to treat insomnia. It may induce drowsiness, but does not improve sleep and should not be used to treat chronic insomnia.

Schedule a Consultation

Identifying and treating an underlying medical problem or sleep disorder may be the first step in treating insomnia. Dr. Shukla will discuss and review your treatment options in order to find the perfect therapy for you. Schedule a consultation with the Asthma Allergy Sleep Center of New York today, and join our many satisfied patients.

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