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Lyndsey Kelly

Dr. Andrienne Cassel

ENG 1201.501

23 March 2020

Sleep and Mental Health: A Two-Way Relationship

With over 70 diagnosable sleep disorders, and more than 50 to 80 percent of patients with

a psychiatric disorder reporting chronic sleep problems, it is evident that humans struggle to get

the sleep they need both mentally and physically. We all know sleep is vital for our physical

health, but little is taught about how it affects us on the inside. Sleep can affect mental health

both positively and negatively. When people get a healthy amount of uninterrupted sleep, they

are refreshed, rejuvenated, and overall happier; however, when people get little to no sleep, or

are interrupted throughout the night, mental illnesses, irritability, and overall tiredness has an

adverse effect on people's everyday lives.

In order to understand the effects of sleep on mental health, it is important to know the

basics of sleep and wakefulness. While we are awake, our brains are constantly working, and all

these tasks tend to build up, causing a sort of debris during periods of wakefulness. During sleep,

humans enter a period of extreme restoration and rejuvenation both physically and mentally,

allowing this build up in the brain to clear out. Physically, sleep helps reenergize cells, and is

also linked to the relief of vascular and other common stresses. Mentally, sleep is linked to

dozens of functions that help upkeep our cognitive abilities, like memory processing and

problem solving functions. According to Maria Konnikova, a writer for The New Yorker, while
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we sleep “our brains replay, process, learn, and extract meaning” (Konnikova). Sleep is a crucial

component to everyday life; without sleep humans would not be able to function physically or

mentally.

The association of sleep and mental health is nothing new to researchers, doctors, and

scientists. According to Andrew Winokur with the Psychiatric Clinics of North America, “sleep

problems have been noted to be present in patients with depression from the age of antiquity”

and around 400 B.C., Hippocrates’ writers concluded that depression was associated with

“sleeplessness, irritability, [and] restlessness” (606). Technology has rapidly progressed since the

age of Hippocrates, allowing modern day scientists and doctors to have a deeper understanding

of the relationship between sleep and mental health. With this contemporary technology also

comes an increased trouble falling and staying asleep for thousands of people. However,

regardless of the moment in history, one conclusion remains the same: sleep disturbances and

mental illnesses tend to coexist in patients.

Modern technology has made it easy for scientists and doctors to further study sleep and

mental health, but not all technology has been beneficial. With helpful research pieces like the

polysomnographic (PSG) test and the Sleep Condition Indicator (SCI), scientists have been able

to produce all the data that backs their claims about the relationship between sleep and mental

health. However, everyday technology, like computers and smartphones, have hindered humans'

ability to get a good night’s rest. According to Mary Jane England with the National Institute of

Mental Health, before the creation of technology, humans relied on their circadian rhythm, or

their biological clock, to regulate sleep. Now in modern times, things like smartphones have

thrown most humans off their natural cycle, making it harder and harder to get a healthy amount
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of sleep. While technology is beneficial to scientists conducting studies, personal devices have

hindered sleep quality for millions.

With the invention of modern technology, scientists have been able to confirm the

commonality of sleep disturbances in a wide spread population of patients. According to Helen

Milojevich of the University of California Department of Psychology and Social Behavior, sleep

disturbances differ from sleep disorders because they are not clinically concerning and are

“defined as ​trouble falling asleep, staying asleep, or waking up too early​” (Milojevich). Sleep

disorders are a more severe problem associated with mental illness. Unlike sleep disturbances,

these disorders tend to be more clinically relevant, requiring a diagnosis from a medical

professional (Milojevich). Both sleep disturbances and sleep disorders are correlated with mental

health; however, they do not cause one or the other. For example, researchers state that there is a

“bidirectional relationship between sleep disturbances and psychiatric disorders” (Winokur 611).

Each patient is unique in their own diagnosis, making it hard to pinpoint exactly how sleep and

mental disorders relate; however, it is clear that the presence of one makes the chance for the

other higher.

Scientists have found that common sleep disorders tend to coexist with common mental

illnesses. The most common sleep disorders associated with mental illness are insomnia,

narcolepsy, and sleep apnea. Insomnia is characterized by difficulty falling or staying asleep.

Narcolepsy is extreme tiredness, or falling asleep uncontrollably during the day. Sleep apnea is a

sleep disorder that affects breathing patterns, causing many individuals to wake up multiple

times during the night. Many of these sleep disorders have been found to coexist with common

mental illnesses like depression, anxiety, and ​attention deficit hyperactivity disorder (​ADHD).
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Depression is an overall loss of interest and persistent feelings of sadness and hopelessness.

