How Does Mental Health Affect Your Sleep?
Contributed By: Rose MacDowell, Sleepopolis
Expert Verified By: Dr. Nicole Moshfegh, Psy.D.
The term mental health describes emotional, cognitive, and social well-being. Mental health is important at every stage of life, from childhood and adolescence through adulthood. Mental health affects not just how we feel, but how we think and behave. Our psychological condition determines how we handle stress, relate to others, and make choices.
There are more than 200 types of mental illness, which is defined by the American Psychiatric Association as “a health condition involving changes in emotion, thinking, and behavior.” Mental illness is based in the brain and can have a significant impact on relationships and quality of life.
Note: The content on Sleepopolis is meant to be informative in nature, but it shouldn’t take the place of medical advice and supervision from a trained professional. If you feel you may be suffering from any sleep disorder or medical condition, please see your healthcare provider immediately.
Mental Illness: Causes and Symptoms
Mental health problems can affect self-esteem, happiness, and basic functions, such as eating and sleeping. (1) Social and financial success is strongly influenced by psychological wellness, including self-awareness and our ability to exercise self-control.
Many factors contribute to mental health issues, including:
Genes and brain chemistry
Family history of mental health problems
Life experiences, such as trauma or abuse
Mental health issues run the gamut from minor difficulty with daily living to full-blown psychosis. Treatment can have a significant impact on the course and outlook of psychological issues, making early detection crucial.
Mental illness can appear in early childhood or not until adulthood. (2) Some psychological issues may not emerge until later in life and can be influenced by certain drugs and medical conditions. There are numerous warning signs of mental health issues. These vary depending on the nature of the condition, and may include:
Eating or sleeping too much or too little
Withdrawing from relationships and usual activities
Having low or no energy
Feeling numb
Experiencing unexplained aches and pains
Feeling helpless or hopeless
FAQ
Q: What is the most common mental illness?A: Depression, a mood disorder that affects 300 million people worldwide, is the single most common mental illness. Anxiety disorders are more prevalent overall.
Psychological difficulties increase the risk of troubled relationships with family and friends. (3) Interpersonal conflict can be caused by irritability and mood swings, or feelings such as fear and anger. Other cognitive signs associated with mental health issues include worry, confusion, memory loss, and intrusive thoughts.
More serious mental disorders may cause hallucinations, including hearing voices or believing things that are not true. Suicidal behavior or thoughts of harming another person are also common signs of psychological issues. A person suffering from mental illness may experience paranoia, imagined physical ailments, or the need to abuse drugs or alcohol.
Types of Mental Health Disorders
Each type of mood disorder is characterized by unique signs and symptoms and may co-occur with other disorders. For example, anxiety might occur along with substance abuse, physical complaints, or a sleep disorder like insomnia.
The following are some of the most common mental health disorders:
Anxiety Disorders. People with anxiety disorders respond to certain objects or situations with fear and dread. Anxiety disorders can include panic disorders, generalized anxiety disorder, and phobias. (4) Symptoms of anxiety include:
Fatigue
Feelings of restlessness or irritability
Difficulty focusing or learning new concepts
Chronic pain or muscle tension
Trouble controlling feelings of worry
Problems sleeping, including the inability to sleep, unsatisfying sleep, or excessive sleeping
Psychiatric Disorders in Children. Common psychiatric disorders in children include attention deficit hyperactivity disorder (ADHD) a neurodevelopmental disorder that usually persists into adulthood. Symptoms include impulsiveness, trouble focusing on tasks or conversations, restlessness, and feeling easily frustrated. Oppositional defiant disorder is part of a spectrum known as disruptive, impulse-control, and conduct disorders. Symptoms of oppositional defiant disorder include hostility toward and lack of cooperation with teachers, parents, and other authority figures. (5)
Eating Disorders. Eating disorders involve extreme emotions, attitudes, and behaviors related to weight and food. Common eating disorders include anorexia, bulimia, and binge eating.
Substance Use Disorders. Mental health problems and substance abuse disorders often occur together. (6) Substance abuse can be a cause or a result of psychiatric issues, and may be an attempt by some patients to self-medicate or reduce symptoms.
