ABSTRACT

Sleep disorders and mental health conditions often coexist, with a complex and bidirectional relationship between the two. This research aims to examine the impact of sleep disturbances on mental health outcomes and explore the efficacy of sleep-focused interventions in managing psychiatric conditions. A comprehensive review of the literature will be conducted to analyze existing research studies, clinical trials, and meta-analyses. The results will shed light on the relationship between sleep disturbances and mental health by outlining the mechanisms underlying it. In addition, this study will assess how well pharmaceutical therapies and other sleep-focused interventions, such as cognitive-behavioral therapy for insomnia, work to improve the mental health of people with psychiatric disorders.

Keywords:

Sleep disorders, mental health, cognitive-behavioral therapy, psychiatric disorders.

Introduction

Sleep disorders and mental health are two interconnected domains that have been extensively studied in recent years. Sleep disturbances, such as insomnia, sleep apnea, and circadian rhythm disorders are prevalent among individuals with psychiatric disorders, and conversely, mental health conditions can significantly impact sleep quality and duration. This bidirectional relationship between sleep disorders and mental health has garnered increasing attention from researchers, clinicians, and policymakers alike.¹

Numerous epidemiological studies have shown that psychiatric problems and sleep difficulties frequently co-occur. For instance, people with schizophrenia frequently have disturbed sleep patterns, which include increased waking up during the night, shorter overall slumber time, and greater sleep latency. Sleep and rest-activity-rhythm (RAR) disturbances are frequently documented in people with schizophrenia spectrum disorder (SSD). However, there is a paucity of detailed characterization of sleep/RAR abnormalities in SSD, including individuals in various treatment settings, as well as the link between these alterations and SSD clinical aspects (e.g., negative symptoms).² In addition, long-term research has shown that insomnia increases the chance of developing depressive symptoms, with higher rates of depression seen in people with chronic insomnia.³ Rapid eye movement (REM) sleep disruptions have also been found as potential diagnostic indicators for depression, with decreased REM latency and increased REM density being frequently seen in depressed people.⁴

Sleep problems have an effect on outcomes related to mental health that goes beyond the intensity of the symptoms or likelihood of onset. According to Grandner et al. (2010), cardiovascular diseases, metabolic disorders, and higher death rates have all been linked to sleep loss and insufficient sleep.⁵

Sex-specific associations have also been reported in previous studies, additionally, other researchers have found sex-specific correlations between sleep duration and all-cause mortality. Previous research has found inconsistencies in sex-specific correlations, with men having a higher risk of all-cause mortality for short sleep duration and women having a higher risk for lengthy sleep duration.

Therefore, it is essential to comprehend how sleep affects mental health to handle mental health issues as well as to advance general wellbeing.⁶

Even though the connection between sleep disturbances and mental health is becoming more widely acknowledged, there is still a need to investigate efficient interventions and treatment modalities. The standard treatment for psychiatric and sleep disorders has traditionally been medication; however, long-term use of these medications may result in negative effects. Non-pharmacological approaches have shown promise in enhancing results for both sleep and mental health.⁷ These strategies include cognitive-behavioral therapy for insomnia (CBT-I) and other sleep-focused therapies.

CBT-I is a multifaceted approach that includes sleep education, behavioral interventions such as bedtime restriction and stimuli management, relaxation, and cognitive therapy (Figure 1). In patients with insomnia without psychiatric comorbidities, CBT-I is extremely successful in improving self-rated insomnia severity as well as various other sleep characteristics such as sleep start latency and wake time following sleep onset, including daytime symptoms. CBT-I is also practical and successful when given via the Internet.⁸ Other therapies include acupuncture, music therapy, bright-light therapy, and yoga.

This study explores the influence of sleep disturbances on psychiatric illnesses and the effectiveness of sleep-focused therapies in controlling the outcomes of mental health, with the goal of examining the bidirectional relationship between sleep problems and mental health. Researchers and medical practitioners can build focused interventions and treatment plans that improve both sleep and mental health by having a better knowledge of this intricate interaction. Improved sleep health and mental health outcomes can be attained by thorough examination and evidence-based practices, improving the overall quality of life for those with sleep disorders and psychiatric diseases.

Discussion

Sleep and mental health are closely intertwined, with a bidirectional relationship that has been increasingly recognized in recent years. Sleep disturbances, including insomnia, sleep apnea, and circadian rhythm disorders, are common among individuals with psychiatric disorders. Likewise, mental health conditions such as depression, anxiety, bipolar disorder, and schizophrenia can significantly impact sleep patterns. Understanding the interplay between sleep and mental health is crucial for developing effective treatment strategies.⁹

The impact of sleep disorders on mental health outcomes

Numerous studies have demonstrated a strong association between sleep disturbances and adverse mental health outcomes. Sleep disorders can exacerbate existing psychiatric conditions, increase the risk of developing new mental health disorders, and contribute to the persistence and severity of symptoms. Sleep deprivation and poor sleep quality have been linked to cognitive impairment, emotional dysregulation, decreased quality of life, and an increased risk of psychiatric relapse. Understanding the specific mechanisms through which sleep disturbances affect mental health outcomes will provide valuable insights into potential intervention targets.^1,3,5

Figure 1. Frequency of TMD among study participants.

