Though medical science has known for some time that sleep disorders and mental illness are linked, we shouldn’t jump to the conclusion that one simply causes the other, says Imran Khawaja, M.D., a UT Southwestern Associate Professor of Psychiatry and of Neurology & Neurotherapeutics. In fact, he notes, both of these problems often are different aspects of the same treatable condition.
“Changes in natural sleep patterns can lead to several types of sleep disorders,” Dr. Khawaja says. “And as we’ve seen in numerous studies, sleep disorders are highly likely to appear in several forms of mental illness. It’s a circular relationship that can make treatment challenging – but not impossible.”
Sleep Disorders and Mental Illness – A Quick Look
Depression and Insomnia
People with insomnia are twice as likely to develop depression as those who don’t have sleep disorders. “Insomnia gives us a clue that a person is at high risk for becoming depressed,” Dr. Khawaja says. “If we can treat the insomnia, we may be able to prevent a patient from being depressed.”
Schizophrenia and Sleep Disorders
Disturbances in sleep patterns are present in as many as 80 percent of people with schizophrenia. Common sleep problems in people with schizophrenia include:
- Taking longer to fall asleep
- Not getting enough sleep
- Waking frequently during sleep
- Sleep apnea
Bipolar Disorder and Sleep Disorders
Up to 80-90 percent of people with bipolar disorder have some type of sleep disturbance or insomnia before a manic episode. “Many patients who are experiencing a manic episode don’t feel like they need to sleep,” Dr. Khawaja says. “But without proper treatment for the sleep disorder, that patient is going to have a manic episode or a psychotic break sooner or later.”
Post-traumatic Stress Disorder and Sleep Disorders
In one study, soldiers who had sleep disorders before they were deployed to Iraq were more likely to have PTSD when they returned home. “People who have trouble sleeping are more likely to develop PTSD – as well as other mental illnesses, potentially – when they’re placed in stressful situations,” Dr. Khawaja says.
First Things First
Treating sleep disorders involves getting a detailed sleep history from patients, according to Dr. Khawaja. That means delineating what’s happening at night as well as what patients are doing during the day. “Do they drink a lot of caffeinated beverages? Do they drink alcohol? How stressed are they? What time do they have to go to work or school? Once we’ve established a patient’s normal routine and what we think is going wrong, we can talk about solutions,” Dr. Khawaja says.
Light Therapy to Improve Sleep and Mental Health
Light exposure plays a large role in regulating sleep patterns, Dr. Khawaja notes. “I use bright-light therapy for patients who have delayed sleep phase syndrome or ‘night owl syndrome,’” he says. The therapy involves exposure to bright light early in the day, which reinforces signals to the brain that it’s time to be awake and active during daytime.
It also helps to minimize exposure to light in the evenings, he adds. This helps signal the brain that it’s time to start winding down and prepare for sleep.
Researchers have found that light in the blue area of the visible light spectrum has the most negative effects on sleep patterns. This could be because blue light is some of the brightest light, but it also happens to be the type of light given off by TVs, computers, smartphones, and tablets, Dr. Khawaja notes.
“With our evening work habits, as well as evenings spent watching TV or using computers, we’re exposed to more blue light later in the day than ever before,” he says. “That’s why we recommend that people reduce or eliminate their exposure to sources of blue light in the evening and nighttime hours.”
Supplements and Medications for Better Sleep
Some patients find relief from sleep disorders by taking a melatonin supplement in the evening to jump-start the brain’s release of the chemical melatonin, which prepares the body for sleep, Dr. Khawaja says. However, he notes, it’s important for patients to take the supplement according to their normal sleep patterns. “Taking melatonin too early or too late can throw the sleep patterns further out of alignment,” he says.
Some patients do well with antidepressant medications that are also sedatives that help them fall asleep at night, he adds. But medications alone are not always the answer, he cautions. “Some depression medications can cause weight gain. If a patient has gained weight and is snoring during sleep, we will examine the patient for sleep apnea,” Dr. Khawaja says. “If we don’t address the sleep apnea, the patient likely is going to stay sleepy and continue to have problems with depression.”
Sleep’s powerful effects on mental health can’t be ignored, he adds. “With the right treatment plan, we can help patients find peace of mind – along with a peaceful night’s sleep.”
UT Southwestern physicians can help patients who are having trouble sleeping, who have some form of mental illness, or both. To schedule an appointment, call 214-645-8300.