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Submitted by PatientsEngage on 21 April 2020

Sleep disorders may make a person more vulnerable to psychiatric illnesses, intensify the severity of the symptoms points out Dr Nileena N.K.M, Specialist in Psychiatry and Sleep Medicine, and stresses the importance of better sleep for better life. Plus Tips For Good Sleep.

What is the correlation between mental health and sleep?

Sleep and mental health go very much hand in hand in our day to day life. Many of the psychiatric illnesses are seen to be associated with sleep complaints and primary sleep disorders are seen to trigger or, at the least, complicate existing psychiatric illnesses. Aside from psychiatric disorders, a good sleep health is often seen to contribute to regular mental make-up. In other words, sleep health and mental health have a bidirectional relationship. It is crucial that everybody is aware about this fact as this overlap can complicate both the diagnosis and treatment of sleep and psychiatric disorders.

Can sleep deprivation give rise to serious long-term psychiatric disorders?

It is an undeniable fact that psychiatric symptoms and disorders are over-represented in people with poor sleep. At times, it is difficult to establish which came first-the psychiatric illness or the sleep disorder. However, studies conducted over a period of time have shown that patients with persistent sleep disturbances have later on developed psychiatric illnesses. Sleep disorders maybe associated with disruption in sleep quantity or quality. In contrast to popular belief, hypersomnia or excessive sleep can also be associated with psychiatric conditions. Both acute and chronic sleep disturbances can be associated with poor mental health. The basic mechanism behind this phenomenon is yet to be understood, but studies so far show that poor sleep disturbs the emotional and mental fabric leading to enhanced negativity. But does it mean that sleep disturbance can lead to mental illness? The existing data suggests that co-existing sleep disorders may make a person more vulnerable to psychiatric illnesses, intensify the severity of the symptoms and further worsen the prognosis.

Which psychological disorders in particular are linked to sleep problems?

Sleep related complaints are so common in psychiatric illnesses that they have become a crucial part of diagnostic criteria of certain illnesses. The most common diagnoses associated with sleep disturbances would be mood disorders (like major depressive disorder, bipolar affective disorder), anxiety disorders (like generalised anxiety disorder, post-traumatic stress disorder), schizophrenia, substance related disorders (alcoholism).

What per cent of patients with psychiatric conditions are affected by chronic sleep conditions?

Elucidating the proportion of patients with sleep problems in each psychiatric diagnosis might be a cumbersome process. However, knowing the prevalence of sleep problems in common psychiatric conditions can help us understand the gravity of the situation.

  • It is seen that sleep disturbances can be present in almost 90% of patients with major depressive disorder.
  • Almost 69-99% of patients with bipolar affective disorder (BPAD) have expressed lessened need for sleep while hypersomnia maybe seen in a minority of patients withBPAD.
  • Studies have estimated that about 60% to 70% of patients with generalised anxiety disorder (GAD) have insomnia complaints.
  • It has been estimated that up to 96% of PTSD complained of insomnia and 83% reported nightmares.
  • Disturbed sleep can be found in 30-80% of patients with schizophrenia.

Again, a significant portion of patients have symptoms suggesting obstructive sleep apneaand restless leg syndrome. Sleep disturbances in the form of insomnia are also prevalent up to 36–72% in patients with alcohol dependence and/or abuse.

Sleep disturbances are common among people with bipolar disorder. Can it also trigger the onset of manic or hypomanic episodes?

Sleep disturbances are common in BPAD. Some of the patients seem to have sleep complaints even between the episodes of mania/depression. Sleep loss is seen to trigger manic episodes especially in female gender and bipolar disorder type I. Sleep loss can also trigger depressive symptoms as well but to a lesser extent.

Children with ADHD (Attention-deficit hyperactivity disorder) experience a number of sleep-related problems. Is there any effective treatment to improve sleep and reduce symptoms?

