SLEEP ISSUES AND MENTAL HEALTH

Sleep and mental health have a close and complex connection.Most people are aware of how sleep impacts their mental condition. After all, there's a reason why a bad mood is said to have "woken up on the wrong side of the bed."As it turns out, there's a lot of truth to this popular saying. Sleep is intimately linked to mental and emotional health, including linkages to depression, anxiety, bipolar disorder, and other illnesses.While research on the links between mental health and sleep is ongoing, data to date suggests a bidirectional relationship. Sleeping problems are often worsened by mental health issues. At the same time, inadequate sleep, especially insomnia, can contribute to the onset and development of mental health disorders.

HOW IS SLEEP RELATED TO MENTAL HEALTH?

During sleep, brain activity fluctuates, increasing and decreasing across the several sleep stages that comprise the sleep cycle. Each stage contributes to brain health by allowing activity in various sections of the brain to ramp up or down, allowing for greater thinking, learning, and remembering.

According to research, brain activity during sleep has a significant impact on emotional and mental health.Sufficient sleep, particularly rapid eye movement (REM) sleep, helps the brain process emotional information. The brain works during sleep to analyse and store thoughts and memories, and it appears that a lack of sleep is particularly detrimental to the consolidation of pleasant emotional content. This can affect mood and emotional reactivity and is linked to the severity of mental health conditions.

As a result, the old opinion that sleep issues were an indication of mental health illnesses is being challenged more and more. Instead, it is becoming obvious that there exists a bidirectional relationship between sleep and mental health, i.e. sleeping issues are both a cause as well as a consequence of mental health issues. More research is needed to determine the various connections between sleep and mental health, as well as how their complicated interaction can be altered by a variety of elements in each individual's instance.

Obstructive sleep Apnea(OSA) is another element of sleep that has been connected to mental health. OSA is a sleep condition characterised by pauses in breathing and a decrease in the body's oxygen levels, resulting in fragmented sleep.OSA is more common in those who have psychological disorders and may harm their physical health while increasing their chance of major emotional discomfort.

TABLE OF CONTENTS

1.Importance of sleep

2.Consequences of not getting enough sleep

3.Relation between sleep and development of specific mental health conditions and neuro developmental disorders

4.Sleep Apnea

5.What are sleep disorders? and type of sleep disorders

6.How does lack of sleep affect mental health?

7.Benefits of sleep on overall health

8.Ways to improve both sleep and mental health.

IMPORTANCE OF SLEEP

Sleep is a basic human requirement that is essential for both physical and mental wellbeing. There are two types of sleep that typically occur in three to five cycles every night:

• Rapid eye movement (REM) is the most common type of dreaming
• Non-REM sleep has three stages, including deep sleep.

It is also crucial to consider when you sleep. Your body operates on a 24-hour cycle (circadian rhythm) that helps you determine when to sleep.How much sleep we require varies with age and from person to person. As stated by the National Sleep Foundation, "most adults require seven to nine hours of uninterrupted sleep per night.' The Foundation amended its sleep recommendations in 2015 based on a thorough evaluation.

Many of us are sleep deprived. Nearly 30% of people sleep for less than six hours per night, while only approximately 30% of high school kids sleep for at least eight hours on a typical school night.2 An estimated 35% of Americans rate their sleep as "poor" or "only fair."Over 50 million Americans suffer from chronic sleep disorders.

CONSEQUENCES OF NOT GETTING ENOUGH SLEEP

?sleep problems can cause changes in mental health, while mental health issues may worsen sleep problems. Sleep deprivation can lead to the onset of some psychological problems, while researchers are unsure of the underlying causes.Because of the inverse association between sleep habits and mental health, it is critical to consult a doctor if you are experiencing difficulty getting or staying asleep.

1.BRAIN FOG- Our brains require sleep in order to function properly. Sleep deprivation can cause brain fog, which commonly manifests as disorientation or difficulty concentrating. When you haven't had enough sleep the night before, you may find it more difficult to recall particular events or find the appropriate words for what you want to say.5 You'll definitely struggle to be productive—the thought of certain chores might be absolutely overpowering when your brain hasn't gotten a full night's rest.

