By David Joel Miller.
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 backwards? 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 the 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?
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For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at Recommended Books