The bidirectional relationship between sleep and mental health

The relationship between sleep and mental health is bidirectional, with mental health conditions influencing sleep patterns and sleep disturbances exacerbating psychiatric symptoms. For instance, individuals with depression often experience insomnia, hypersomnia, or abnormal sleep architecture. Similarly, anxiety disorders can lead to difficulties falling asleep, staying asleep, or experiencing nightmares, in addition, migraines and headaches can occur.¹⁰ The underlying mechanisms for this bidirectional relationship include dysregulation of neurotransmitters, alterations in stress response systems, and disruptions in the circadian rhythm. Investigating these mechanisms will enhance our understanding of the complex interplay between sleep and mental health.¹¹

In bipolar disorder, disturbances in sleep patterns are a hallmark feature, with individuals experiencing episodes of insomnia and hypersomnia during different phases of the disorder. Disrupted sleep-wake cycles have been implicated in the onset of manic and depressive episodes in bipolar disorder.¹²

Schizophrenia, a severe mental illness characterized by psychotic symptoms, is also associated with significant sleep disturbances. Individuals with schizophrenia often exhibit irregular sleep patterns, reduced sleep efficiency, and abnormal sleep architecture. Sleep disturbances in schizophrenia have been linked to worsened cognitive functioning, increased symptom severity, and a poorer prognosis.¹²

Efficacy of sleep-focused interventions in managing psychiatric conditions

Sleep-related interventions have shown promise in enhancing outcomes for mental health. Numerous studies have shown that the non-pharmacological treatment method CBT-I is successful in lowering the symptoms of insomnia and easing related psychiatric problems. CBT-I is an effective long-term management technique for sleep-related symptoms in psychiatric illnesses since it has demonstrated maintained effects even after treatment cessation.⁷

Bright light treatment (BLT) is another sleep-related technique that is attracting interest. BLT involves being exposed to bright light, usually in the morning, to control circadian rhythms and increase alertness. Seasonal affective disorder, a form of depression characterized by seasonal rhythms, has proven effective in its therapy.¹³ In addition, recent research reveals that BLT may improve sleep characteristics in a variety of psychiatric illnesses, such as bipolar disorder and major depressive disorder. It is currently unclear exactly how BLT affects sleep and mood regulation, but modulatory effects of light on melatonin secretion and circadian rhythms are probably involved.¹⁴

Yoga, mindfulness-based therapies, and sleep hygiene instruction are further sleep-focused interventions that have shown potential in addressing mental problems. Meditation and body awareness practices are used in mindfulness-based interventions, such as mindfulness-based stress reduction, to promote present-moment awareness and lessen stress. These therapies have been shown to improve mental health outcomes and sleep quality, especially in people who struggle with anxiety and depression.¹⁵ Similar results have been reported for yoga practices, which incorporate physical postures, breathing techniques, and meditation. These practices have also been linked to better sleep patterns and diminished symptoms of anxiety and sadness. Sleep hygiene education, which involves promoting healthy sleep habits and behaviors, is often included as a component of sleep-focused interventions and can contribute to improved sleep quality in individuals with psychiatric conditions.¹⁶

However, the effectiveness and potential side effects of these interventions need to be carefully evaluated.

Conclusion

The bidirectional relationship between sleep disorders and mental health has significant implications for clinical practice and patient care. The purpose of this research is to inform clinicians, researchers, and policy makers about the importance of addressing sleep disturbances in mental health management and help develop evidence-based interventions to improve patient outcomes. Healthcare practitioners can offer patients with psychiatric diseases more thorough and holistic care by recognizing and treating the relationship between sleep and mental health.

Acknowledgement

None.

List of Abbreviations

Conflicts of interest

None to declare.

Grant support and financial disclosure

None to disclose.

Ethical approval

Not applicable.

Authors’ contributions

MA: Concept and design of the study and drafted the manuscript

UV: Critical revision of the manuscript

All Authors: Approval of the final version of the manuscript to be published.