Mood Disorders. Almost one in ten people aged eighteen or older have a mood disorder. Mood disorders involve persistent feelings of sadness, or feelings that fluctuate between extreme happiness and extreme sadness. Mood disorders include:
Depression. Approximately 17.3 million people in the US — 7.1% of adults — suffered from one or more major depressive episodes in the last year. Depression is characterized by sadness and lack of usual enjoyment that continue for two weeks or longer. Grief and sadness related to a change in life circumstances are different from depression, which doesn’t improve in response to external events
Bipolar disorder. Bipolar disorder affects approximately six million adults in the US, and impacts men and women equally. The disorder is characterized by severe fluctuations in mood, behavior, and thought patterns. Fluctuations can last from a few hours to several months, and may be affected seasonal and light changes
Personality Disorders. People with personality disorders have inflexible personality traits that are distressing to the sufferer and may cause problems in work, school, or social relationships. (7) These disorders are highly resistant to treatment, and include the following:
Antisocial personality disorder, or APD. People with antisocial personality disorder exploit, manipulate, and disregard the feelings of others. APD describes the behavior of sociopaths and psychopaths. Psychopaths do not have a conscience, whereas sociopaths have a conscience that is severely disordered
Narcissistic personality disorder, or NPD. Approximately 1% of people are afflicted with NPD. The disorder is associated with lack of empathy, feelings of superiority, and a need for admiration. Narcissists tend to be easily hurt and are unable to tolerate criticism. Treatment is generally ineffective because people with NPD don’t believe they have a mental health issue
Borderline personality disorder, or BPD. People with borderline personality disorder have trouble regulating their emotions. They tend to act impulsively, resulting in career and relationship difficulties. Of the 1.4% of the population with BPD, 75% are women, though this number may represent misdiagnosis in many men with the disorder
Psychotic Disorders. Psychotic disorders are characterized by abnormal perceptions such as hallucinations and delusions. Hallucinations are false perceptions that involve hearing or seeing things that don’t exist. Delusions are false beliefs, such as being pursued by authorities or people wishing to do the sufferer harm. The most common psychotic disorder is schizophrenia, which typically appears in the mid to late twenties. Possible causes of schizophrenia include genetic and environmental factors, disordered brain circuitry, trauma, and drug abuse.
Psychosis
Psychosis describes mental conditions that involve loss of contact with reality.
Mental Health and Sleep
One common sign of mental health difficulty is trouble sleeping. (8) The sleep disorder most closely associated with psychiatric disturbances is chronic insomnia. Some common mental illnesses and their effect on sleep include the following:
Depression. Clinical depression often presents with persistent insomnia, or the inability to sleep. (9) Hypersomnia, or excessive drowsiness, can be a sign of depression, as well. Sleep disorders are associated so strongly with depression that some medical practitioners advise caution in diagnosing depression in patients without symptoms of a sleep disorder. Up to 75% of people diagnosed with depression also suffer from insomnia.
Bipolar Disorder. Bipolar disorder is strongly associated with the inability to fall asleep, stay asleep, fall back to sleep, or all three. People in the manic phase of bipolar disorder often have difficulty sleeping, whereas those in the depressive phase may sleep much more than usual. Studies show that sleep deprivation can aggravate the struggles with emotional regulation that are common in people who are bipolar. (10) For many sufferers, trouble sleeping can be an indication of an approaching manic phase.
Anxiety Disorder. Anxiety is a principal cause of chronic insomnia. Even common anxiety related to work and life circumstances may trigger insomnia. A primary cause of chronic insomnia is conditioned anxiety related to sleep and the bedtime routine. Anxiety’s impact on the body includes hyperactivity of the central nervous system and excessive release of stress hormones, such as adrenaline and cortisol. Studies show a strong association between a history of insomnia and anxiety disorder, panic disorder, and social anxiety disorder. (11)
Borderline Personality Disorder. BPD sufferers with insomnia typically experience the daytime consequences of sleep loss, including sleepiness, difficulty concentrating, and irritability. Symptoms of BPD can be worsened by insomnia, leading to a vicious cycle of sleeplessness and behavioral issues.
Personality Disorders. Some personality disorders may be associated with disturbed sleep patterns. (12) One study revealed that people with circadian rhythm disorder are more likely to have a personality disorder than people with normal sleep and wake cycles.
