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Mental Health and Sleep

To feel healthy, we need to sleep healthy. It’s as simple as that.

Healthy sleep can differ by person, but generally it means that you feel tired and wake up around the same time every day, and you get a sufficient amount of sleep each night (7 to 7.5 hours for adults). When you wake up in the morning, you feel rested.

Your sleep health is a critical part of your overall health: physical and mental. Most of us know that when we sleep well, we don’t get injured as easily, or feel sore and achy.

But it’s easy to overlook the relationship between mental health and sleep. And with mental health at an all-time low in America, it’s essential that we understand the intersection of mental health with sleep, and do what we can to improve both.

According to the General Social Survey, a nationwide survey conducted since the 1970s, the number of people who would rate their happiness a 1 on a scale of 1 to 3 has increased nearly 50% in the past thirty years. In just the past ten years, people’s sense of “overall life satisfaction” has fallen 6%.

Researchers attribute the decline in mental health to a host of factors: the opioid epidemic, worsening physical health, the shrinking of the middle class. There’s also sleep. That’s what we’re looking at today.

How Mental Health Issues Impact Sleep

Mental health refers to your overall psychological, social, and emotional well-being. Mental health is distinct from mental illness, which describes diagnosed conditions like depression, anxiety, bipolar disorder, and schizophrenia, although poor mental health may develop into a mental disorder.

When your mental health is poor, your sleep tends to be poor too. Which mental health issues impact sleep?

Anxiety

Independent of having clinical anxiety, individuals who are prone to everyday feelings of anxiety and worry are more likely to take longer to fall asleep, spend more time in light sleep, and consequently miss out on restorative deep sleep. Unhealthy emotional investment in social media is also associated with higher rates of anxiety and poor sleep, as well as depression and low self-esteem.

Depression

Like anxiety, people can experience symptoms of depression without being clinically depressed. These feelings of sadness, isolation, and hopelessness can worsen sleep. Among children, more extreme sleep issues (over- or under-sleeping) are correlated with more severe depression.

children with sleep issues at increased risk of depression

Losing one hour of sleep has been linked to significantly greater feelings of hopelessness and suicidal ideation among high school students.

Stress

School and work stress can be overwhelming for people, and directly impact their sleep. Those who experience higher levels of job stress are more likely both to experience insomnia in the first place, as well as to experience it more frequently.

Loneliness

Researchers have even been able to pinpoint how feelings of loneliness impact sleep, independent of other mental health issues or stress. Lonely individuals are much more likely to experience fragmented or restless sleep.

Grief

The loss of a spouse, child, or loved one can be devastating. Sleep problems accompany grief, making it more difficult for people to cope with the loss of a loved one, and to recoup their emotional well-being. In one study of widows, all participants reported poor sleep, compared with only 25 percent of their non-grieving peers. Other studies have found that individuals experiencing more intense grief tend to experience worse sleep as well.

The research indicates that poor mental health is associated with poor sleep. The reverse also holds true. The better our mental health, the easier it is for us to sleep at night. What types of positive mental health habits are linked with better sleep?

  • Because insomnia can be related to elevated levels of hyperarousal throughout the day (which may present as anxiety), meditation has been suggested as a viable treatment option. Further, mindfulness meditation has significantly improved sleep quality among people with insomnia in some studies.
  • In one study of adolescents, students who practiced better sleep habits had fewer symptoms of depression and anxiety. Delaying school start times and reducing stress resulted in longer sleep, improved mental well-being, and better alertness in another study.
  • People who have “positive affect,” the scientific expression for people with generally enthusiastic personalities and positive outlooks on life, are more likely to report feeling rested upon waking up and to enjoy better sleep quality.

Who Is at Risk of Sleep & Mental Health Issues?

Certain conditions and demographic groups are more likely to experience sleep issues related to mental health.