Anxiety is characterized by a state of constant uneasiness, usually accompanied by panic attacks.

Symptoms of ADHD include hyperactivity, impulsivity, and inattention. While there are dozens

of sleep and mental disorders, it is important to note that the most commonly diagnosed sleep

disorders tend to coexist as primary or secondary diagnoses to the mental disorder and vice

versa. The following figure shows that, in three different countries, poor sleep quality and mental

illnesses often coexist in patients. Poorer sleep quality, or a score of C4 and higher, tends to

correspond with mental illnesses, showing that certain mental illnesses are more common in

different countries.

Fig. 1. Data shows that the relationship between common mental illnesses and sleep quality is

present in many countries (Del Rio João 248).

Because mental illnesses and sleep disorders are so closely related, scientists believe they

may have similar roots. For example, Harvard Health states that “​studies using different methods

and populations estimate that 65% to 90% of adult patients with major depression, and about

90% of children with this disorder, experience some kind of sleep problem” (Harvard).​ Because
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the ratio of patients suffering from a mental illness and a sleep disorder is so high, it is clear that

they are related, and—depending on the patient—the sleep or mental disorder may help to create

an ideal situation for the development of the other. For example, researchers at Harvard found

that “​insomnia and other sleep problems also increase the risk of developing depression and

anxiety disorders” (Harvard). Because there is a high ratio of patients with both types of

disorders, it is clear that sleep and mental disorders have a two-way relationship.

So how exactly does this two-way relationship work? The relationship between sleep and

mental disorders is formed through physical interactions during sleep. Within the brain, a sleep

disturbance throws the sleeper off their sleep cycle, further creating mental issues. Healthy

sleepers go through cycles of quiet and REM sleep, both important to physical and mental health.

In each cycle, mental functions like memory, learning, and emotions are enhanced. According to

researchers at Harvard Health, being thrown out of one of these cycles prematurely, specifically

“​affects levels of neurotransmitters and stress hormones” (Harvard). Because the body is thrown

off its natural cycle, the restoration and rejuvenation taking place within the brain is impaired.

Therefore, those suffering from a mental disorder suffer from emotional impairment brought on

by sleep disturbances that can amplify the effects of their mental disorder or vice versa.

Trouble sleeping is commonly associated with multiple mental disorders, but the

association is not always negative. Those suffering from mental disorders and sleep problems

have the option to seek treatment without fear of judgment due to the association between the

two. Daniel Freeman, a professor of Psychiatry at the University of Oxford, states that because

there is little to no stigma surrounding sleep problems, “it provides a much more acceptable

focus for a first step in a care pathway” and that an early detection of insomnia “might indicate a
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promising route into the early treatment of some psychotic problems” (755). Individuals may be

nervous or unwilling to seek treatment solely for a mental illness, but when seeking treatment for

a sleep disorder, doctors are knowledgeable about the relationship between sleep and mental

disorders, making it easier for the patient to take that first step in the treatment of their mental

disorder as well as their sleep disorder. The idea of feeling safe and comfortable while also being

treated may also boost mental health because the individual is no longer suffering in silence, and

is also not facing stigmas from the public for having a societally taboo mental disorder. By

understanding that sleep problems are related to certain mental disorders, patients can safely and

comfortably receive treatment for both problems without the stigmas.

Low quality sleep is associated with mental disorders, but high quality sleep can benefit

individuals mentally. Getting an adequate, uninterrupted amount of sleep every night allows the

body and mind to completely rejuvenate. Scientists call this ratio of total hours of restful sleep to

total hours in bed, sleep efficiency. For example, Kareine Alexandra Del Rio João of the

University of Algarve in Portugal states that “habitual sleep efficiency has a positive effect on

depression, which means that better sleep efficiency corresponds to better mental health” (248).

When individuals improve the quality of their sleep, they are allowing their bodies’ to complete

the full sleep cycles, further improving their physical and mental health.

It is important to find ways to improve sleep and mental health for dozens of people.