Psychotic Disorders. Psychotic disorders such as schizophrenia can have a profound impact on sleep. Sleep disturbances are often an early sign of schizophrenia and can precede psychiatric symptoms by months or years. Schizophrenia patients are more likely to suffer from other sleep disorders, as well, including:
Obstructive sleep apnea
Restless legs syndrome
Periodic limb movement disorder
Circadian rhythm dysfunction
FAQ
Q: What is circadian rhythm dysfunction?A: Circadian rhythm dysfunction is caused by a loss of synchronization between sleep-wake cycles and natural light and darkness signals. Symptoms include the inability to fall or stay asleep, cognitive dysfunction, and trouble maintaining a traditional sleep schedule.
Does Depression Cause Insomnia, or Vice Versa?
It was once thought that insomnia symptoms resulted from psychiatric disorders and depression, not the other way around. Now the evidence isn’t so clear. Sleep problems may not just be the result of emotional disturbances, they may increase the likelihood of suffering from them, as well.
Medications to treat psychiatric disturbances may also cause insomnia. Psychotropic medications can have stimulating effects that contribute to interrupted sleep. Restless leg syndrome and periodic limb movements may be triggered or exacerbated by antidepressants and other drugs used to treat mood disorders.
An analysis of major studies revealed that volunteers who suffered from insomnia symptoms were twice as likely to be diagnosed with depression as those without sleep difficulties. Why? Though the connection between mood disorders and insomnia isn’t entirely understood, it is well-known that hormones and neurotransmitters are affected by poor sleep. Sleep is a restorative activity that reduces stress in the body and areas of the brain, especially the axis between the hypothalamus and adrenal and pituitary glands. Excess secretion of cortisol — also known as “the stress hormone” — may play a role, as well.
Lack of sleep and the resulting physiological stress may predispose insomnia sufferers to major mood disturbances, making early treatment of sleep disorders essential, especially in people with a family history of mental health issues. (13)
Depression and Other Sleep Disorders
Insomnia is not the only sleep disorder associated with depression and anxiety. (14) Sleep apnea is a common cause of depression, as is hypersomnia. Sleep apnea is characterized by blockage of the airway and repeated awakenings during the night. Chronic sleep apnea can result in weight gain, increased risk of heart attack and stroke, and memory problems.
Hypersomnia is associated with excessive time spent sleeping and daytime sleepiness. The disorder can be caused by medical conditions, certain drugs, and immune system dysfunction. Though most people need between seven and nine hours of sleep each night, the need for significantly more can indicate a mood disorder. Like sleep apnea, hypersomnia is related to a greater likelihood of heart attack and stroke.
Hypersomnia
A sleep disorder associated with excessive sleeping. Hypersomnia includes narcolepsy, an autoimmune disease that can cause extreme sleepiness and muscle weakness.
Psychiatric Medications and Sleep
Medications to treat psychological disturbances can have a positive or negative impact on sleep. (15) Most antidepressant medications influence the neurotransmitters dopamine, serotonin, and norepinephrine, all of which help to regulate sleep and wake cycles. Some can have stimulating effects that contribute to insomnia.
Restless legs syndrome and periodic limb movements can be triggered or exacerbated by antidepressants and other drugs used to treat mood disorders. (16) These medications can be helpful in patients without movement-related sleep disorders who suffer from hypersomnia.
Other medications such as older tricyclic drugs can help establish healthy sleep patterns in depressed patients with insomnia. Once a depressed patient starts taking medication, insomnia may be the last symptom to improve. Newer antidepressants such as selective serotonin reuptake inhibitors can suppress the REM stage of sleep, as well as the vivid dreaming that occurs during REM sleep.
Antipsychotic medications can help with insomnia, a common issue for schizophrenia sufferers. Some of these drugs can also cause daytime sleepiness, which may be preferable to insomnia. (17) Hypnotic medications are often prescribed along with antipsychotics, and may initially help with insomnia due to their sedative effects. However, many patients become tolerant of hypnotics or develop a rebound response, which can limit their usefulness for insomnia over the long-term.
Suicidal Behavior and Sleep
Suicidal behavior is a common feature of certain psychiatric conditions, including bipolar disorder and depression. Suicidal thoughts and actions can also occur in the absence of a psychiatric condition. Suicide is the second leading cause of death in people between 15 and 24. Suicide is more likely to be completed by people with access to guns.
