Researchers find lack of sleep can contribute to mental health problems

Nicola Davis
The Guardian
Wed, 06 Sep 2017 15:59 UTC

Mental health problems including psychotic experiences could in part be down to a lack of sleep, researchers have revealed.

A new study found that people who had undertaken a course of cognitive behavioural therapy (CBT) designed specifically to treat insomnia not only found their sleep improved, but also experienced reduced paranoia and fewer hallucinations - both psychotic experiences - as well as improvements in depression and anxiety.

"The dominant view is that sleep [problems are] either a symptom of several mental health problems or it is a secondary consequence," said Daniel Freeman, co-author of the research from the University of Oxford. "Really, sleep is one of the contributing causes."

Writing in the journal Lancet Psychiatry, a team of researchers from institutions across the UK describe how they examined the link between sleep and mental health using online surveys to quiz students from 26 universities up and down the country. Individuals were invited to take part in the study if they were found to have insomnia after answering a web-based questionnaire

In total more than 3,700 students signed up to the study, with participants randomly split between two groups - those who were offered an online course of six 20-minute sessions of CBT directed at tackling insomnia, and those who received no treatment. Both groups undertook online assessments at the start of the study and after three weeks, 10 weeks and 22 weeks.

The results reveal improvements in both sleep and mental health were greater for members of the CBT group.

After taking into account effects not linked to treatment - as deduced from the no-treatment group - insomnia in the CBT group was found to have fallen by almost half 10 weeks into the study, while both anxiety and depression dropped by a fifth, and paranoia and hallucinations fell by 25% and 30% respectively.

"Having insomnia doubles your chances of developing depression and we now know that if you treat the insomnia it reduces depression," said Freeman.

While symptoms of mania increased among those in the sleep treatment group, the team say that could actually reflect increased wellbeing, since assessments for mania probe factors such as cheerfulness and self-confidence.

However the authors admit that the drop out rate was high at about 50%, with just 18% of those in the treatment group accessing all six CBT sessions. But, they add, a number of different scenarios were considered for those who quit the study, including that their mental health issues continued to change in line with those who remained in the study, or that they became worse, with all scenarios giving rise to the same conclusions.

"It is very clear that even despite there being a lot of drop-out, you can still see the pattern emerge," said Freeman, adding that the study also underlined the link between sleep and mental health was two-way, with psychotic experiences affecting sleep - albeit to a smaller degree.

While most participants did not have clinically diagnosed mental health disorders, the team say they believe insomnia is also likely to be a contributing factor for severe psychological problems.

"The realistic view of mental health problems is that there is a spectrum of severity and all the evidence we have is that the causes and the treatments are similar across the spectrum," said Freeman.

The upshot, he says, is that insomnia-focused CBT programmes could do much more than help individuals sleep.

"There is good news here: [insomnia] is something that can be treated, and not only does the distressing sleep problem itself improve, but there are knock-on benefits to a number of areas of your psychological health," said Freeman, adding that with little social stigma attached to insomnia, focusing on sleep problems could offer young people a way in to discussing mental health problems.

Ian Hamilton, a lecturer in mental health at York University who was not involved in the study, cautioned that the research relied on self-selection of participants and self-reporting in the assessments - both of which could have affected the results - and was carried out only in students.

But, he added, the research offered hope. "The important message from this research is that there is a real opportunity to help young people with insomnia and reduce their chances of developing psychotic experiences," he said. "The challenge will be for mental health workers and services who may routinely ask [individuals] about sleep but are not usually equipped or skilled in tackling sleep issues."

Nicole Tang, an expert in insomnia and CBT from the University of Warwick and who was not involved in the research, described the study as important. "Considering that more students than ever suffer from ill mental health, findings of this study suggest that investment in providing sleep-related interventions is a logical and possibly cost-effective way to tackle this growing problem among our young people," she said.

Reader Comments

baron · 2017-09-09T02:05:10Z

"Mental health problems including psychotic experiences could in part be down to a lack of sleep."

Psychotic is significantly different from depression and emotional distress induced by lack of sleep. Psychotic is the definition for delusional state of mind where a person hears or see's things which others do not and are called hallucinations.The way this has been put together implies that a lack of sleep can induce psychosis. A delusional state wherein hallucinations take place.

There is no doubt whatever that anyone deprived of sleep long enough can become psychotic. I think that was established long ago. Russian sleep experiments and an so on and so forth. Very old and well known information.

This so called research has the smell of guidance to it: That making an extreme connection to depression by way of association with a lack of sleep under the cover or vestiges of presumed scientific study must have some objective beyond the results, and because the study is completely unscientific whereby no such radical connections exist which have been conclusively demonstrated in any measure of formalized scientific process.

Heart is All · 2017-09-10T21:28:30Z

baron Definitely agree and what you said, makes sense. Individual bio-rhythms also play a huge part when it comes to sleep. While I am just and ordinary Joe, I am pretty attuned to my physical needs-- aware when I am pushing boundaries leading to sleep deprivation. Not as informed as you are, still from what I have noticed amongst friends and colleagues, are that their general sleeping patterns-- how many hours sleep each one needs, often differ. Some people are night people (I am one) -- others are morning people, meaning that some are mentally and physically at peak performance, either in the morning or late evening onwards into the night.

Furthermore, some folks need 8 hours sleep, while others feel groggy after such a long sleep-- but are in top form after 6 hours sleep. Then too, worries and stress-- often due to debt problems-- reduce the quality of sleep. The mind becomes overworked and sound and refreshing sleep goes out the window, which over time could lead to insomnia.

However, today, people are generally more informed about their mental and physical wellbeing-- either identifying for themselves that they are not in balance and the reasons for it-- or this noticed by a helpful friend or colleague-- the problem(s) is/are addressed and sorted-- and without hitting sleep medications or anti-depressants. Rather, if need be, seeking herbal alternatives to improve sleep or realigning to healthier lifestyles-- improving diet and increasing physical activity, almost always the first to be neglected when people are short of sleep and stressed, are too tired to even lift a finger.

Yet, most people are aware today that exercise for a troubled mind, brings amazing benefits-- improves sleep and energy levels, boosts the immune system and returns balance to body and mind-- virtually immediately. Especially with people on average not well off today-- a daily walk and some yoga stretch exercises on the living room carpet or outdoors on the patio, often replace work outs at the gym-- saves money too.

There is no way I've ever been able to accept that one sleep quantity fits all. Maybe the article here refers to city executives and those climbing the corporate ladder-- people who see their shrinks once a week because they are constantly on edge and so stressed out mentally, that the body also falls into disrepair and a good night's sleep seems to allude them almost permanently.