Specifically, people like new mothers and third shift employees need to be knowledgeable about

the effects of sleep on mental health and vice versa. It poses a threat for the individual and those

surrounding them if an individual is sleep deprived, or not in the right mindset. Raising a child is

no easy task, and doing it while sleep deprived is even harder, and more dangerous for the
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parents and the baby. Third shift employees, like semi truck drivers, put lives in danger every

night if they operate on low quality sleep. Simple “brain farts” can turn into dangerous events

when the brain is sleep deprived; therefore, it is vital for those affected by sleep deprivation to

fully understand the relationship between sleep and mental health, and ways to improve both, for

the safety of themselves and others.

Making small changes to everyday life can improve sleep efficiency and sleep quality,

helping individuals feel better physically and mentally. Harvard Health suggests reducing the

amount of alcohol, nicotine, and caffeine consumed before bed. In addition to removing

addicting substances, experts recommend working on good sleep hygiene, or the act of

“​maintaining a regular sleep-and-wake schedule, using the bedroom only for sleeping or sex, and

keeping the bedroom dark and free of distractions like the computer or television” (Harvard)​. ​By

maintaining a healthy sleep environment and lifestyle, individuals can start to see improvements

in sleep quality and mental health. However, lifestyle changes may not work for everyone with

more severe sleep or mental problems. According to Harvard Health, cognitive behavioral

therapy is a popular therapy technique for those suffering with insomnia because they become

almost obsessed with the idea of sleep. This therapy technique helps train the brain to stop

having “​negative expectations and try to build more confidence” (Harvard).​ The figure below

further discusses how cognitive behavioral therapy actively changes the way a patient thinks

about their disorder. Poor sleep quality is linked to many mental disorders, but not all hope is

lost; there are many options to improve both sleep quality and mental disorders regardless of the

severity. ​Because​ sleep and mental disorders are closely related, there is a higher chance that one
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healthy lifestyle change positively affects both the individual’s sleep quality and mental disorder.

Fig. 2. Cognitive Behavioral Therapy works by training the patient to change their perceptions of

how they feel, think, and act (Woodland).

Because there is a two-way relationship between sleep and mental health, techniques

used to improve mental health may help with sleep as well. The University of Michigan suggests

a wide array of options to help boost mental health including volunteering, finding new hobbies,

developing healthy eating habits, and daily exercise. Although it may seem odd, another great

way to help improve mental health is to set small realistic goals, or step out of a regular routine.

These, along with other coping skills can provide patients with an outlet and aid in stress relief.

A common technique, mentioned by both Harvard and the University of Michigan, for overall

health improvement is meditation. Meditation can aid in extreme mental and muscle relaxation,

and it can even “enhance the effects of therapy” (University). The most important, and arguably

the hardest change for those with a mental illness is taking the initiative to get professional help

when needed. If a mental illness goes untreated for too long, it can lead patients down a
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dangerous path of sleep deprivation and/or suicidal thoughts. Mental disorders can be incredibly

overwhelming, but with these simple changes, patients can hopefully begin to take the first step

in improving their mental health, which may lead to improvements in sleep as well.

Dozens of people claim to get an adequate amount of sleep, but are still experiencing

tiredness, irritability, anxiety, and depression. This is likely because of a popular myth that

humans can catch up on sleep on weekends or days off. In reality, trying to catch up on those

missed hours results “in jet-lag like symptoms” (England). Because of these symptoms, most

humans develop a large deficit of sleep, causing prolonged sleep deprivation. This is dangerous

because ​“sleep deprivation, mood disturbance, and impaired concentration and self-regulatory

skills can spiral into more severe symptoms of impairment” (England). Instead of trying to catch

up on sleep, it is healthier to follow the recommended lifestyle changes, regulate sleep patterns,

and get the same amount of adequate sleep every night.

While most studies focus on how poor sleep quality relates to mental illness, there is

some research that suggests differently. In a self-reported study on undergraduate students,

mental health problems were found to be prominent “​both in students with sleep problems and in

those with generally healthy sleep habits” (Milojevich). However, it is important to note that

undergraduate students are in a transitional period of life, leaving them vulnerable to mental

illness. In this situation, some students’ mental illness may have been caused by their

environment or situation, rather than their sleep habits. This study contradicts many other studies

that state that sleep problems are a causing factor in mental illnesses, and “improving sleep

should benefit psychological health” (Freeman 749). Although this study on undergraduate

students may be controversial with others, it proves that there are many causes of mental illness,
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and having healthy sleep habits may not be enough to combat the development of a mental

disorder.