Signs of suicidal thoughts and behavior may include the following:
Speaking about suicide or the desire to die
Feeling or talking about feeling hopeless
Researching ways to commit suicide
Appearing anxious or depressed
Excessive use of alcohol, or use of drugs
Exhibiting unusual behavior, such as rage, mood swings, or agitation
Suicidal behavior is often caused by psychiatric conditions, but may also be triggered by difficult life events, stress, loss of a loved one, or past trauma such as emotional, physical, or sexual abuse. Suicidal behavior is also more common in people suffering from post-traumatic stress disorder or chronic pain.
Recent research reveals that suicidal behavior and lack of sufficient sleep are related in adolescents and adults. (18) People who completed their suicidal actions were more likely to have suffered from insomnia, hypersomnia, or another sleep disturbance. Though further research is needed to better understand this link, existing studies reveal a strong association between mental health and sleep.
FAQ
Q: What is suicidal ideation?A: Suicidal ideation involves thinking about, planning, or considering suicide.
Last Word From Sleepopolis
Mental health is critically important to happiness and well-being. Research reveals a connection between mental illness and disturbed sleep, an association that may exist months or years before psychiatric symptoms appear.
Medications and other mental health treatments can help regulate sleep patterns, but may also cause or worsen insomnia, hypersomnia, and other sleep difficulties. Adjustment of medications or separate treatment of sleep issues can help establish healthy sleep patterns and improve quality of life for people suffering from mental health disorders.
References
Amy C. Watson, Self-Stigma in People With Mental Illness, Schizophrenia Bulletin, January 25, 2007
William Copeland Ph.D., Cumulative Prevalence of Psychiatric Disorders by Young Adulthood: A Prospective Cohort Analysis From the Great Smoky Mountains Study, Journal of the American Academy of Child & Adolescent Psychiatry, March 2011
Alan R. Teo, Social Relationships and Depression: Ten-Year Follow-Up from a Nationally Representative Study, Plos One, April 30, 2013
Peter J. Norton, Transdiagnostic models of anxiety disorder: Theoretical and empirical underpinnings, Clinical Psychology Review, August 2017
Martin B. Keller, MD, The Disruptive Behavioral Disorder in Children and Adolescents: Comorbidity and Clinical Course, Journal of the American Academy of Child & Adolescent Psychiatry, March 1992
Robert E Drake, et al. A systematic review of psychosocial research on psychosocial interventions for people with co-occurring severe mental and substance use disorders, Journal of Substance Abuse Treatment, January 2008
Tyrer P, Mulder R, Crawford M, Newton-Howes G, Simonsen E, Ndetei D, Koldobsky N, Fossati A, Mbatia J, Barrett B., Personality disorder: a new global perspective, World Psychiatry, February 2010
Krahn LE., Psychiatric disorders associated with disturbed sleep, Seminars in Neurology, March 25, 2005
Chiara Baglioni et al., Insomnia as a predictor of depression: A meta-analytic evaluation of longitudinal epidemiological studies, Journal of Affective Disorders, December 2011
Harvey AG, Talbot LS, Gershon A, Sleep Disturbance in Bipolar Disorder Across the Lifespan, Clinical Psychology, New York State Psychiatric Institute, April 8, 2012
Heidemarie Blumenthal, et al., The Links Between Social Anxiety Disorder, Insomnia Symptoms, and Alcohol Use Disorders: Findings From a Large Sample of Adolescents in the United States, Behavior Therapy, January 2019
Yaron Dagan, High prevalence of personality disorders among Circadian Rhythm Sleep Disorders (CRSD) patients, Journal of Psychosomatic Research, October 1996
Liu X, Buysse DJ, Gentzler AL, Kiss E, Mayer L, Kapornai K, Vetró A, Kovacs M., Insomnia and hypersomnia associated with depressive phenomenology and comorbidity in childhood depression, Sleep, January 30, 2007
Nutt D, Wilson S, Paterson L., Sleep disorders as core symptoms of depression, Dialogues in Clinical Neuroscience, September 2008
DeMartinis NA, Winokur A., Effects of psychiatric medications on sleep and sleep disorders, CNS and Neurological Disorders Drug Targets, February 6, 2007
Staner L., Sleep disturbances, psychiatric disorders, and psychotropic drugs, Dialogues in Clincal Neuroscience, December 7, 2005
Waite F, Myers E, Harvey AG, Espie CA, Startup H, Sheaves B, Freeman D., Treating Sleep Problems in Patients with Schizophrenia, Behavioural and Cognitive Psychotherapy, May 2016
Goldstein TR, Bridge JA, Brent DA., Sleep Disturbance Preceding Completed Suicide in Adolescents, Journal of Consulting and Clinical Psychology, February 17, 2010
Original article: https://sleepopolis.com/education/how-does-mental-health-affect-your-sleep/
Rose MacDowell
