Sleep-A Key to Mental Wellness

When did it become a bragging right to say that you only get 4 or 5 hours of sleep a night? We would think it is ridiculous for someone to brag that their labs came back with only half the normal hemoglobin level as we would recognize that as clearly unhealthy. So when did we start equating sleep-deprivation with some kind of superpower? Does it make sense for our society to celebrate sleep- deprivation?

Just because we have 24/7 access to light and technology does not mean our brains and body should be awake all of these hours. I am sure that when Edison patented the light bulb his goal was not to create a society of sleep-deprived zombies.  Perhaps society’s lack of respect for sleep is due to the fact that the function of sleep used to be such a mystery.  There is still a lot to learn about sleep, but as we learn more about sleep we are learning how critical good quality sleep, in sufficient quantity, is necessary for optimal physical and mental health.

As a psychiatrist I ask all of my patients about their sleep.  If you ask most everyone who has suffered with depression, anxiety, and bipolar disorder if they have experienced sleep disturbances during, or preceding their mood symptoms,  you will hear a resounding “yes” from the majority of these individuals.

So are sleep problems cause or effect of mood disturbances? Clearly both.  Intentionally cutting short your nightly sleep hours has been shown to precipitate mood disturbances in vulnerable individuals.  Likewise, people with an episode of depression, anxiety or mania often experience insomnia and other sleep disturbances despite their best efforts to get good sleep. Sleep disturbances and mood disturbances are clearly bidirectional.

As lack of sleep can often trigger mood disturbances I emphasize to my patients to work on their sleep hygiene. What does this mean exactly? In our modern world improving sleep hygiene means applying a little bit of self-discipline. Turning off the computer at a reasonable hour and not over-scheduling oneself is necessary for good sleep hygiene but a challenge in today’s society. 

What about sleep disturbances being an effect of a mood disturbance? As sleep disturbance is often a co-occurring symptom of depression, anxiety, and mania, sleep should be monitored in patients with a history of these mental health conditions.  Besides counseling my patients on good sleep hygiene I also counsel them on monitoring their sleep patterns. The goal in monitoring one’s sleep patterns may help a person gain insight into how their sleep patterns vary during times of mental stability and times of instability.  Gaining this insight may help a person recognize a pending psychiatric episode before it fully evolves into a psychiatric crisis.

Documenting co-occurring sleep and mood disturbances can be helpful for some patients to become more insightful into their own patterns of mental health and mental illness, but many patients get exasperated with making these self-reports part of their regular routine. Besides documenting one’s subjective experience of sleep quality can only tell us part of the story.  In fact, sleep physiologists will often report that the objective results of a sleep study of an individual often contrasts significantly from the patient’s own subjective experience of their sleep quality and quantity.

Subjective self-reports of sleep may not always be a reliable tool to use for mental health monitoring, but objective data collected during sleep can be utilized as a mental health monitoring tool. Distinct heart rate variability (HRV) patterns during sleep clearly coincide with certain mood disturbances. In fact, these HRV patterns often precede the subjective experiences of an episode of depression and other mood disturbances.  Obtaining this type of data on individuals during sleep used to only be possible while the individual was in a sleep lab or a hospital, but with technology currently available, it can be collected by individuals in their own homes.  Current technology makes it convenient to collect individual's HRV data with the use of wearable devices that are so commonly used today. Europe has recognized the utility of this technology and recently approved its use as a mental health monitoring tool. 

Monitoring for these prodromal changes in HRV patterns serves as an incredibly useful tool in managing chronic psychiatric conditions. Utilizing these HRV warnings of a pending psychiatric episode provides an alert to an individual to make behavioral changes to proactively minimize the severity of a pending psychiatric episode.  Medication changes can also be made proactively in response to early changes identified in HRV patterns.  Considering that many psychiatric medications take several weeks to have effect, these early alerts to pending mood disturbances give the opportunity for a psychiatric medication to take effect before a psychiatric crisis occurs.  Averting a psychiatric crisis is definitely preferable to reacting to a crisis.

As a psychiatrist, I will always have a role in managing psychiatric crises that occur in patients referred to me.  However, in my patients with chronic psychiatric illnesses the goal is to serve as a manager of my patient’s mental wellness rather than reactor to mental health crises.  Between coaching on sleep hygiene and recognizing early indicators of pending psychiatric episodes, sleep is clearly a key in optimizing mental health wellness.