Associations between and sleep disorders and mental health

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25 Oct Associations between and sleep disorders and mental health

Posted at 06:16h in Blog by admin

The association between mental health and the presence of a sleep disorder has been well established, though widely undervalued. With an estimated 1 in 5 Australians aged 18-65 experiencing a mental health disorder in 2020-20211, understanding the aetiology and confounding variables of a mental health disorder can motivate the patient to make benevolent changes in their cognitive, emotional, and social lives. Sleep impairment is highly prevalent amongst the general population; a meta-analysis of several hundred epidemiological studies concluded:

 

  • Approximately 1/3 of the general population experience symptoms of insomnia2.
  • 4-26% of the general population experience excessive daytime sleepiness2.
  • 2-4% of the general population have obstructive sleep apnoea2.

 

The effect of a lack of sleep or an untreated sleep disorder on mental health and cognitive ability is well documented. The relationships between sleep disorders and mental health are bidirectional, with many sleep disorders classified as co-morbid or a secondary health condition in a range of mental health and psychiatric illnesses listed in the DSM-5 (Diagnostic and Statistics Manual of Disorders, 5th Edition). For example, individuals with insomnia are 10-17 times more likely to experience clinically significant levels of depression and anxiety than those without2. Similar associations and relationships are seen across several mental health disorders:

 

  • Chronic insomnia is estimated to affect more than 40% of individuals with schizophrenia spectrum disorders3.
  • High prevalence of sleep disorders (obstructive sleep apnoea; 25-30%, restless-leg syndrome; approximately 44%) in children with ADHD4.
  • Significant associations between insomnia and suicide ideation5.
  • Strong correlations between PTSD and obstructive sleep apnoea (40-90% of patients), limb movement disorders (approximately 33% of patients), and insomnia symptoms (approximately 70% of patients)6.
  • Sleep aberrations in individuals with bipolar disorders, both in manic (66-99% experience hypersomnia) and depressive (40-100% experience insomnia; 23-78% experience hypersomnia)7.

 

With proper treatment of sleep disorders, many of the symptoms of mental health may lessen, due to the bi-directional relationship these conditions have. A meta-analysis of 65 randomised-controlled trials showed that improving sleep led to a significant medium-sized effect on composite mental health, depression, anxiety and rumination3. For this reason, the successful and ongoing treatment of a sleep disorder such as obstructive sleep, restless leg and insomnia could improve the quality of life, improve physical health, and potentially prevent any further intervention for individuals with mental health disorders.

Author: Alex Bruce (BSci), Sleep Technician/CPAP educator

References:

[1] Australian Institute of Health and Welfare. Mental Health: Prevalence and impact. AIHW, November (2022).;

[2] Scott AJ, Webb TL, Martyn-ST James M, Rowse G, Weich S. Improving sleep quality leads to better mental health: A meta-analysis of randomised controlled trials. Sleep Medicine Reviews, 2021. 60 (101556). DOI: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8651630/;

[3] Taylor JD, Lichstein KL, Durrence HH, Reidel BW, Bush AJ. Epidemiology of insomnia depression, and anxiety. Sleep, 2005. 11 (Pg. 1457-1464). DOI: https://doi.org/10.1093/sleep/28.11.1457;

[4] ter Heege FM, Mijnster, T, van Veen MM. et al. The clinical relevance of early identification and treatment of sleep disorders in mental health care: protocol of a randomized control trial. BMC Psychiatry. 2020. 20 (331). DOI: https://doi.org/10.1186/s12888-020-02737-3;

[5] Hvolby A. Associations of sleep disturbance with ADHD: implications for treatment. Attention Deficits and Hyperactivity Disorders, 2014. 7, 1 (Pg. 1-18). DOI: 10.1007/s12402-014-0151-0;

[6] Harris LM., Huang X, Linthicum KP, Bryen CP, Ribeiro JD. Sleep disturbances as risk factors for suicidal thoughts and behaviours: a meta-analysis of longitudinal studies. Scientific Reports, 2020. 10 (13888). DOI: https://doi.org/10.1038/s41598-020-70866-6;

[7] Lancel M, van Marle HJF, Van Veen MM, van Schagen AM. Disturbed Sleep in PTSD: Thinking Beyond Nightmares. Front. Psychiatry, 2021. 12 (767760). https://doi.org/10.3389/fpsyt.2021.767760;

[8] Steardo L Jr, Filippis R, Carbone EA, Segura-Garcia C, Verkhratsky A, De Fazio P. Sleep Disturbance in Bipolar Disorder: Neuroglia and Circadian Rhythm. Front. Psychiatry, 2019. 10 (501). DOI: https://doi.org/10.3389/fpsyt.2019.00501

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