People With Mood Disorders

Mental health issues, including low self-esteem, feelings of despair or worry, and hyperarousal are common symptoms for people suffering from depression, anxiety, or another mood disorder.

Sleep problems are comorbid among this population. People with anxiety and depression are both likely to have insomnia (difficulty falling or staying asleep), while people with depression are also likely to experience hypersomnia (oversleeping). When these individuals have poor sleep, the symptoms of their mental health disorder often worsen.

People Experiencing Stress

Stress is a common contributor to both mental health and sleep problems. Unfortunately, stress levels are at an all-time high among Americans, according to the latest Gallup poll. Just under a majority (45 percent) of Americans feel worried “a lot.”

levels of stress worry and anger increasing in the united states

At a physiological level, stress functions oppositely to sleep. At night, your melatonin levels rise, increasing as you sleep. In the morning, melatonin dips as stress hormone cortisol rises, energizing you throughout the day. People who are stressed tend to remain in a state of hyperarousal, with higher cortisol levels all day long, so their sleep is more fragmented and less restful.

People Who Are Sleep Deprived

According to the CDC, one-third of Americans don’t get enough sleep on a regular basis. Sleep deprivation is linked to increased anxiety, stress hormones, memory problems, and more. In the long-term, it’s linked to diabetes, cardiovascular disease, and some cancers. Problematically, sleep deprivation lights up the same brain regions as excessive worry, and researchers theorize that those who are already anxious tend to be the ones who feel the most impact from sleep deprivation.

Sleep deprivation is of particular concern for individuals with mental health issues because of how our sleep cycles work. Throughout the night, you cycle through different stages of sleep, from light sleep to deep sleep to REM. During REM sleep, your brain sorts, processes, and organizes your memories and emotions, stabilizing your mood and focus. As the night goes on, we spend more time in REM and less time in stages of light sleep. When you don’t get enough sleep, you don’t get enough REM, resulting in poor mood.

Certain Age Groups

Sleep and mental health affects different age groups differently. Individuals between ages 25 and 54 are most likely to experience short sleep, according to the CDC’s data.

Although, sleep and mental health also significantly impact younger demographics, particularly adolescents, according to the research. In a study of nearly 100,000 Japanese adolescents, individuals who slept either too long (over 9 hours) or too little (less than 7) had poorer mental health than their counterparts who experienced healthy sleep. Further, individuals with poorer mental health were also more likely to subjectively rate their sleep as poorer as well.

High school students who get fewer than 8 hours of sleep per night experience significantly higher depression symptoms, use more caffeine (which increases stress), and are more likely to engage in substance abuse. Sadly, fewer than 15 percent of high schoolers get enough sleep.

On the other side of the age spectrum, older adults also experience sleep and mental health issues. Grief becomes a more common experience in old age, as loved ones pass, and serious health issues develop. Older adults also experience changes to their sleep architecture: while they need as much sleep as before, the neurons responsible for regulating sleep die off, so they wake up earlier than expected without feeling sufficiently rested.

This excessive daytime sleepiness persists throughout the day, and was found by one study to be a significant predictor of poor mental and physical health. Fortunately, filling in this sleep gap, through a mid-afternoon nap, appeared to improve sleep quality, reduce daytime sleepiness, and improve mental health.

Income Levels

Your income level can also affect how well you sleep. Depending on your socioeconomic status, you may or may not be dealing with additional obstacles that make sleep and good mental health harder to come by. In one study of over 60,000 middle-aged women, depression and low socioeconomic status were the two most likely predictors between long sleep and eventual mortality rates.

Other studies, by the CDC and others, have likewise demonstrated a linear relationship between lower household income and increased risk of short sleep. Among all races, whites are the least likely to experience short sleep, while almost half of black and Pacific Islanders don’t get sufficient sleep on a regular basis.

