24 February 2024 , 07:28
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Experts have warned how problems associated with sleep could actually be linked to an increased risk in mental health issues.
A review of recent research shows trouble sleeping can cause or worsen a range of serious psychiatric disorders. The review, published in the journal Proceedings of the National Academy of Sciences (PNAS), suggests understanding the relationship between sleep, the internal body clock - known as circadian rhythms - and mental health could unlock new holistic treatments.
An international team from the University of Southampton, as well as Kings College London, Stanford University in the US and other institutions explored recent evidence on sleep and circadian factors, focusing on teenagers and young adults with psychiatric disorders. This period is when people are most at risk of developing mental health disorders and when disruption to sleep and circadian rhythms are likely to occur.
The researchers found insomnia is more common in people with mental health disorders than in the general population . It affected them during remission, acute episodes and especially in early psychosis, where difficulty falling and staying asleep affects more than half of patients. Around a quarter to a third of people with mood disorders have both insomnia and hypersomnia. In these circumstances patients find it hard to sleep at night, but are sleepier in the daytime. Similar proportions of people with psychosis experience the same combination of sleep disorders.
The few studies looking at circadian rhythm sleep-wake disorders (CRSWD) suggest that 32% of patients with bipolar disorder go to sleep and wake later than usual, a condition known as Delayed Sleep-Wake Phase Disorder.
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Body clock processes have been reported to run seven hours ahead during manic episodes and four to five hours behind during the depressive phase. Timing is normalised on successful treatment. The research team examined the possible causes of sleep-circadian disturbances in psychiatric disorders. During adolescence, physiological changes in how we sleep combine with behavioural changes - such as staying up later, getting less sleep on school nights and sleeping in on weekends.
Getting less sleep during the week and sleeping in on weekends can impact body rhythms (Getty Images/iStockphoto)Dr Sarah Chellappa, senior author, from the University of Southampton, said: “Sleep-circadian disturbances are the rule, rather than the exception, across every category of psychiatric disorders. Sleep disturbances, such as insomnia, are well understood in the development and maintenance of psychiatric disorders, but our understanding of circadian disturbances lags behind. It is important to understand how these factors interact so we can develop and apply sleep-circadian interventions that benefit the sleep and mental health symptoms of patients.”
Review co-leader Dr Nicholas Meyer, of King's College London, said: “This variability in the duration and timing of sleep can lead to a misalignment between our body clock and our sleep-wake rhythms can increase the risk of sleep disturbances and adverse mental health outcomes.”
Researchers also looked at the role of genes, exposure to light and other possible factors. Those with a genetic predisposition towards a reduced change in activity levels between rest and wake phases are more likely to experience depression, mood instability, and neuroticism. Surveys showed self-reported time outdoors was associated with a lower probability of mood disorder. Sleep is thought to play a key role in how the brain forms new neural connections and processes emotional memories.
Struggling with sleep can prompt other disorders (Getty Images)Review co-leader Dr Renske Lok, of Stanford University, said: “Targeting sleep and circadian risk factors presents the opportunity to develop new preventative measures and therapies. Some of these are population-level considerations, such as the timing of school and work days, or changes in the built environment to optimise light exposure. Others are personalised interventions tailored to individual circadian parameters.”
Meanwhile, Cognitive Behavioural Therapy for Insomnia (CBT-I) has been shown to reduce anxiety and depressive symptoms, as well as trauma symptoms in people experiencing PTSD. In unipolar and bipolar depression, light therapy - delivered upon waking in the morning - was effective compared with a placebo. Using it in combination with medication was also more effective than using medication alone. Other findings suggest light is effective in treating perinatal depression.
The timing of medication, meals and exercise could also impact circadian phases, according to the the review. Nightshift work can adversely affect mental health, but eating in the daytime rather than during the night could help - showing daytime eating prevents mood impairment. Dr Chellappa added: “Collectively, research into mental health is poised to take advantage of extraordinary advances in sleep and circadian science and translate these into improved understanding and treatment of psychiatric disorders.”