2.MOOD CHANGES- Sleep deprivation can lead to mood swings, including irritation. As a result of sleep loss, participants in one study reported emotions of worry and sadness.According to research, a lack of sleep can contribute to heightened levels of rage and violence. Because the brain cannot operate correctly while sleep-deprived, it is unable to regulate the responsiveness of the amygdala (the brain's emotional centre).

3.BEHAVIOUR CHANGES- Unusual behaviours may accompany changes in mood. Sleep deprivation can result in increased impulsivity, hyperactivity, and emotional outbursts. When we are sleep deprived, we may find it difficult to interact with others.You may act erratically and have a short fuse—perhaps you rage at someone at work for making a mistake, or you leave the room altogether if someone says something that irritates you.

4.STRESS- Even moderate stress can be made much more difficult to handle if you don't get enough sleep. Daily annoyances can quickly escalate into huge sources of annoyance. Everyday happenings may cause you to get stressed.Even thinking about your poor sleep quality might be stressful. You understand the need of getting a good night's sleep, but you fear that you won't be able to fall or stay asleep (which can also keep you up at night).

5.PSYCHOTIC SYMPTOMS- Severe sleep deprivation has been associated to the emergence of temporary psychotic symptoms. According to one study, some people who went 24 hours without sleep had hallucinations and other perceptual modifications, while others who lasted 60 hours without sleep had both hallucinations and delusions.

RELATION BETWEEN LACK OF SLEEP AND DEVELOPMENT OF SPECIFIC MENTAL HEALTH CONDITIONS:-

1.DEPRESSION:

Insomnia and other sleep issues can be symptoms of sadness, but recent study has linked a lack of sleep to depression itself.According to one meta-analysis of 21 different research, those who have trouble sleeping are twice as likely as those who don't to develop depression.The question then is whether assisting people in improving their sleep may reduce their chances of developing depression.

SEASONAL AFFECTIVE DISORDER- Seasonal affective disorder is a type of depression that most commonly affects people during the winter months when there are fewer daylight hours. People in northern climates, for example, may suffer from seasonal affective disorder in the autumn and winter.The interruption of a person's internal biological clock, or circadian rhythm, which helps manage many bodily processes, including sleep, is intimately linked to this disorder. Not unexpectedly, patients with seasonal affective disorder tend to sleep too much or too little, or their sleep cycles fluctuate.

2.ANXIETY:

People who suffer from anxiety have greater sleep problems, but sleep deprivation can also lead to anxiety symptoms. This can create a vicious cycle, perpetuating both sleep and anxiety problems.Furthermore, sleep disturbances appear to be a risk factor for the development of anxiety disorders. One study discovered that sleep issues were a predictor of generalised anxiety disorder in children and adolescents aged nine to sixteen.Those who have sleep disorders are more prone to acquire an anxiety disorder, especially if their sleep problems are protracted and untreated.

3.POST TRAUMATIC STRESS DISORDER(PTSD):

Sleep deprivation is not only a prevalent symptom of post-traumatic stress disorder (PTSD), affecting 80% to 90% of those suffering from the disease, but it is also thought to play a role in both the start and maintenance of the disorder.

4.BIPOLAR DISORDER:

People with bipolar disorder frequently experience sleep difficulties. Insomnia, inconsistent sleep-wake cycles, and nightmares are examples of such issues.Sleep alterations can be a sign of the disorder, but they can also affect the course of the ailment, treatment outcomes, and an individual's general quality of life.Manic or hypomanic symptoms might be aggravated by a lack of sleep.11 If you have bipolar disorder, talk to your doctor about any sleep problems you are experiencing.

5.ADHD:

Attention deficit hyperactivity disorder (ADHD) is a prevalent psychiatric illness that affects up to 5.3% of children aged six to seventeen.ADHD is related with sleep issues, and evidence suggests that sleep difficulties may be a predictor or possibly a contributor to ADHD symptoms. According to studies, between 25% and 55% of children with ADHD suffer sleep problems.

6.EATING DISORDERS:

According to research, most people with eating disorders (EDs) have interrupted sleep; nevertheless, additional research is needed to fully understand the association between EDs and sleep. While insomnia may raise the chance of developing an eating disorder, having an eating disorder may also cause sleep disruption.According to one study, people with anorexia binge-eating/purging had much worse sleep quality than those with anorexia restricting, implying that therapy for eating disorders should focus on increasing sleep, particularly for those who purge.