Authors’ Details

Mohammad Ali¹, Urbah Viqar²

1. House Officer, Dr. Akbar Niazi Teaching Hospital, Islamabad, Pakistan
2. Clinical Fellow Psychiatry, Addiction Recovery Community Hillingdon (ARCH), London, UK

References

1. Guidi J, Fava GA. Sequential combination of pharmacotherapy and psychotherapy in major depressive disorder: a systematic review and meta-analysis. JAMA Psychiatry. 2021;78(3):261–9. https://doi.org/10.1001/jamapsychiatry.2020.3650
2. Mayeli A, LaGoy AD, Smagula SF, Wilson JD, Zarbo C, Rocchetti M, et al. Shared and distinct abnormalities in sleep-wake patterns and their relationship with the negative symptoms of schizophrenia spectrum disorder patients. Mol Psychiatry. 2023;28(4):2049–57. https://doi.org/10.1038/s41380-023-02050-x
3. Hertenstein E, Benz F, Schneider CL, Baglioni C. Insomnia - a risk factor for mental disorders. J Sleep Res. 2023;32(6):e13930. https://doi.org/10.1111/jsr.13930
4. Wu YY, Chang ET, Yang YC, Chen SF, Hsu CY, Shen YC. Risk of obstructive sleep apnea in patients with schizophrenia: a nationwide population-based cohort study. Soc Psychiatry Psychiatr Epidemiol. 2020;55(11):1671–77. https://doi.org/10.1007/s00127-020-01870-4
5. Grandner MA, Jackson NJ, Pak VM, Gehrman PR. Sleep disturbance is associated with cardiovascular and metabolic disorders. J Sleep Res. 2012;21(4):427–33. https://doi.org/10.1111/j.1365-2869.2011.00990.x
6. Svensson T, Saito E, Svensson AK, Melander O, Orho-Melander M, Mimura M, et al. Association of sleep duration with all- and major-cause mortality among adults in Japan, China, Singapore, and Korea. JAMA Netw Open. 2021;4(9):e2122837. https://doi.org/10.1001/jamanetworkopen.2021.22837
7. Samara MT, Huhn M, Chiocchia V, Schneider‐Thoma J, Wiegand M, Salanti G, et al. Efficacy, acceptability, and tolerability of all available treatments for insomnia in the elderly: a systematic review and network meta‐analysis. Acta Psychiatr Scand. 2020;142(1):6–17. https://doi.org/10.1111/acps.13201
8. Hertenstein E, Trinca E, Wunderlin M, Schneider CL, Züst MA, Fehér KD, et al. Cognitive behavioral therapy for insomnia in patients with mental disorders and comorbid insomnia: a systematic review and meta-analysis. Sleep Med Rev. 2022;62:101597. https://doi.org/10.1016/j.smrv.2022.101597
9. Streamlining cognitive behavioral therapy for chronic insomnia. Tokyo, Japan: University of Tokyo; 2024. Available from: https://medicalxpress.com/news/2024-01-cognitive-behavioral-therapy-chronic-insomnia.html
10. Merrill RM. Mental health conditions according to stress and sleep disorders. Int J Environ Res Public Health. 2022;19(13):7957. https://doi.org/10.3390/ijerph19137957
11. Chattu VK, Manzar MD, Kumary S, Burman D, Spence DW, Pandi-Perumal SR. The global problem of insufficient sleep and its serious public health implications. Healthcare (Basel). 2018;7(1):1–9. https://doi.org/10.3390/healthcare7010001
12. Matthew JB, John AT, Nicholas BA. Mechanisms underlying the association between insomnia, anxiety, and depression in adolescence: implications for behavioral sleep interventions. Clin Psychol Rev. 2018;63(2):25–40. https://doi.org/10.1016/j.cpr.2018.05.006
13. Meyer N, Faulkner SM, McCutcheon RA, Pillinger T, Dijk DJ, MacCabe JH. Sleep and circadian rhythm disturbance in remitted schizophrenia and bipolar disorder: a systematic review and meta-analysis. Schizophr Bull. 2020;46(5):1126–43. https://doi.org/10.1093/schbul/sbaa024
14. Blume C, Garbazza C, Spitschan M. Effects of light on human circadian rhythms, sleep and mood. Somnologie (Berl). 2019;23(3):147–56. https://doi.org/10.1007/s11818-019-00215-x
15. Pjrek E, Friedrich ME, Cambioli L, Dold M, Jäger F, Komorowski A, et al. The efficacy of light therapy in the treatment of seasonal affective disorder: a meta-analysis of randomized controlled trials. Psychother Psychosom. 2020;89(1):17–24. https://doi.org/10.1159/0005028912
16. Chan SH, Lui D, Chan H, Sum K, Cheung A, Yip H, et al. Effects of mindfulness-based intervention programs on sleep among people with common mental disorders: a systematic review and meta-analysis. World J Psychiatry. 2022;12(4):636–50. https://doi.org/10.5498/wjp.v12.i4.636
17. Baranwal N, Phoebe KY, Siegel NS. Sleep physiology, pathophysiology, and sleep hygiene. Prog Cardiovasc Dis. 2023;77(1):59–69. https://doi.org/10.1016/j.pcad.2023.02.005