The following information to be used for educational purposes only, and is not intended to serve as treatment or a substitute for mental health services:
Sleep is an incredibly important part of maintaining good mental health.
Sleep allows the body and mind to recover and replenish neurotransmitters in the brain, as well as physiologic and metabolic processes. [1]
Sleep is also when the mind is able to consolidate memories and skills we have learned throughout the day.
Poor sleep will make nearly all mental health conditions worse.
There are many ways to improve sleep, but the most effective, longest lasting methods require dedication from the patient.
Sleep Medications
Patients commonly request medications for sleep, and sometimes they are helpful, but oftentimes sleep medications will only give a patient 1 hour of extra sleep initially, which decreases to 10 minutes of extra sleep after 1 year. [2]
More complicated sleep disorders such as narcolepsy and sleep apnea, will need to be treated by a trained professional, and may require medications.
For uncomplicated cases of insomnia, the best and most long lasting approach is to address sleeping issues with Cognitive Behavioral Therapy for Insomnia (CBT-i) and improving one’s Sleep Hygiene.
Cognitive Behavioral Therapy for Insomnia (CBT-i)
CBT-i is a 4-8 week long course in which a qualified therapist trains the patient with techniques that will help them improve their quality and quantity of sleep, and is a good approach for patients that do not want to rely on medications.
Sleep Hygiene
Sleep Hygiene is a collection of habits and practices to maximize your restorative sleep, for example:
Make sleep a strict routine and keep the same schedule of what time you go to bed and wake up.
Keep your house bright during the day, and dark at night
Use your bed only for sleeping and sexual activity.
If you cannot sleep, get out of bed and do something that makes you tired- don’t toss and turn for more than 10 minutes. For example, sit on the couch and read a book or listen to a podcast (but don’t watch TV or browse your phone because screen light can be stimulating).
Exercise during the day, but not right before bed.
Find a solution for snoring partners and bothersome pets.
Hide your clock if you keep looking at it.
Resist the urge to take naps during the day.
Do not drink more than one cup of caffeine or drink caffeine after noon.
Stages of Sleep
We will talk about 4 different stages of sleep, each of which shows different brain activity and have various restorative properties. Normally, humans will cycle through phases of sleep during the night.
Stage 1: Represents the change from wakefulness to sleep, and lasts several minutes. This is light sleep, and the body’s automatic functions, like heart rate and breathing begin to slow.
Stage 2: Light sleep in which heart rate and breathing slow, muscles relax even further, and body temperature drops. Brain activity also slows down.
Stage 3: Deep sleep that is required in order to feel rested and refreshed in the morning. Brain waves are slow and it may be hard to wake during this phase of sleep.
Rapid Eye Movement (REM) sleep, is a stage in which the eyes will move rapidly behind closed eyelids. Most dreaming occurs during this stage. Your muscles become temporarily paralyzed, which prevents you from acting out your dreams. Brain activity can look as though you are fully awake. It is thought that the purpose of dreams is to train our bodies and minds to help solve problems that we have encountered during the day. [3]
Why is this important?
Different types of sleep problems will require different solutions. For example not being able to fall asleep may be caused by anxiety or drinking too much caffeine. If you are waking up frequently in the night, you may not be getting enough deep sleep, which might be caused by waking up due to bad dreams, or from a medical cause, such as obstructive sleep apnea.
Some patients drink alcohol to help them sleep, but alcohol prevents them from entering Stage 3, deep sleep, so even if they are sleeping for 12 hours, their sleep stays in Stage 1 or Stage 2, which are not restorative.
Sleep Apnea
Obstructive Sleep Apnea (OSA) can occur in adults and is a treatable condition. It is a condition in which the relaxation of the throat muscles in the neck during phases of deep sleep obstruct the patient’s breathing, which can wake the patient up from sleep, or prevent the patient from entering a phase of deep sleep. [4]
Patients with OSA may not even know they are waking up several times a night. Because OSA prevents deep sleep, the patient could sleep for over 10 hours every night and never feel fully rested.
OSA typically occurs in overweight patients with thick neck circumference, who snore loudly when sleeping. They can experience headache, fatigue and high blood pressure during the day as a result of inadequate quality sleeping at night.
The good news is there is treatment for this condition, which is commonly a machine called a CPAP. Ask your doctor if you suspect you may have sleep apnea.
Sleep is immensely important to mental health, so ask your doctor if you feel like your sleep is insufficient, and try to incorporate good sleep hygiene habits on a regular basis.
1. The Neuroprotective Aspects of Sleep, Andy R. Eugene, and Jolanta Masiak
2. https://www.nytimes.com/2007/10/23/health/23drug.html
3. https://www.sleepfoundation.org/how-sleep-works/stages-of-sleep
4. https://www.ncbi.nlm.nih.gov/books/NBK459252/
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