While environments and situations may aid in the development of a mental disorder even

in the presence of healthy sleep habits, other factors associated with a mental disorder can also

affect the relationship between the mental disorder and the quality of sleep. For example, in

individuals with more severe mental disorders, such as schizophrenia or bipolar disorder, it is

difficult to understand if sleep quality is affecting the disorder and vice versa, due to factors like

medications and psychiatric episodes. Andrew Winokur, a doctor with the Psychiatric Clinics of

North America, states that there are many factors that affect studies in sleep disturbances, “in

particular related to the sleep-modulating effects of antipsychotic medications when used in the

treatment of schizoprena” (606). He also found that in patients with bipolar disorder, “the

manifestation of the specific sleep disturbance is strongly influenced by the type of mood

episode the patient is experiencing” (Winokur 606). It is important to note that some individuals

with more severe mental disorders or individuals being treated with antipsychotics may

experience suppressed or different symptoms from other similar patients. While sleep quality and

mental health are closely related, it is important to note that the side effects of certain

medications and sleep disorder symptoms may overlap, making it hard to determine the real

relationship between the two disorders.

Overall, sleep is one of the most important human functions, but with over 70

diagnosable sleep disorders and more than 50 to 80 percent of patients with a physiatric disorder

reporting chronic sleep problems, it is obvious that the negative effects of sleep and mental

health are widely felt around the world. Sleep can affect people both positively and negatively.
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When people get a healthy amount of uninterrupted sleep, they are refreshed, rejuvenated, and

overall happier; however, when people get little to no sleep, or are interrupted throughout the

night, mental illnesses, irritability, and overall tiredness has an adverse effect on people's

everyday lives. By recognizing the relationship between sleep and mental health, society can

begin to take the first step in improving the lives of those suffering with both mental illnesses

and sleep disorders. The key to a healthier, happier life may just be in your sleep habits.
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Works Cited

Del Rio João, et al. “Sleep Quality Components and Mental Health: Study with a Non-Clinical

Population.” ​Psychiatry Research​, vol. 269, Nov. 2018, pp. 244–250. ​EBSCOhost​,

doi:10.1016/j.psychres.2018.08.020. Accessed 26 Feb. 2020.

England, Mary Jane, et al. “Blueprint for Change: Research on Child and Adolescent Mental

Health.” ​National Institute of Mental Health​, U.S. Department of Health and Human

Services, 2001,

www.nimh.nih.gov/about/advisory-boards-and-groups/namhc/reports/blueprint-for-chang

e-research-on-child-and-adolescent-mental-health.shtml#ch-ii-b-2. Accessed 28 Feb.

2020.

Freeman, Daniel, et al. “The Effects Of Improving Sleep On Mental Health (OASIS): A

Randomised Controlled Trial With Meditation Analysis.” ​The Lancet Psychiatry,​ vol. 4,

no. 10, 2017, pp. 749-758. Accessed 28 Feb. 2020.

Harvard Health Publishing. “Sleep and Mental Health.” ​Harvard Health​, 18 Mar. 2019,

www.health.harvard.edu/newsletter_article/sleep-and-mental-health. Accessed 29 Feb.

2020.

Konnikova, Maria. “The Work We Do While We Sleep.” ​The New Yorker,​ 8 Jul. 2015,

www.newyorker.com/science/maria-konnikova/why-we-sleep. Accessed 28 Feb. 2020.

Milojevich, Helen M, and Angela F Lukowski. “Sleep and Mental Health in Undergraduate

Students with Generally Healthy Sleep Habits.” ​PloS one​ vol. 11, no. 6, e0156372. 9

Jun. 2016, doi:10.1371/journal.pone.0156372. Accessed 29 Feb. 2020.

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University of Michigan. “Ten Things You Can Do for Your Mental Health.” ​University of

Michigan: University Health Service,​ ​www.uhs.umich.edu/tenthings​. Accessed 02 Apr.

2020.

Winokur, Andrew, and Jayesh Kamath. ​Sleep Disorders and Mental Health: An Issue of

Psychiatric Clinics of North America​, Elsevier, vol. 38, no. 4, 2015. Accessed 28 Feb.

2020.

Woodland, Satu. “Cognitive Behavioral Therapy for ADHD.” ​Cognitive Behavioral Therapy for

ADHD: Hope Mental Health: Psychiatric Mental Health Specialists,​

www.hopementalhealth.com/blog/cognitive-behavioral-therapy-improves-adhd-scores​.

Accessed 02 Apr. 2020.