Why do we sleep? This is a question for which we don't have an exact and clear answer, but what we do know is that sleep has an important and necessary function for our bodies. We spend a third of our lives sleeping, that number might be enough to show the importance of sleep, otherwise we wouldn't sleep that long. What is known is that sleep has an important restorative function, that is, sleeping makes our body recover from the energies spent during the day, leading us to a framework of energy balance, benefiting our physical and emotional health.
We may not know for sure what the exact function of sleep is, but we know very well the effects that its lack has on our organism, don't we? Have you ever woke up grumpy and angry? Have you ever been sleepy and more tired than usual during the day? Have you ever had memory and attention problems when you needed to spend the night up? By then, we already have an idea that lack of sleep can lead to impairment of both our physical and our emotional health.
The relationship between sleep and mental health is complex and requires a broad understanding of the factors involved. It is also bidirectional, that is, both sleep problems can interfere with our emotional health, and our emotional and psychological condition can interfere with the quality of our sleep.
Sleep disorders, including insomnia, are among the most common and disabling symptoms in patients with some psychiatric disorder, such as depression and anxiety (1), as well as burnout syndrome and bipolar disorder. We can say that insomnia is the sleep disorder that is most associated with psychiatric disorders, as well as having a more evident relationship with mental health (2).
The most striking feature of insomnia is the difficulty in initiating or maintaining sleep or the existence of non-restorative sleep, causing discomfort to the patient or impairing their social and occupational functioning. The most frequent causes of insomnia are environmental, behavioral or psychological factors such as fear and anxiety.
Insomnia and depression
Another important relationship is between insomnia and depression. This relationship is also complex, but people with insomnia tend to have a higher level of depression and vice versa. According to a study on sleep in the general population of São Paulo (3), people who had chronic insomnia were four times more likely to have psychiatric symptoms when compared to people who had no complaints or sleep problems.
The opposite also happens: patients with depression, anxiety or other psychiatric illness may have alterations in their circadian rhythm of wakefulness/sleep, thus leading to a worsening of the condition presented. In patients with bipolar disorder, for example, sleep deprivation can lead to mania, and the presence of insomnia symptoms can indicate that the patient is moving from the depressive phase to the hypomanic phase (4). In these cases, it is necessary to manage sleep disorders in order to avoid worsening psychiatric symptoms.
Another important point to be taken into account when we talk about the relationship between sleep and mental health is the use of medication. Psychotropic drugs used in the treatment of psychiatric conditions, including antidepressants, generally change the structure of sleep, affecting its quality. Some neurotransmitters involved in the regulation of mood and motivation may have an abnormal regulation in patients with depression, thus contributing to sleep disorders in these patients (5).
Cognitive Behavioral Therapy (CBT)
Therefore, it is noted that the symptoms of insomnia or psychiatric symptoms are usually very distressing for the individual who experience such events. Thus, their identification and treatment can not only improve the severity and course of psychiatric illnesses, but also the quality of life and the quality of sleep.
The treatment of choice in most cases is Cognitive Behavioral Therapy (CBT), as there are dysfunctional behavioral and cognitive components that perpetuate the insomnia disorder, as well as the maintenance of psychiatric symptoms. CBT is effective when the patient has negative content beliefs about himself, others and the future, leading to bad feelings and, consequently, dysfunctional behaviors.
Tips to keep your mental health up to date
Thus, taking care of our sleep is taking care of our mental and physical health, so here are some tips to keep your mental health up to date and quality sleep.
· Do physical activity, even if you haven't had enough sleep, physical activity helps release substances that relax and give you pleasure;
· Try to have regular sleep times, especially when waking up, this can improve sleep onset at night;
· Stay in your routine during the week and on weekends, the brain needs synchronizers, this helps to regulate your biological rhythm;
· Expose yourself to the sun in the morning, but if you can't, look for sunnier places, the sun is a great ally for both sleep and our mind.
· Eat well, healthy eating is also important for well-being and quality of life, if necessary, look for a nutrition professional;
· Try to empty your mind, breathe, relax, these exercises calm down, reduce anxiety, thus improving your nights sleep.
· Do activities that give you pleasure, reserve a little time a week for yourself, it makes all the difference to your emotional health.
· And lastly, be light and flexible with yourself, it helps you cope with the burden of routine and day-to-day tasks.
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1 Becker PM. (2006). Insomnia: prevalence, impact, pathogenesis, differential diagnosis, and evaluation. (Review) Psychiatr Clin North Am.;29(4):855–870).
2 Pigeon, Wilfred R., Todd M. Bishop, and Kelsey M. Krueger. "Insomnia as a precipitating factor in new onset mental illness: a systematic review of recent findings." Current psychiatry reports 19.8 (2017): 44.
3 Castro LS, Poyares D, Leger D, Bittencourt L, Tufik S. Objective prevalence of insomnia in the São Paulo, Brazil epidemiologic sleep study. Ann Neurol 2013; 74(4): 537-46
4 Harvey, Allison G., et al. "Sleep-related functioning in euthymic patients with bipolar disorder, patients with insomnia, and subjects without sleep problems." American Journal of Psychiatry 162.1 (2005): 50-57.
5 Sousa. K.M.M, Piovezan. R. D, Poyares. D. Alterações de Sono na Depressão. In: Demência, depressão e sono: correlações complexas. Editora OMNIFARMA , 2019;