Rose is the Chief Research Officer at Sleepopolis, which allows her to indulge her twin passions for dense scientific studies and writing about health and wellness. An incurable night owl, she loves discovering the latest information about sleep and how to get (lots) more of it. She is a published novelist who has written everything from an article about cheese factories to clock-in instructions for assembly line workers in Belgium. One of her favorite parts of her job is connecting with the best sleep experts in the industry and utilizing their wealth of knowledge in the pieces she writes. She enjoys creating engaging articles that make a difference in people’s lives. Her writing has been reviewed by The Boston Globe, Cosmopolitan, and the Associated Press, and received a starred review in Publishers Weekly. When she isn’t musing about sleep, she’s usually at the gym, eating extremely spicy food, or wishing she were snowboarding in her native Colorado. Active though she is, she considers staying in bed until noon on Sundays to be important research.
Americans are getting more ZZZZs
Decline in reading and watching TV before bed and increasing opportunities to perform tasks online and from home could be why
January 18, 2018
University of Pennsylvania School of Medicine
Although more than one in three Americans still don't get enough sleep, a new analysis shows first signs of success in the fight for more shut eye. According to data from 181,335 respondents aged 15 and older who participated in the American Time Use Survey (ATUS) between 2003 and 2016, most Americans averaged an extra 7.5 hours of sleep each year over the 14-year period. The study, by researchers at the Perelman School of Medicine at the University of Pennsylvania, was published online this month in the journal Sleep.
The findings reveal that daily sleep duration increased by 1.4 minutes on weekdays and 0.8 minutes on weekends per year. At first glance, this may not seem like substantial progress. However, over the 14-year period it translates to 17.3 minutes more sleep each night, or 4.4 full days more sleep each year. This is the first study to show that sleep duration has increased among broad segments of the United States population (students 15 and older, people who are employed, and retirees) over this period. The increase in sleep duration was mostly explained by respondents turning in earlier at night, and to a lesser degree by getting up later in the morning.
In addition to sleep, the ATUS covers all waking activities over a 24-hour period and thus allowed Penn researchers to investigate behaviors that could be responsible for the increase in sleep duration. For example, over the 14-year period, fewer respondents decided to read or watch TV prior to bed in the evening, two prominent activities that compete with sleep for time.
"This shows an increased willingness in parts of the population to give up pre-bed leisure activities to obtain more sleep," said the study's lead author, Mathias Basner, MD, PhD, an associate professor of Sleep and Chronobiology in Psychiatry. "Also, the data suggest that increasing opportunities to work, learn, bank, shop, and perform administrative tasks online and from home freed up extra time, and some of it was likely used to get more sleep."
No significant sleep time trend was found for unemployed respondents or those not in the labor force, thus bringing attention to the difficulty of work/family balance and the finding that sometimes people sacrifice sleep to make the other two work. In earlier work, the Penn team identified time spent working as the #1 waking activity competing with sleep for time. Changes in time spent working were not found to play a substantial role in the increasing sleep time trend in this study, though.
The study also showed that the number of Google searches on the topic "sleep" has more than doubled and scientific publications on "short sleep" and its consequences has grown more than 10 fold from 2003 to 2016, and was highly correlated with the observed increase in sleep duration. Although the team says this does not prove causality, it gives hope that increasing awareness through reports of insufficient sleep and its consequences as well as campaigns to encourage healthy sleep -- such as the 2013 National Healthy Sleep Awareness Project -- may be working.
The dangers of short sleep are well documented. Earlier research by senior author David F. Dinges, PhD, chief of the division of Sleep and Chronobiology, showed that cognitive performance and vigilant attention decline quickly after being awake past 16 hours or if sleep is chronically curtailed, which increases the risk for errors and accidents. Also, additional studies have found associations between chronic short sleep and obesity, hypertension, diabetes, cardiovascular disease, and declines in cognitive function.
