Sleep and Mental Illness connection

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.


Child sleeping.
Photo courtesy of

Does poor sleep cause mental illness or does mental illness keep you from sleeping?

There is a huge connection between mental health issues and insomnia. This fact has been recognized for a long time and its recognition has been built into most of the diagnostic codes.

Some recent studies are making mental health professionals question if have gotten the connections right. Could be there are more connections between sleep and good mental health than we thought.

Sleep disturbances are a diagnostic feature of Major Depressive Disorder. Typical depression includes the inability to sleep. Depression with atypical features is characterized by excessive sleeping. Clients might describe this as hibernating in bed. But depression is not the only mental illness in which sleep features play a role.

Bipolar disorder requires a period of mania or hypomania for diagnosis. One key feature of the “mania spectrum” is needing less or very little sleep and being able to function on reduced sleep. I don’t recall ever reading about a “mania spectrum” but the variability of the way clients report manic-like symptoms is making me think that there is a continuum of manic symptoms just like the continuum of other disorders.

There are specific sleep disorders but as a counselor and therapist, I don’t believe I have ever been called on to work in that area. Most sleep disorders are seen as more medical problems. It is only when a lack of sleep or excessive sleep begins to affect someone’s overall mental health that we counselors get to talk with them.

One health concern has become that increasing weight, the epidemic of obesity it has been called, can cause poor sleep. So we need to wonder if inactivity, excess calories, and weight gain are harming our mental as well as our physical health.

There is also a connection between poor sleep and Posttraumatic Stress Disorder (PTSD.) Nightmares, as well as daytime intrusive memories, are considered symptoms of PTSD. We probably should observe a distinction between bad dreams and nightmares. With bad dreams, people do not awaken until the morning and may or may not have detailed memories of the dream. Sometimes others around them are aware they had a bad dream even if the dreamer is not aware.

Nightmares are much nastier creatures. They are characterized by strong negative emotions and frequent “awakenings” from the dream. People who have nightmares are much more likely to remember them because they keep waking up.

We also know that having nightmares will prolong the symptoms of PTSD. In a previous post, I wrote about the way in which nightmares play a role in maintaining PTSD symptoms. Nightmares and dreams, good or bad dreams are strongly connected to spiritual, religious, and cultural values. Some people also see nightmares as warnings about the future and as a source of intuition. Given that past experiences are a basis for dreams and that what happened in the past may happen again, dreaming about worries would seem to be a normal phenomenon.

What if we have this all backward? Could a sleep disruption be a cause of mental illness rather than a symptom or a maintenance factor?

One study of veterans of the Iraq war looked at the relationship between insomnia and PTSD. Now this is just one study so the results are preliminary and more studies may not get the same result, still, the results were surprising.

What they found was that for these veterans insomnia came BEFORE the PTSD symptoms. Insomnia 4 months after returning from deployment predicted the development of PTSD symptoms at 8 months post-deployment (Wright, Et al., 2011.) It seems likely that an increase in anxiety resulting from being in a risky situation could cause sleep disruptions and the result, much later, would be episodes of mental health problems.

Their suggestion and there was a lot more to this study was that sleep functioned as an emotional regulator. So insomnia may be both a symptom of, and a cause of, mental illness. An increase in insomnia predicted who would develop depression as much as three years later.

Good self-care, including a healthy diet, exercise, and good sleep hygiene has long been an integral part of relapse prevention in substance abuse. We are also seeing that relapse prevention is an important part of mental health recovery.

What if sleep changes could be an effective predictor of mental health relapse? In what ways might we be able to improve our sleep and thereby improve our mental health?

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

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4 thoughts on “Sleep and Mental Illness connection

  1. Pingback: PTSD or Acute Stress? | counselorssoapbox

  2. Pingback: Increase mental efficiency – Remembering people better | counselorssoapbox

  3. Hi David! *waving* I just got home from our country property and I’m exhausted! 🙂
    I’m not blogging for another week but had to check out, and respond to this post.
    As tired as I am, I will struggle to go to sleep as I have insomnia and sleep aponea. I know? the list seems endless with me 🙂
    Anyway, after a few nights of not sleeping well my whole personality changes! I obsess more and my mind races even more than normal. Seroquel puts me asleep but not for the whole night!
    I have about 4 nightmares a week. Not sure if the Seroquel causes them or if it’s just my crazy personality?
    Turning the laptop off or i will be tempted to start blogging. Lol
    Have a great New year! Paula xxx


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