7.SCHIZOPHRENIA:

Schizophrenia is a mental illness characterised by difficulty distinguishing between what is and is not real. Insomnia and circadian rhythm abnormalities are more common in people with schizophrenia. Medications used to treat schizophrenia may increase sleeping issues. Poor sleep and schizophrenia symptoms may be mutually reinforcing, thus there may be benefits to stabilising and normalising sleep patterns.

8. AUTISM SPECTRUM DISORDER:

Autism Spectrum Disorder (ASD) refers to a group of neurodevelopmental abnormalities that impact communication and social interaction. These disorders are typically diagnosed in childhood and can last into maturity.Sleep issues, such as insomnia and sleep-disordered breathing, are more common in children and adolescents with ASD. These challenges are more chronic than sleeping problems in children who do not have ASD, and they can contribute to a worsening of symptoms and quality of life in persons who have the disease. Insomnia and other sleep disorders are key components of therapy because they may reduce excessive daytime drowsiness as well as other health and behavioural issues in people with ASD.

SLEEP APNEA

Breathing disruptions during sleep are a symptom of obstructive sleep apnea. Sleep apnea is characterised by frequent bouts of airway obstruction during sleep, resulting in snoring, snorting/gasping, or breathing pauses. This disrupted sleep results in daytime tiredness and fatigue. A clinical sleep study is used to identify sleep apnea. During a sleep study (polysomnography), the number of obstructive apneas (absence of airflow) or hypopneas (decrease in airflow) is counted.Sleep apnea is estimated to affect 2 to 15% of middle-aged people and more than 20% of elderly persons.1 Obesity, male gender, and a family history of sleep apnea are major risk factors for sleep apnea.Changes in lifestyle, such as decreasing weight if necessary or sleeping on your side, can help to improve sleep apnea. In some circumstances, a custom-fit plastic is required.. A custom-fit plastic mouthpiece can assist maintain airways open during sleep in some circumstances. A dentist or orthodontist can create the mouthpiece. A doctor can prescribe a CPAP (continuous positive airway pressure) equipment for moderate to severe sleep apnea. The CPAP works by softly pushing air through a tube and face mask that covers your mouth and nose to keep your airways open.

• CENTRAL SLEEP APNEA- The brain does not effectively manage breathing during sleep in central sleep apnea, causing breathing to start and stop. It is diagnosed when a sleep study reveals five or more central apneas (breathing pauses) per hour of sleep. Central sleep apnea is uncommon and less common than obstructive sleep apnea. It can be addressed while sleeping with a CPAP or other equipment.
• SLEEP RELATED HYPOVENTILATION-Sleep-related hypoventilation includes episodes of shallow breathing, increased blood carbon dioxide levels, and low oxygen levels during sleeping. It is commonly associated with medical disorders such as chronic obstructive pulmonary disease (COPD) or the use of medications or substances. Those who suffer from sleep-related hypoventilation frequently experience insomnia or excessive daytime sleepiness. Medical disorders such as obesity and hypothyroidism, as well as the use of certain drugs such as benzodiazepines and opiates, are risk factors for sleep-related hypoventilation.

WHAT ARE SLEEP DISORDERS? TYPES OF SLEEP DISORDERS

Sleep disorders (or sleep-wake disorders) are difficulties with sleep quality, timing, and quantity that cause daily distress and impairment in functioning.Obstructive sleep apnea, parasomnias, narcolepsy, and restless leg syndrome are examples of other sleep-wake disorders.Sleep problems are linked to both physical and emotional issues. Sleep issues can both contribute to or exacerbate mental health difficulties, as well as be a sign of other mental health issues.About one-third of persons suffer symptoms of insomnia, and 6-10% match the criteria for insomnia disorder.

Types of sleep disorders include:

1.Non-Rapid Eye Movement Sleep Arousal Disorders- Non-rapid eye movement (NREM) sleep arousal disorders are characterised by bouts of incomplete awakening from sleep, which typically occur during the first third of a large sleep cycle and are followed with sleepwalking or sleep terrors.Sleepwalking is characterised by frequent experiences of rising from bed and moving around during sleep. The individual has a blank, staring face during sleepwalking, is relatively unresponsive to others, and is difficult to rouse up. Almost one-third of people have experienced sleepwalking at some point in their lives.Sleep terrors (also known as night terrors) are occurrences of waking up unexpectedly from sleep, generally with a panicked scream. the individual feels extreme fear and exhibits physical symptoms such as rapid gasping, an increased heart rate, and sweating.

