Does lack of sleep cause mental health problems, or do mental health problems cause lack of sleep? Cris Andrews reports.

Get a bad night’s sleep and the next day you’ll likely be tired, irritable, find it hard to concentrate, nowhere near your best.

"The very act of going to bed can trigger an insomnia sufferer into a state of alertness."

Struggle to sleep, regularly (insomnia) and this can soon turn to a more general fatigue, short-temperedness, distraction and under performance.

Medical studies link lack of sleep to physical health issues like high blood pressure, heart disease, diabetes, weakened immunity and memory loss. But more recently, experts have suggested that poor sleep can also contributes to mental health problems.

A University of California Berkley study, out last month, claimed that people with insomnia are more likely to be lonelier and socially isolated. Last year, Oxford University experts found that insomnia doubles the chance of a person developing depression, and is partly responsible for paranoia and hallucinations. The Mental Health Foundation says that lack of sleep can make people feel stressed and anxious. Mind calls it the other way around, saying that people with anxiety, paranoia, psychosis and mania find it difficult to sleep.

Psychiatry professor Daniel Freeman, who led the Oxford University study, says that clinical trials prove that getting enough sleep improves psychological health. “A lot of psychological work occurs during sleep, we process all the new memories of the day, while our older memories are managed,” he says. “Sleep prepares the mind for the following day.”

Freeman explains that during poor sleep, your thoughts become skewed towards the downbeat and fearful, while brain processing tends towards loops of repetitive, negative thinking. “You’re aroused, alert, and with worries coming into mind from the day’s stresses,” he says. “The longer that a sleep problem persists the greater the psychological consequence and the likelihood of depression and anxiety.”

Negative cycles

Professor Freeman also says that people stuck in negative thought cycles can become more suspicious and mistrustful of others. Matthew Walker, the Professor of Neuroscience and Psychology at UC Berkley, who led their study, explains sleep deprivation leads to hypersensitivity in brain regions that warn of human approach and impairment in regions that aid understanding of another’s intent.

The UC Berkley researchers also found that loneliness is perceived by others as a social turn off, which can actually perpetuate the sleep-deprived person’s social isolation. Daniel Freeman adds that the psychological effects of poor sleep are more likely to affect people who already feel anxious, insecure or miserable.

It’s not all bad news, though. According to Matthew Walker it only takes one night of good sleep to make you feel more outgoing and socially confident. It’s also possible to make environmental changes to manage the immediate effects of insomnia whilst seeking to find, and deal with, the root cause of the issue.

For a start, try less time in front of your computer screen at night. Switch off your smartphone and tablet at night two hours before bedtime. “Otherwise the blue light from the computer screen tells our brains that we’re awake,” says Insomnia therapist Kathryn Pinkham

Dr Patrizia Collard, a psychotherapist and stress management consultant, says that notifications from our phones and computers, train our brains to be in a constant state of stress and fear, fight or flight.

“In this state, we cannot produce serotonin, this can only be produced when we feel cool, at ease, relaxed, or at peace,” she says. “If we don’t produce much serotonin during the day, we will produce less melatonin in the evening, which is what we need to go to sleep.”

Mind suggests devising a pre-sleep relaxation routine that combines meditation, mindfulness, visualisation, breathing exercises and muscle relaxation. The US military once used a combination of these practices to send pilots off to sleep, within two minutes.

Certain natural remedies can help with sleep and relaxation. As can technology. For instance, there’s a smart bed that adjusts itself in the night to stop people from snoring, a tiny gadget that fits under a mattress to monitor sleep and a water-based, app-controlled mattress topper, to encourage deep sleep.

Avoid quick fixes

Kathryn Pinkham warns though, that short term fixes are not the answer, and in some cases can actually make the sleep problem and any associated mental health problem, worse.

“You end up spending more time worrying about whether this gadget, or that potion, will work,” she says. “The bedroom should be a relaxing place where you switch off and sleep. But instead you worry about whether you will sleep or not.”

Many people who struggle to sleep associate the bedroom with wakefulness, anxiety and stress. The very act of going to bed can trigger an insomnia sufferer into a state of alertness and Kathryn Pinkham believes that the solution is to deal with these unhelpful beliefs, thoughts and habits. ‘Using Cognitive Behavioural Therapy for insomnia, you learn how to let go, become more accepting,” she says. “Your sleep issues are less on your mind and you’re able to release certain behaviours.”

Pinkham adds that writing down any anxieties about sleep, can help you let go of the offending thoughts. “Either keep a journal, or rip the pages up, whichever works,” she says.

She also believes that it’s better to go for a shorter window of sleep, with a set time to get up. “Then at least you’ll be tired enough to get some sleep and over time, a regular sleep routine can emerge,” she says.

Daniel Freeman agrees. “Our bodies appreciate rhythms, so keep to a consistent routine of going to bed and getting out of bed,” he says.

The insomnia problem isn’t going away, either. Diets are getting worse, routines more fluid and disrupted, technology more invasive and mental health problems more common. According to the Oxford University study, around 5-10 percent of UK people meet the clinical criteria for insomnia. The Mental Health Foundation says its 20 percent. A 2017 Aviva report claimed that 31 percent of British people believe that they have insomnia.

Daniel Freeman thinks that sleep problems have for too long been marginalised in the treatment of mental health issues, thought of as just a symptom of other mental health problems rather than a problem in itself. Professor Freeman believes its time that treatment for insomnia was made a central part of what mental health services offer.

“For many people, insomnia can be part of the complex package of causes of mental health difficulties,” he says. “If you can sort out your sleep, you’ll also be taking a significant step forward in tackling a wide-range of psychological and emotional problems.”