People With Health Conditions

Other health conditions can also contribute to increased mental health issues and sleep problems. For example, rates of anxiety are higher among people with obstructive sleep apnea, a sleep-related breathing disorder:

anxiety and insomnia symptoms of obstructive sleep apnea

Cancer patients are more likely to experience sleep deprivation, insomnia, and other sleep disorders. The worse their sleep, the harder it is for them to emotionally and physically cope with their treatment.

How to Address Mental Health Concerns to Sleep Better

To sleep better, you need to feel better. Below we share recommendations for improving your mental health, so you can improve your sleep in turn.

Meditation

Multiple studies have found that mindfulness meditation is particularly effective at relieving anxiety and depression. This type of meditation encourages you to focus on the present moment: how you are feeling, breathing, and thinking. In other words, meditation helps you focus on something other than your distressing thoughts. Practicing meditation for just 10 minutes a day can be helpful.

To get started, sit somewhere quiet and focus on your breath. How does it sound, and how does it move your body and the air around you? When thoughts drift into your mind, acknowledge them but stay focused on your breathing. If you find it difficult to stay focused, acknowledge that you’re having trouble focusing, and return again to your breathing — without judging or criticizing yourself. You can also try guided meditations in free podcasts or apps.

Guided Imagery

Guided imagery encourages you to use all your senses to create a mental image and experience it in your mind. You can start by remembering a happy memory, or envisioning a relaxing environment. Nature-based guided imagery in particular has been found to be an effective form of anxiety management.

You can use these same exercises to calm yourself to sleep. Instead of a happy birthday party, imagine drifting off to sleep in a hammock by the beach.

Breathing Exercises

Like meditation and visualization, deep breathing exercises also help you focus on the body, instead of sad or anxious thoughts. By slowing down your breathing, you naturally slow down your body and your mind, inviting the stress to melt off as your body physically relaxes. You might try visualizing the air traveling as you breathe, alternating breathing between different nostrils, or exhaling for longer than your inhale.

Progressive Muscle Relaxation (PMR)

PMR is another technique commonly used to help people fall asleep, although you can just as easily use it during the day to take your focus off stressful or racing thoughts. Nursing students have used PMR to successfully relieve test anxiety, just as teen soccer players have used it to regulate their mood during games.

To get started, lie down and close your eyes. Pay attention to your breath, and gradually work through your body, progressively tensing each group of muscles one at a time, before relaxing.

Journaling

Journaling helps many people process their emotions in a healthy way. One study found that writing for 20 minutes, on four separate occasions, about their emotions surrounding a significant trauma alleviated anxiety among a sample of otherwise healthy adults. Results were sustained at a three-month follow-up, too.

Some people who find themselves stressed or anxious before sleep will write in a bedtime journal before bed, emptying their anxieties and worries from their mind onto the page. Even taking 5 minutes to write a to-do list helped people fall asleep faster, according to one study.

Environmental Improvements

From your bedroom to your desk at work, your car, or your locker at the gym, you have a few places you can call your own. Transform these areas into places of mental health refuge, filling them with natural mood boosters, like a sachet scented with lavender essential oil, or happy reminders, like photos of loved ones. Decorate your spaces with colors that make you happy.  Write an inspirational message or positive affirmation on a mirror, so you can see these encouraging words when you see yourself.

Social Support

Reach out to others for support. The more sleep-deprived you are, the less likely you are to want to reach out, but it’s important to avoid this kind of social isolation. Instead, talk to close friends about how you are feeling. If you’re not comfortable opening up, continue to spend time with friends and loved ones who care about you and lift you up. Strong social relationships improve your mental health and are even associated with longer life.

Volunteer

To take your mind off your thoughts, focus on others instead. Turn your energy outwards to your community. Studies have documented the link between volunteering and better physical and mental health, higher self-esteem, lower depression symptoms, and increased happiness. Volunteering can also be a way to grow your social support network.