2.Nightmare Disorder-Nightmare disorder is characterised by recurring instances of long, stressful, and vivid dreams that frequently include attempts to evade threats or danger. They usually happen during the second portion of a large sleep session.Nightmares are often long, detailed, story-like sequences of dream images that appear to be real and produce anxiety, terror, or misery. People who have nightmares are often attentive when they wake up and can explain their dreams in detail. The dreams cause severe anxiety or interfere with daily functioning. Nightmares commonly begin between the ages of three and six years, but they are most common and severe in late adolescence or early adulthood.

3.Rapid Eye Movement Sleep Behaviour Disorder- Rapid eye movement (REM) sleep behaviour disorder is characterised by episodes of alertness during sleep that are accompanied by speaking and/or activity. The person's actions are frequently reactions to events in the dream, such as being attacked or attempting to flee a dangerous situation. Speech is frequently loud, emotional, and profane. These behaviours (such as falling, jumping, or flying out of bed; running, hitting, or kicking) may pose a serious problem for the individual and their bed partner and may cause serious damage. When the person awakens, he or she is immediately attentive and frequently recalls the experience.These behaviours frequently occur more than 90 minutes after falling asleep and occur during REM sleep. The behaviours involve self- or other-injury and significantly disrupt daily functioning.

4.Hypersomnolence Disorder-Even after having at least 7 hours of sleep, people with hypersomnolence condition are extremely drowsy. They exhibit at least one of the following signs:

• Recurrent sleep periods or sleep lapses throughout the same day (for example, unintentional naps while attending a lecture or watching TV)
• Not feeling rested after sleeping more than nine hours every day
• Difficulty remaining fully awake after a sudden awakening

For at least three months, the excessive tiredness happens at least three times per week. Individuals with this problem may struggle to wake up in the morning, seeming foggy, disoriented, or belligerent (a condition known as sleep inertia). Sleepiness causes substantial distress and can lead to functional concerns such as poor concentration and memory.The disorder usually develops in the late teens or early twenties, but it may not be detected for several years.

5.Narcolepsy-People with narcolepsy have spells of uncontrollable sleepiness or numerous lapses into sleep during the day.Sleepiness happens on a daily basis, but it must occur at least three times each week for at least three months to be diagnosed with narcolepsy. Cataplexy, a short loss of muscle tone caused by laughter or joking, occurs in people with narcolepsy. This can cause head swaying, jaw drops, and falls. During cataplexy, people are awake and aware.Narcolepsy is almost usually caused by a loss of hypothalamic hypocretin (orexin)-producing cells. A lumbar puncture (spinal tap) can be used to test for hypocretin insufficiency using cerebrospinal fluid. Narcolepsy is uncommon, affecting around 0.02%-0.04% of the overall population. It usually starts in childhood, youth, or young adulthood.

6.Restless Leg Syndrome: Restless legs syndrome is characterised by an impulse to move one's legs, which is commonly accompanied with unpleasant sensations in the legs, such as creeping, crawling, tingling, burning, or itching.

The desire to move one's legs:

• starts or gets worse during periods of relaxation or inactivity;
• is partially or completely eased by movement;
• and is worse in the evening or at night than during the day, or happens only at night.

The symptoms appear at least three times per week, last at least three months, and cause severe distress or difficulties in everyday functioning. Restless legs syndrome symptoms can make it difficult to fall asleep and frequently wake the sufferer up, leading to daytime sleepiness.Restless legs syndrome usually appears in a person's teens or twenties and affects 2% to 7.2% of the population.

7.Circadian Rhythm Sleep-Wake Disorders: Circadian rhythm sleep-wake disorders cause an imbalance of a person's sleep-wake rhythms (body clock) and the environmental light-darkness cycle. This misalignment causes major persistent sleep issues and intense drowsiness during the day, resulting in significant distress or functional problems.Circadian rhythm problems can be caused by either internal (a person's body clock differs from the light-dark cycle) or external (shift work or jet lag).In the general population, the prevalence of delayed sleep phase type (staying up late and getting up late) is roughly 0.17%, while it is predicted to be larger than 7% in adolescents.