In 2015, the American Academy of Sleep Medicine and Sleep Research Society published a consensus statement that adults should sleep 7 or more hours per night on a regular basis to promote optimal health.
"As researchers, increasing awareness of short sleep and its consequences remains a critically important task to improve public health," said Basner. "At the same time, this data provides new hope that these efforts may be effective in motivating many Americans to sleep more."
The researchers caution that the findings need to be replicated and that there is still a long way to go in the fight against chronic, widespread sleep loss. Since the ATUS is a survey, more population research with objective measures of sleep is needed. The authors also add that an increase in reported "long sleep," i.e. for more than nine hours each night, of 0.48 percent/year over this 14-year period, calls for further research into the health effects of "long sleep."
https://www.sciencedaily.com/releases/2018/01/180118175315.htm
Cognitive Behavioral Therapy is an Effective Treatment for Chronic Insomnia
June 16, 2009
Science Daily/American Academy of Sleep Medicine
A majority of people experiencing chronic insomnia can experience a normalization of sleep parameters through the use of cognitive behavioral therapy for insomnia, according to new research.
Results indicate that 50 percent to 60 percent of participants with chronic sleep onset insomnia, sleep maintenance insomnia or both experienced remission of their primary sleep difficulty. Among the 64 participants who completed five or more treatment sessions, there were significant improvements on presenting complaints, as well as all other measures, including sleep efficiency, average nightly awakenings, total sleep time and average nights of sleep medication use per week.
The multi-component, CBT-I program included comprehensive evaluations of patients' habits, attitudes and knowledge concerning sleep. The program was designed to involve six to seven treatment sessions. Specific strategies included education on sleep regulating systems, sleep scheduling recommendations, sleep hygiene education, sleep consolidation therapy, stimulus control therapy, relaxation training, cognitive therapy and mindfulness training.
According to Wetzler, a related study found that of participants who completed at least four treatment sessions of CBT-I, 78 percent of those using sleep medication for three or more nights per week were able to completely discontinue use of sleep medications. Findings from this study indicate that those who discontinued use of sleep medications not only stopped using drugs to sleep but also slept better than when they were taking sleep medications.
http://www.sciencedaily.com/releases/2009/06/090609072709.htm
Chronic Insomnia Requires Increased Brain Activation to Maintain Daily Function
June 12, 2009
Science Daily/American Academy of Sleep Medicine
Patients suffering from chronic primary insomnia have higher levels of brain activation compared to normal sleepers during a working memory test.
According to a research abstract that will be presented on June 9, at Sleep 2009, the 23rd Annual Meeting of the Associated Professional Sleep Societies, patients suffering from chronic primary insomnia (PIs) have higher levels of brain activation compared to normal sleepers during a working memory test.
Results show that PIs use increased brain activation relative to good sleepers during the working memory task, particularly in areas responsible for visual-spatial attention and coordination of cognitive processes. This activation may explain how PIs maintain performance on the task despite their sleep difficulties. PIs also were found to have decreased activation in visual and motor areas, which may suggest that PIs have higher baseline activation in these regions relative to good sleepers.
http://www.sciencedaily.com/releases/2009/06/090609072811.htm
Adolescents with Chronic Insomnia Report 2x – 5x Increase in Personal Problems
March 23, 2008
Science Daily/University of Texas Health Science Center at Houston
Chronic insomnia is costing adolescents more than sleep. It’s been linked to a wide range of physical, psychological and interpersonal problems, according to public health researchers at The University of Texas Health Science Center at Houston, who completed the first prospective study of adolescents with persistent sleep problems.
Documenting a “twofold to fivefold” increase in personal problems among adolescents with persistent sleeplessness, public health researchers at The University of Texas Health Science Center at Houston say they have completed the first prospective study demonstrating the negative impact of chronic insomnia on 11 to 17 year olds.