Therapy

If you start to notice that your mental health issues persist throughout the day, consider finding a professional therapist to help. One type of therapy, cognitive behavioral therapy, is effective in treating both mental health disorders like anxiety and depression, as well as sleep problems, as they can both stem from unhealthy thought patterns and behaviors.

How to Address Sleep and Mental Health Holistically

The relationship between mental health and sleep is a cyclical one. When you sleep better, you feel better, and vice versa. In fact, U.S. Department of Health & Human Services lists “eating or sleeping too much or too little” as the first early warning sign of a mental health problem.

In addition to improving your mental health, you can work to address your sleep and mental health together, using the holistic approaches we outline below.

Create and Follow a Calming Bedtime Routine.

When you follow the same set of activities each night before bed, it trains your mind to associate these with falling asleep. If you fill your bedtime routine with calming activities that help you relax and make you smile, you can give yourself a respite from your troubles and get in a better emotional mindset before bed, which will naturally make it easier to fall asleep. Popular choices include aromatherapy, reading, listening to music, taking a bath, or enjoying a cup of bedtime tea.

In the long run, dedicating 30 to 60 minutes a day to these activities may help restore your mental health.

Observe What You Eat and Drink.

Your diet plays a role in how you feel throughout the day, both physically and emotionally. It can also either help you sleep better — or worse, as anyone with acid reflux can attest. Avoid caffeine, alcohol, and overly spicy or sugary foods past the afternoon. These are no friend to mood or sleep. Some, like caffeine, can increase anxiety while also keeping you way up past your bedtime.

Instead, adopt a healthier diet, stay hydrated throughout the day, and limit dinner and late-night snacks to sleep-promoting foods like bananas, legumes, nuts, dairy, and fish.

Spend Time Outdoors Each Day.

Spending time outdoors makes you feel better. Workers who get more sunlight during the day report lower levels of depressed mood and anxiety, and higher feelings of job satisfaction.

Plus, the more light exposure you get during the day, in the morning or the afternoon, helps reinforce your natural circadian rhythms (your sleep cycle). The light you receive during the day contrasts with the darkness you experience in the evening, signaling to your brain that it’s time to begin melatonin production and start the process of falling asleep.

Exercise Several Times a Week.

If you need an excuse to get outdoors, pair it with exercise. Like many of the items on this list, exercise holds the happy honor of both boosting mood and aiding sleep. Studies consistently show exercise is correlated with better sleep quality or duration. It physically tires the body, encouraging deeper sleep at night. Just make sure you don’t exercise too close to bedtime, or you may be too wired to fall asleep.

Exercise is also regularly touted as a treatment for mild to moderate symptoms of depression. You can choose from a variety of aerobic exercises: jogging, swimming, bicycling, walking, gardening, and dancing have all been proven to improve anxiety and depression. Among healthy individuals, a twice-weekly yoga regimen significantly and immediately reduced anxiety symptoms:

yoga reduces anxiety in seniors

Final Thoughts on Sleep and Mental Health

Sleep and mental health are two significant issues affecting people today. Over a third of people aren’t getting the sleep they need, and stress, worry, and anxiety levels are higher than ever.

Whether you’re living with a mental health disorder, or experiencing a temporary bout of stress, you can expect your sleep to suffer, too. Some people are at increased risk of sleep and mental health issues, including those who are sleep-deprived, have other health conditions, or are in certain age groups or income levels.

Fortunately, the relationship between mental health and sleep works both ways. People in good mental health tend to sleep better. Studies show that there are a variety of techniques people can employ to improve their mental health, and their sleep. Strengthening social bonds and the sense of self, through therapy, journaling, and spending time with friends and family, leads to better mental health. Taking up meditation, relaxation exercises, and physical exercise (especially outdoors), can also improve sleep and emotional well-being.

To feel better, you need to sleep better. Addressing your sleep and mental health issues together is a good first step toward a happier, healthier life.

Additional Resources

For more information on mental health and sleep and tools to help promote better sleep, check out these resources.

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