Have you ever tossed and turned and counted 100s of sheep, but couldn’t quite fall asleep? A lot of people struggle with sleep-related issues. The CDC found that around one third of Americans are not getting sufficient sleep, which is defined as sleeping seven hours or more a night. There are a myriad of reasons for those dreaded nights of insomnia, lack of sleep, but if you are experiencing consistent nights of difficulty sleeping then it could be a sign for underlying mental health problems.
It is well established that sleep influences mental health and vice versa, but what came first? What we do know is that people who are undergoing a depressive episode often experience hypersomnia, excessive sleep, or insomnia. People feeling intense, prolonged anxiety or PTSD can have a problem with falling or staying asleep. Yet, what is the catalyst for causing the other, mental health or sleep? Under- or oversleeping is another age-old chicken or the egg conundrum.
Freeman et al. (2017)’s conclusion is that mental health might be leading to sleep related issues. Freeman et al. (2017)’s study administered cognitive behavioral therapy (CBT) to young adults experiencing bouts of insomnia at 26 different universities. They found that these students’ mental health difficulties, including experiencing hallucinations and paranoia, significantly improved after their sleep was better by the CBT. They reached the conclusion that sleep might be causing mental health problems.
Scott et al. (2021) did a sleep intervention to measure whether improved sleep has a statically significant effect on mental health. They found that the more sleep the participant acquired the greater the positive effect on mental health. This finding is more aligned with Freeman et al. (2017)’s accepted hypothesis, meaning that better quality sleep improves mental health; it is logical to conclude that lack of sleep is causing mental health difficulties.
Other scientists have not been so convinced by Freeman et al. (2017) and Scott et al. (2021)’s conclusions. Franceschini et al. (2020)’s study collected thousands of online surveys from people in Italy, currently undergoing lockdown precautions for Covid-19. They concluded that those who were experiencing the greatest sleep deficits were being affected by mental and emotional distress. Thus, Franceschini et al. (2010) reached the conclusion that mental health was leading to sleep problems.
Of course, prolonged sleep difficulties are sometimes not related to mental health issues at all. Al-Khani et al. (2019) did a study where they gave over 200 medical students a comprehensive questionnaire on their sleep habits. Over 60% of medical students reported poor sleep quality. Those that reported bad sleep habits also held the highest-grade point averages, illustrating that students that are staying up throughout the night studying would not have time for optimal sleep.
Ultimately, everyone is right. Sleep and mental health have a bidirectional relationship, meaning that in some cases sleep leads to mental health concerns, and in other cases poor sleep is a consequence of mental health problems. The directional association between sleep and mental health needs to be determined on a case-by-case basis.
1. Al-khani, A.M., Sarhandi, M.I., Zaghloul, M.S. et al. A cross-sectional survey on sleep quality, mental health and academic performance amoung medical students in Saudi Arabia. BMC Res Notes 12, 665 (2019). https://doi.org/10.1186/s13104-019-4713-2.
2. Franceschini, C., Musetti, A., Zenesini, C., Palagini, L., Scarpelli, S., Quattropani, M. C., Lenzo, V., Freda, M. F., Lemmo, D., Vegni, E., Borghi, L., Saita, E., Cattivelli, R., De Gennaro, L., Plazzi, G., Riemann, D., & Castelnuovo, G. (2020). Poor sleep quality and its consequences on mental helath during the COVID19 lockdown in Italy. Frontiers in Psychology, 11. https://doi.org/10.3389/fpsyg.2020.574475.
3. Freeman et al., The effects of improving sleep on mental health (OASIS): a randomized controlled trial with mediation analysis, The Lancet Psychiatry, Volume 4, Issue 10, 2017, Pages 749-758, ISSN 2215-0366, https://doi.org/10.1016/S22150366(17)30328-0.
4. Suni, E. (2020, September 18). Mental health and sleep. Sleep Foundation. Retrieved November 12, 2021, from https: //www.sleepfoundation.org/mentalhealth.
5. CDC. (2016). 1 in 3 adults don’t get enough sleep. Retrieved from https://www.cdc.gov/media/releases/2016/p0215-enough-sleep.html
Author: Katrina Peavy
Editor: Anum Khan
Health scientist: Aseelah Saiyed