HOW DOES LACK OF SLEEP AFFECT MENTAL HEALTH?

Sleep deprivation has been related to a range of negative health outcomes, including heart disease and type 2 diabetes.When you don't get enough quality sleep, your body has less time to recover during the night. This can also reduce your body's resistance to diseases and medical disorders. But what effect does sleep have on mental health.Some psychiatric ailments can interfere with sleep, and sleep abnormalities can increase the symptoms of many mental illnesses, including depression, anxiety, and bipolar disorder.According to research, the relationship between sleep and mental health is complicated. While sleep deprivation has long been recognised as a symptom of many psychiatric diseases, newer research suggests that it can also play a causative role in the development and maintenance of several mental health problems.In other words, sleep problems can cause changes in mental health, while mental health issues can exacerbate sleep problems. Sleep deprivation can lead to the onset of some psychological problems, while researchers are unsure of the underlying causes.Because of the inverse association between sleep habits and mental health, it is critical to consult a doctor if you are experiencing difficulty getting or staying asleep.

BENEFITS OF SLEEP ON OVERALL HEALTH

1.Strengthens your heart

2.Boosts your mood

3.Regulates your blood sugar

4.Improves creativity and problem solving skills

5.Reduces stress levels

6.Decreases inflammation

7.Increases life expectancy

8.Lowers the likelihood of depression and other mental health disorders

9.Increases energy and alertness

WAYS TO IMPROVE BOTH SLEEP AND MENTAL HEALTH

Because each person's condition is unique, the best treatment for mental health and sleep issues is unique to them. Because these disorders can have a significant influence on one's quality of life, it's critical to get the correct care, which includes consulting with a competent health expert.A medical doctor or psychiatrist can discuss the benefits and hazards of various treatments, including prescription drugs. They can give individualised care, even when there are several co-occurring physical or mental health conditions. For example, detecting and treating an underlying problem such as obstructive sleep apnea may have mental health advantages.If you've been having trouble sleeping or are experiencing extreme daytime sleepiness, consult a doctor about your treatment options. A doctor may advise:-

• CBT-I (cognitive behavioural therapy to treat insomnia): CBT-I is similar to CBT in that it focuses on reducing insomnia. A therapist will assist you in addressing the thoughts and feelings that may be preventing you from falling or staying asleep. You'll discover relaxing techniques to help you prepare for sleep.
• Sleep Studies: ?sleep study is when you sleep in a controlled environment, similar to a bedroom, while doctors analyse your brain waves, heartbeat, eye movements, and other factors. They can also tell you whether you have a sleep disorder like sleep apnea or restless legs syndrome.
• Over-the-counter sleep aids: Some people find over-the-counter (OTC) sleep aids, such as melatonin, to be beneficial. Melatonin, on the other hand, should only be used for a limited amount of time. Before using, contact with a doctor and report any odd side effects (such as dizziness or confusion) to a doctor right away.
• Sleep medication: In some situations, a doctor may prescribe a sleep medication to help you get a good night's sleep. Because of the potential for adverse effects and reliance, it is generally recommended that you do not use these medications for more than a few weeks, so use them only under the supervision of a doctor and report any odd side effects.

IMPROVING SLEEP HABITS

In addition to seeking medical attention, there are activities you may take on your own to enhance your sleep and overall health. Good sleep hygiene, or sleep-supportive practises, are essential for remaining refreshed and avoiding daytime sleepiness. Certain things one can include in daily life to improve sleep include-

• Finding ways to unwind, such as through relaxation techniques, as part of a regular nighttime routine
• In the evening, avoid alcohol, smoke, and caffeine.
• Dimming lights and putting electronic gadgets away for an hour or more before going to bed
• Regular activity and exposure to natural light during the day
• Blocking out excessive light and sound that could interfere with sleep
• Limit your naps.
• Create a nightly routine.
• Caffeine intake and similar stimulants should not be taken too close to bedtime.
• Consume alcohol in moderation.
• Turn off all electronic gadgets before going to bed.

REFRENCES-

https://www.psychiatry.org/patients-families/sleep-disorders/what-are-sleep-disorders

https://www.sleepfoundation.org/mental-health

https://www.verywellmind.com/how-sleep-affects-mental-health-4783067