Treating Insomnia Alone Doesn’t ‘Fix’ Underlying Disorder

Millions of people in the U.S. struggle to get a good night’s sleep on a regular basis.  In some cases, insomnia is caused by physical ailments, such as seasonal allergies or chronic pain.  For many others, however, sleep disturbances are directly linked to mental health problems, such as depression or anxiety.  Unfortunately, frequent or chronic insomnia not only tends to make an existing mental health disorder worse, it can also increase your risk of developing a disorder. Every year, as many as 40% of adults will suffer from insomnia at some point. It’s been estimated that as many as nine out of every 10 individuals with depression also struggle with insomnia.  Stress and / or anxiety contribute to over half of those who have difficulties sleeping. It’s no wonder that medications for sleep are some of the most frequently prescribed by physicians all over the country.  Unfortunately, they are also some of the most frequently abused by those desperate for a good night’s sleep. Insomnia caused by a mental health condition will rarely improve or go away until the disorder is properly treated.  While sleep medications can help to some degree, they won’t address or “fix” the underlying cause. Mood Disorders Mood disorders are one of the biggest culprits when it comes to insomnia.  Depression is one of most frequently diagnosed psychiatric conditions, impacting millions of individuals – from children to seniors.  While there are different types of depression, individuals diagnosed with major depressive disorder are the most likely to experience sleep disturbances. Depression With depression, insomnia may manifest in a few ways.  One of the most common is early morning wakening.  When this occurs, depressed individuals find themselves waking up much earlier than desired – and then unable to go back to sleep.  If your alarm is set for 6 a.m. and you wake up at 4:30 or 5, it’s going to be difficult getting through the day due to insufficient sleep.  Difficulty falling asleep, waking up multiple times throughout the night, and tossing and turning are other ways in which insomnia impacts individuals with depression. When insomnia is a prominent symptom of major depression, it makes other symptoms worse.  When you’re depressed, you’re ability to cope is already limited.  It’s difficult to think clearly, concentrate and make even simple decisions.  Your energy and motivation are already lagging.  Feelings of hopelessness and worthlessness are often present.  Suicidal thoughts may creep in at times.  Add insomnia to the mix, and each of these things – which are troubling enough already – become even more pronounced. Bipolar Disorder Bipolar disorder is another serious mental health condition that can trigger significant insomnia and other serious sleep disturbances.  Bipolar disorder typically involves alternative mood episodes, including major depression and mania or hypomania.  Some individuals with bipolar disorder may also experience “mixed” mood episodes that include both depressive and manic symptoms at the same time.  These mood episodes can last several days to a few weeks. During a period of depression, the sleep disturbances in bipolar disorder are much the same as those listed for depression above.  Manic or hypomanic episodes, however, typically disrupt sleep even more severely. Mania is an extreme mood state involves a variety of symptoms.  In addition to an unusually elevated, expansive, or irritable mood, a manic or hypomanic person will also display three or more of the following symptoms:

  • Decreased need for sleep
  • Grandiosity or inflated self-esteem
  • Talkativeness or rapid, pressured speech
  • Racing thoughts
  • Agitation
  • A high level of distractibility
  • Involvement in highly pleasurable and risky behaviors (e.g. sleeping with multiple partners, going on an expensive shopping spree )
  • Taking on multiple projects at the same time
  • Hallucinations or delusions (not part of hypomania)

Although the decreased need for sleep is only one of several possible symptoms of mania, it’s rare for someone who’s manic to not exhibit a notable sleep disturbance. Sleep can be severely limited for days on end during a manic episode.  Manic individuals often feel rested after just two or three hours or sleep.  In some cases, they may not sleep at all for a lengthy period of time.  Their sleep deprivation takes a toll both physically and mentally, and as the manic episode comes to an end, they “crash” and may need significant sleep in order to recuperate both physically and mentally. Anxiety Disorders Anxiety is another major factor for many people who struggle with insomnia.  Anxiety disorders include generalized anxiety disorder, panic disorder, specific phobias, social anxiety, obsessive-compulsive disorder, and both acute and posttraumatic stress disorders.  It’s not uncommon for individuals with depression to also struggle with anxiety, and many individuals with an anxiety disorder often also have at least some symptoms of depression.  The combination can make sleep especially difficult. Anxiety makes it very difficult for a person to relax – both physically and mentally.  Individuals with an anxiety disorder are often restless and fidgety.  Troubling thoughts in the form of excessive worry and / or fear are present much (and sometimes practically all) of the time.  When individuals struggling with an anxiety disorder try to sleep, they often find it very hard to “shut off” or quiet their minds.  That, combined with tense muscles and a restless, “keyed-up” feeling, can make falling asleep a very difficult task. Once they do fall asleep, anxious individuals often toss and turn.  Although early morning wakening is not usually as common as it is with depression, troubling dreams may also disturb sleep.  Nightmares are particularly common with both PTSD and acute stress disorder, further adding to insomnia. As with depression, sleep deprivation makes dealing with anxiety that much more difficult.  The worse the insomnia, the worse the symptoms are likely to be. Complications When sleep is often or chronically disrupted, it leads to even more problems.  Sleep is restorative.  Without sufficient sleep, your body can’t function normally or repair itself adequately.  Your immune system is compromised, and hormones – like cortisol, serotonin, and HGH (human growth hormone) – become imbalanced.  Hormones play a vital role in mood regulation and your overall sense of well-being, so a hormonal imbalance will definitely wreak havoc on everything else.  Poor or insufficient sleep can also contribute to unwanted weight gain and stall weight loss efforts. Tips for Improving Sleep There are several things you can do to improve your sleep and overcome – or at least significantly reduce – sleep problems.  They include:

  • Developing good “sleep hygiene” habits (includes adhering to a regular sleep schedule, keeping your bedroom dark and cool at night, having a relaxing pre-bedtime routine, and avoiding stimulating activities like watching TV (especially the news), using the computer, or arguing or discussing problems with your spouse just before bedtime)
  • Regular aerobic exercise (e.g. running, brisk walking, biking, or swimming laps).  Regular exercise has also been shown to be very beneficial for both depression and anxiety, and studies have shown that it’s as effective for depressive symptoms as taking an antidepressant. (Always check with your doctor before starting an exercise program.)
  • Meditation (practiced regularly for at least a few minutes each day)
  • Yoga (most beneficial if practiced regularly)
  • Relaxation exercises (such as progressive relaxation, deep breathing, and guided imagery) – use these when feeling especially anxious as well as at nighttime
  • Avoiding caffeine, alcohol, spicy foods, and sugar late in the day and especially late in the evening
  • Managing and reducing stress

Mental Health Treatment If you know or suspect you have a mental health disorder, proper treatment can play a very important role in improving your sleep.  The primary treatment for most mental health disorders is psychotherapy.  Medication may also be necessary or beneficial, depending on the particular disorder and / or the severity of symptoms.  For example, bipolar disorder often requires ongoing medication to reduce and control symptoms in general, but especially to reduce the risk of future manic episodes. It is generally not recommended, however, to treat depression or anxiety with medication alone. When medication is used, it is best to do so in conjunction with psychotherapy. While there are many different approaches to psychotherapy, one of the most effective types of therapy for both depression and anxiety is cognitive behavioral therapy (CBT).  CBT helps you learn how to identify, manage, and change the negative and irrational thoughts and beliefs that play a significant role in these disorders.  Learning how to manage negative or troubling self-talk can be very helpful when it comes to battling insomnia. Medication While medication is rarely, if ever, a good long-term solution for chronic insomnia, it may be necessary in the short term for some individuals. It should always be taken with caution, as some medications used for sleep are potentially addictive.  Undesirable side effects are always a potential problem as well, so the benefits versus the costs should always be carefully weighed. There are several different types of medication prescribed to help with sleep:

  • Popular newer insomnia medications include Ambien, Lunesta and Sonata.
  • Benzodiazepines (such as Ativan, Klonopin, and Xanax) are typically prescribed for severe anxiety, and may also be prescribed for sleep.  These older drugs can be quite effective, but they have a high risk for dependence and addiction.  They are meant for very short-term use only.
  • Older antidepressants, particularly Remeron and Desyrel, are often prescribed for sleep.
  • Antipsychotic medications, such as Seroquel, are sometimes prescribed in low doses for insomnia due to their highly sedating effects.  However, these powerful drugs (used primarily to treat schizophrenia and bipolar disorder) have many serious potential side effects.

When sleep issues are a symptom of a mental health disorder, it’s important to treat the disorder and not just the insomnia itself.  Proper mental health treatment, combined with good sleep hygiene and healthy lifestyle habits (such as regular exercise and meditation), will be far more effective in the long-run than medication by itself (or at all in many cases). Get the Help You Deserve If you are having difficulties with your sleep, it’s a good idea to talk to your doctor to rule out any possible underlying medical issues.  If nothing is found, then consider having an evaluation by a psychologist or other mental health professional.  You don’t have to have a specific diagnosis, like major depression or PTSD, to have psychological stressors that are making it difficult to sleep.  That doesn’t make you “crazy”; it just means you’re human.  A skilled therapist can help you find ways to effectively manage those stressors and reduce the impact they are having on your sleep – and on your life. Good sleep is absolutely vital to good health, optimal performance and productivity, and emotional well-being.  Don’t let insomnia or other sleep problems rob you of living your best life!

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