We have come a long way from the institutional care that many still associate with mental illness. In the last twenty years treatment and support has been transferred into the community and drug and psychotherapy have been transformed.
Current estimates claim that 1 in 4 people experience mental health problems during their lifetime. Depression affects 10% of the UK population and it is likely that most people will have some personal experience or know someone who has been affected by mental health problems during their lifetime.
Studies have also tried to assess how many people suffer from sleep problems. Statistics vary but one study on mental health showed that insomnia concerned more people than other mental health problems including irritability and depression. This suggests that people are increasingly dissatisfied with the quality of their sleep and are aware of how it affects how they feel. There is also a growing interest is what makes us happy and content. The demand for courses and therapies that help increase a sense of ‘wellness’ and fulfilment suggests that many people are looking outside the material world for a sense of purpose.
There are physical and psychological causes of insomnia. Assessing the problem and finding the cause is the first step towards finding the right solution. Sometimes there is more than one cause or no definable reason for the problem. Physical causes may include Sleep Related Breathing Disorders, Circadian Disorders, Parasomnias such as Sleepwalking, Restless Limb Movements or Hypersomnia…
Secondary Insomnia may affect those suffering from illness or pain that makes it difficult to fall or stay asleep.
Brain and Sleep
Insomnia or other sleep problems, such as sleeping too much, are associated with mental health problems such as Anxiety and Depression. In fact sleep is unlikely not to be affected by mood and distress. Sleeping Pills, antidepressants and stimulants all affect the body and minds ability to find the right balance between sleep and waking. Insomnia also increases with age.
Many people underestimate the amount of sleep they have each night. The only way to accurately measure how many hours sleep is in a sleep laboratory, but the fact that sufferer’s feel that they are missing out on sleep suggests that the mind is affected by the need for sleep.
The link between sleep and depression is well established. Which comes first is hard to define, but lack of sleep can cause mood changes and may precipitate the development of a depressive disorder.
Sleep problems are also a symptom of depression. Even mild depression can cause sleep disturbance, from oversleeping to wakefulness, and in severe cases the inability to leave the security of the bedroom.
It may be helpful to try and identify whether the insomnia developed with the depression or if they are separate. Effective treatment will help ease both problems and there are a number of ways including drug therapy, psychotherapy, and mind/body therapies that can help recovery.
Stress and anxiety are two of the main reasons for Insomnia. The hormonal changes, tension and activity in the brain mean that it is almost impossible to fall and stay asleep. Anxiety can manifest itself in a number of ways including compulsive repetitive behaviour, panic attacks or just a feeling of unease and feeling on edge.
The physiological changes in the body that accompany anxiety including shortness of breathe increased blood pressure and heart rate, and muscle tension. Similar to depression, the symptoms of anxiety may include difficulty in sleeping. It may also be the lack of sleep that is causing the anxiety. It may not be possible to separate the two but with treatment sufferers may find that when the anxiety eases their sleep problems disappear.
Children and Sleep
A recent study looked at a possible connection with children with sleep related breathing disorders and behaviour problems. Difficulty in sleeping, especially when accompanied by snoring, showed a connection with problems in concentration, learning difficulties and behavioural difficulties… This suggests that there is a connection with sleep and mental development and learning.
The relationship between sleep and its affect on the mind is evident when sleep is forcefully removed. Sleep deprivation has been used as a form of torture for centuries. Experiments have also shown that being forcefully kept awake causes feelings of disorientation and loss of concentration.
Being deprived of sleep, victims lose the ability to act and think coherently and start to suffer from hallucinations and waking dreams.
Many people, especially teenagers are voluntarily not having enough sleep to meet there needs. Long term lack of sleep causes problems with concentration, learning and coordination. Shift workers also suffer from lack of sleep and are at increased risk of accidents and mood disturbance.
Despite recommendations that Sleeping Pills should only be prescribed for severe insomnia and for short term use, they are still frequently prescribed and many people suffer from the affects of withdrawal.
The resulting dependence and withdrawal from long term use of sleeping pills differs between individuals. Symptoms may include increased anxiety and depression and in difficulty in sleeping. In severe cases symptoms can include hallucinations, confusion, paranoia and fits.
Withdrawal may take weeks or even months and should be done gradually with the support of a GP. The possibility of distressing physical and emotional symptoms means that many people stay dependent on the pills long after their effectiveness has diminished.
Help and Support
The connection between sleep and mood means that it is hard to treat one without the other. Sadly, drug treatments for insomnia, depression and other mood related disorders may also cause the development or an increase in the sleep problem. More positively, effective treatment may help the condition and life will be back in balance.
GPs are encouraged to restrict sleeping pills for short term use. Unfortunately they are often unable to provide the time, counselling and other therapies that have been shown to be effective in treating insomnia and sleep problems. Self help organisation and helplines are good resources for providing information and support to anyone affected by a mental health problem. Pharmacists will provide information and advice on prescriptive drugs and over the counter remedies.
It is important to discuss problems and seek help as early as possible. Doctors, employers, and others are becoming more aware and accepting of mental health problems. Intervention and support at an early stage can help identify the problem and prevent an escalation of symptoms.