Various sleep disorders like sleep-disordered breathing, restless leg syndrome, circadian rhythm sleep disorder, insomnia, and narcolepsy are seen in patients with ADHD, but often overlooked. Prevalence of sleep problems in individuals with ADHD may be as high as 25-50%. This may be due to the disease itself, medications, difficulty following a regular routine, co-existent psychiatric conditions like depression or anxiety, or any substance abuse. Various studies have shown that concomitant sleep disorders will significantly decrease the efficacy of an intervention targeting ADHD symptoms. Hence, it is imperative that the individual is screened and treated for sleep complaints if present. Following a strict daily routine and sleep hygiene cannot be emphasized enough. Medication maybe modified with respect to timing or even changed to suit the patient better.

What sleep disturbances are characteristic of individuals with major depressive disorder?

The link between the two is so vital that a diagnosis of depression without sleep complaints is said to be made with caution. Insomnia maybe present in three quarters of patients with depression, while hypersomnia is observed in about 40% of young depressed adults. Apart from these sleep disorders like obstructive sleep apnea, restless legs syndrome, periodic limb movement, or REM sleep behaviour disorder, may arise or worsen with certain antidepressant medications.

Can sleep apnea exacerbate the symptoms of many psychiatric conditions?

Many are not even aware of the disease entity - obstructive sleep apnea (OSA). It is a part of the umbrella diagnosis of sleep disordered breathing. It is characterized by repeated episodes of upper airway obstruction during sleep. The main symptoms include snoring, choking episodes, sleep fragmentation, daytime sleepiness and mental cognitive disturbances. Many studies reveal the strong association between OSAand psychiatric conditions. OSA itself may manifest with mood disturbances, irritability, cognitive disturbances, daytime drowsiness which are common in mental illnesses. Studies do not yet conclusively say whether OSA causes mental illness but it definitely increases the susceptibility or worsen the prognosis of existing mental Illness. So a holistic approach is crucial.

What is sleep anxiety?

Sleep anxiety, sleep dread or bed anxiety is commonly seen among people with insomnia. People having chronic insomnia may become restless and anxious as they approach bedtime. They start worrying about not falling asleep and not getting enough sleep. As part of maladaptive behaviours

  • They may go to bed early
  • Keep on tossing turning and worrying about their insomnia.
  • When in bed they might become ‘hyper-alert’ to all the sensory stimuli (sounds and lights)around them.
  • They might overestimate the time they actually lay awake- sleep state misperception

This will worsen their insomnia and becomes a vicious cycle

Can treating sleep disorder help alleviate symptoms of mental health problems?

Treatment of any mental illness requires a holistic approach of which treatment of the sleep disorder is an important part. Addressal of sleep issues not only alleviates the current symptoms but has shown to improve long term prognosis as well.

What are the new advancements in sleep technology and medicine?

Sleep medicine is a novel yet rapidly evolving medical specialty which saw its origin around the middle of the 20th century. The awareness about sleep medicine or sleep disorders is pretty abysmal even among the medical personnel. However, the necessity of management of sleep complaints, be it primary or secondary to other diseases or medication, cannot be emphasized enough. The general population is always sceptical when it comes to hypnotics. However, there is a wide variety of hypnotics present and proper guidelines available for management of sleep disorders involving maximum effect and minimal adverse effects. Various advancements have been made with regards to polysomnography studies and the procedure as such has become less cumbersome. Positive airway pressure (PAP) therapy remains the gold standard treatment for sleep apnoea. Compliance to PAP therapy has always been a major issue. Various technical modifications have been made to make the therapy more comfortable, portable and customised to the individual

Could you give five tips and ideas on how to help get good sleep?

Sleep hygiene is the core of sleep health. Here are some tips one could include in their life to get better sleep.

  1. Have a fixed sleep schedule. Let us not confuse our biological clock by sleeping and/or waking up at different times (including weekends)
  2. Give yourself at least 30 min to relax before bedtime. One can do it by reading, listening to music, meditation, deep breathing, etc. or anything that calms them. However, alcohol or cigarette/tobacco are not included in healthy relaxation techniques.
  3. Bedroom should be quiet, cool and dark
  4. Avoid late dinner, exercise, late coffee/ tea, TV or other light emitting gadgets.
  5. Bed is meant to sleep and not for reading, exercising, working, etc.

In conclusion, let us take an oath to live up to the sloganof World sleep day 2020 - Better Sleep, Better Life, Better Planet.

(Dr.Nileena N.K.M. is Associate Consultant at Nithra Institute of Sleep Sciences, Chennai)