More than one fourth of the youths surveyed had one or more symptoms of insomnia and almost half of these youngsters had chronic conditions. Findings appear in the March issue of the Journal of Adolescent Health and are based on interviews with 3,134 adolescents in metropolitan Houston.
http://www.sciencedaily.com/releases/2008/03/080320192339.htm
Service members diagnosed with chronic insomnia may face increased risk of type II diabetes, high blood pressure
November 4, 2014
Science Daily/Armed Forces Health Surveillance Center (AFHSC)
Service members diagnosed with chronic insomnia had a two times higher risk of developing hypertension and type II diabetes than military personnel who had not been diagnosed with the condition, according to a newly released health surveillance report of a study of the associations between these diseases.
Insomnia is a common complaint among service members due to career-related stress factors, such as frequent deployments with demanding military operations, varying work shifts, and the challenges of maintaining relationships with their spouses and families.
"This type of analysis has military relevance because it supports the notion that adequate sleep among our service members is important not only for accident prevention and work performance, but also for additional long-term health benefits," said Air Force Lieutenant Colonel Paul E. Lewis, the author of the study and a preventive medicine resident at the Uniformed Services University of the Health Sciences.
The association of chronic insomnia with hypertension was seen both in service members younger than 30 years of age and in those aged 30 years or older, with adjusted hazard ratios of 2.32 and 1.94, respectively. By gender, chronic insomnia had a stronger association with hypertension in men (adjusted hazard ratio of 2.17) than in women (adjusted hazard ratio of 1.59).
The adjusted hazard ratio was also greater for white, non-Hispanics (ratio of 2.26) than for black, non-Hispanics (ratio of 1.72). Both obese subjects and non-obese subjects had significantly increased risks of hypertension related to insomnia, with adjusted hazard ratios of 2.09 and 1.86, respectively.
Previous studies on this topic have provided conflicting results, with some demonstrating a strong association and others finding minimal to no association. There are several reasons why the findings of this study may not be directly comparable to studies in civilian populations. Military members are generally younger and have less co-morbidity than their civilian counterparts.
This analysis employed a longitudinal study design that allowed for follow-up of individuals over time, whereas many previous study designs did not allow evaluation between an exposure to a risk factor and a subsequent outcome. The average follow-up time was 3.09 years in the insomnia cohort and 3.42 years in the control cohort. These differences in methodology might partially explain the observed increased risks of hypertension and diabetes associated with chronic insomnia in this study but not seen in some other studies.
http://www.sciencedaily.com/releases/2014/11/141104111156.htm
Taking stock of research on sleepless soldiers
October 16, 2013
Science Daily/Springer
Various behavioral treatment options are helping to treat the sleeplessness experienced by American soldiers who have been deployed in recent military operations. A review of research has been done on deployment-related insomnia among military personnel and veterans, conducted since 2010.
Insomnia is reported by up to 54 percent of the two million men and women who have served in various American combat efforts since 11 September 2001, compared to up to 22 percent of civilian adults. Although it is possible that a person's insomnia may develop prior to joining the military, it can also occur during the service period, or post-deployment when the soldier returns to civilian life. Studies have found that deployment-related stressors like combat exposure, mild traumatic brain injury, irregular sleep/wake schedules and the adjustment of returning home, all contribute to sleeplessness.
Soldiers who suffer from insomnia while being deployed have a bigger chance of developing traumatic stress reactions such as depression and posttraumatic stress disorders, and even committing suicide. Also, it contributes to physical war-related injuries.
Behavioral interventions such as cognitive-behavioral therapy and imagery rehearsal therapy often yield positive results in trying to reduce the effects of insomnia and nightmares, respectively. These treatments can be delivered during in-person sessions with clinicians, brief follow up sessions via telephone, or online and mobile resources. Training was recently rolled out to prepare providers in the Veterans Health Administration to use cognitive behavioral treatment of insomnia.
The goal is to eventually educate 1,000 clinicians in an effort to bridge the gap between veterans who need treatment, and available providers. Training of clinicians in military settings and other non-VA clinics is equally important to meet the needs of our service members and veterans.
"Training providers to be knowledgeable about insomnia and behavioral treatment options is a vital component to the treatment of chronic insomnia and managing its impact on other disorders," say the authors, who believe more research is needed on methods to increase access to care.
"In addition to research and clinical efforts specifically for service members and veterans, research and clinical efforts directed at military family members are also important components in providing the care needed and promoting health and recovery among service members and their families."
http://www.sciencedaily.com/releases/2013/10/131016123732.htm