Mental illness and sleep: A two way street

I know when I'm feeling anxious about something—be it work or a family matter—I find it hard to fall asleep at night. A friend has mentioned that when she's feeling a lot of stress, she can fall asleep fine but will wake up in the middle of the night and not be able to get to sleep. So it's not surprising that mental health disorders more serious than the standard anxiety that sometimes comes with everyday life can disrupt sleep, too. Here's what Improving Sleep: A guide to a good night's rest, a Special Health Report from Harvard Medical School, says about this subject:

Almost all people with anxiety disorders have trouble falling asleep and staying asleep. In turn, not being able to sleep may become a focus of some sufferers' ongoing fear and tension, causing further sleep loss.

General anxiety. Severe anxiety, formally known as generalized anxiety disorder, is a mental illness characterized by persistent, nagging feelings of worry, apprehension, or uneasiness. These feelings are either unusually intense or out of proportion to the real troubles and dangers of the person's everyday life. People with the disorder typically experience excessive, persistent worry every day or almost every day for a period of six months or more. Common symptoms include trouble falling asleep, trouble staying asleep, and not feeling rested after sleep.

Phobias and panic attacks. Phobias, which are intense fears related to a specific object or situation, rarely cause sleep problems unless the phobia is itself sleep-related (such as fear of nightmares or of the bedroom). Panic attacks, on the other hand, often strike at night. In many phobias and panic disorders, recognizing and treating the underlying problem — often with an anti-anxiety medication — may solve the sleep disturbance.

Depression. Because almost 90% of people with serious depression experience insomnia, a physician evaluating a person with insomnia will consider depression as a possible cause. Waking up too early in the morning is a hallmark of depression, and some depressed people have difficulty falling asleep or get fitful sleep throughout the whole night. In chronic, low-grade depression, insomnia or sleepiness may be the most prominent symptom. 

Bipolar disorder. Disturbed sleep is a prominent feature of bipolar disorder (manic-depressive illness). Sleep loss may exacerbate or induce manic symptoms or temporarily alleviate depression. During a manic episode, a person may not sleep at all for several days. Such occurrences are often followed by a "crash" during which the person spends most of the next few days in bed.

Schizophrenia. Some people with schizophrenia sleep very little when they enter an acute phase of their illness. Between episodes, their sleep patterns are likely to improve, although many schizophrenics rarely obtain a normal amount of deep sleep.

Julie K. Silver, M.D., is an assistant professor in the Department of Physical Medicine and Rehabilitation at Harvard Medical School. She is also the Chief Editor of Books for Harvard Health Publications.

Need better sleep? Learn how to get it with Improving Sleep: A guide to a good night's rest. This special report from Harvard Medical School describes the factors that can disturb sleep, the latest in sleep research, and, most importantly, what you can do to get a good night's sleep. It also includes in-depth information on sleep disorders, including restless legs syndrome, narcolepsy, and sleep apnea.

Are you Living With Insomnia? Connect with others with similar health concerns and issues. Click here to join the group.

This content is not intended to substitute for personalized medical advice, diagnosis, or treatment from your healthcare provider. Read our full disclaimer.