Understanding the impact of poor sleep on mental health

This month we discuss the importance of sleep on our mental health with Cognitive Behavioural Therapist, Steve Brown, at Priory Hospital Woodbourne.

Steve focuses on the adverse impact certain lifestyle choices can have on sleep quality, offers advice on the best types of treatment a patient experiencing poor sleep can undertake, and provides helpful tips for how to improve sleep hygiene.

Sleep is vital for healthy functioning and good mental wellbeing. However, it is reported that at least a third of the UK population experience poor sleep on a regular basis.

In 2017, The Sleep Council of Great Britain found that 12% of the population were sleeping for five hours or less – a 5% increase since 2013. In addition, 61% of the people surveyed felt that five to seven hours of sleep was the norm.

In the study, the top three reasons given for poor sleep were:

• Stress and worry
• Being disturbed by noise or a partner
• An uncomfortable bed

It is clear that lifestyle continues to have an adverse impact upon our ability to obtain good sleep. Findings from the 2017 study include:

• 25% of people admitted to using alcohol as a sleep aid – an increase of 9% from 2013
• 30% of people watch TV in bed – an 8% decrease from 2013
• 38% of people now use smartphones and go on social media in the bedroom
• The number of British couples who are choosing to sleep apart has increased from 8% to 12%
• 45% claim to exercise at least twice a week but 34% take no exercise in a week at all

Why is sleep so important?

The impact of persistent poor sleep can have devastating effects on the mind and body. For example, insufficient sleep has been linked to the development of Alzheimer’s disease.

During sleep, the brain turns on a ‘cleaning system’ called the glymphatic system, which cleanses the brain of a sticky toxic protein called beta amyloid. If this protein isn’t cleansed from the brain, the risk of such diseases increases.

It is suggested that routinely having less than six hours of sleep may compromise the immune system and also increase the risk of cancer. Loss of sleep, even two or three hours in a week, can disrupt blood sugar levels which can lead to a pre-diabetic condition and may contribute to diabetes if sleep loss persists.

Lack of sleep is also linked to cardiovascular disease, strokes and heart failure due to coronary arteries becoming blocked and brittle. It is suggested that working nights or irregular shift patterns may also shorten life expectancy.

Understanding the different types of thinking

There are two types of thinking that can make it difficult for us to get a good night’s sleep – rumination and worry.

Rumination

This is a mental process which involves repeatedly playing out scenarios from the past. When you play out such scenarios in your mind, you never really find a solution to the problem and you keep returning to the scenario and playing it out. This is likely to lead to you feeling anxious, low in mood and can keep you awake at night.

Worry

This differs from rumination because you are focusing on future events. You play out future scenarios in your mind and you might develop many scenarios. Or you might go over the same worry but refine it in some way.

Both rumination and worry can make us feel anxious and restless which, in turn, can keep us awake at night and impair our ability to sleep.  This can lead into a seemly endless vicious circle of worry and poor sleep.

What can you recommend to a patient experiencing poor sleep?

Medication

While it may be that hypnotic medication such as Zopiclone does have some benefit in assisting with obtaining sleep, they are only recommended as a short-term treatment (up to two weeks). If they are used long term, the effectiveness decreases and may even be responsible for re-bound insomnia.

Therapy

An effective alternative to medication are talking therapies such as cognitive behavioural therapy (CBT). The aim of this approach is to establish natural sleep without the aid of drink and drugs. This is done by helping to develop a sleep rhythm based on the person’s sleep requirements, synchronised with the body’s circadian rhythm, also known as a body clock.

There are two main ways someone can improve sleep with CBT – learning new behavioural approaches and addressing worries.

Behavioural approaches include:

Sleep hygiene

• Establish fixed times for going to bed and for waking up, 7 days a week (and resist the urge to sleep in after a poor night’s sleep)
• Maintain a comfortable sleeping environment: not too hot, cold, noisy or bright. Remove any clutter from the bedroom and don’t use the bedroom in the day time for resting
• Avoid napping during the day. However, an occasional short ‘power’ nap of no more than 20 minutes, can be restorative
• Avoid caffeine, nicotine, and alcohol within 6 hours of going to bed. Consider the complete elimination of caffeine from the diet
• Avoid exercise within 4 hours of bedtime (although exercise earlier in the day is beneficial)
• Avoid eating a heavy meal late at night
• Eliminate the use of all electronic devices in the bedroom and turn them off 1 hour before bed

Stimulus control

• Stimulus control is aimed at helping you to associate certain things with sleep and to weaken the stimuli that are cues for wakefulness
• Associate your bed and bedroom with sleep
• Establish at least 1-hour wind-down routine before your regular bed-time to prepare physically and mentally for sleep. This may include preparing for the next day or engaging in relaxation or mindfulness
• Switch off the lights with the intention of going to sleep. If after 15-20 minutes, you haven’t fallen asleep, do something relaxing like reading a book
• Avoid tossing and turning in bed. Use a relaxation technique such as mindfulness if you find that you are tossing and turning in the night
• If you just cannot drop off, get up and do something relaxing in another room. Try to avoid doing anything overly stimulating, such as watching TV. Go back to bed when you feel sleepy with intention of going to sleep
• If you wake during the night avoid clock watching