Since 90% of people with insomnia have proved to have other coexisting conditions, insomnia was until 2005 seen as a symptom rather than an independent ailment.
Insomnia is now viewed as a disorder of hyperarousal rather than of sleep deprivation, according to Thomas Roth, Ph.D., a member of the American Academy of Clinical Psychiatrists.
Dr. Roth mentioned a study from his laboratory in which the scientists evaluated 1,000 individuals who had never had a psychiatric disorder and established that 240 of them met criteria for insomnia disorder. Interestingly, at a follow-up study 3.5 years later, the individuals with insomnia had almost 5 times higher risk of developing a mental illness.
Sleep quality is now viewed almost a barometer of mental health with sleep disorder lasting for an extended viewed as potential symptom of mental illnesses. This is an oversimplification, obviously, and only a qualified doctor can make a diagnosis of mental disease, but individuals who sleep well seldom have mental health problems.
A Symptom and a Cause
Inadequate sleep can contribute to the prolongation or development of mental illness. It serves as both a symptom and a cause. Poor sleep can make it tough to cope with mental disorders.
Insufficient sleep can make schizophrenia and depression worse. Sleep disorders and mental illness are co-morbid conditions. It’s estimated that 40% of insomnia patients and over 45% of hypersomnia patients have a psychiatric condition.
People with mental disease often complain about having “non-restorative sleep” – this can be especially frustrating as the patients feel no relief from their discomfort.
Frequently treating the mental disorder eliminates insomnia as well. This is mainly true in cases of minor depression. Many individuals find that their sleep problems go away quickly when they start treatment with antidepressant drugs.
Bipolar disorder affecting some 5 million Americans alone includes major swings in waking and sleep among its most visible symptoms. Such patients may go long periods without feeling the very need for sleep.
Sometimes, sleep problems may arise due to your attention deficit hyperactivity disorder symptoms. According to Lenard Adler, MD at NYU Langone Medical Center, patients with ADHD often have difficulty tuning off as their overactive minds just churn when it is time to go to bed.
Other mental illnesses that are frequently comorbid with lack of sleep include:
- Anxiety disorders including generalized anxiety disorder, posttraumatic stress disorder, and social phobia.
- Panic disorders
- Dissociative Disorders
- Schizoaffective Disorder
The good news is the overlap of mental disorders with insomnia indicates that doctors can often simultaneously treat multiple symptoms. Solve sleep problem and the mental health problem diminishes and vice versa. Of course, there is a whole range of cases and physicians assess each individual case separately.
Some therapeutic plans might include concurrent treatment of insomnia and the mental illness with separate modalities. Alternatively, a patient may be given medicines for the mental disease and a cognitive behavior therapy to target sleep issues.
Poor sleep escalates the risk of the mental disease relapse. In such situations, the patient and the physician should take extra care to prevent a reappearance of insomnia that might launch another downward spiral.
Antidepressant medicines that are frequently used in insomnia treatment are the sedating antidepressants, as well as more common SSRI antidepressants. Some individuals react to antidepressant drugs by becoming more energetic and agitated, making it someway more difficult for a patient to fall asleep (the sleep onset insomnia), even when the relief of the depression improved the sleep maintenance insomnia. Specialists sometimes administer both a hypnotic and an antidepressant medicine to such individuals.
Although treatment of insomnia remains quite a challenge, the recognition of the frequency of comorbidities and the role of hyperarousal allows for therapeutic success.