The complicated relationship between insomnia, depression and anxiety

Mental Health

by Brighton Miller, DO

Aug 3, 2020

Do you find yourself having trouble falling asleep, staying asleep or not feeling rested when you wake up? Let us dig into some of the reasons why you may not be getting your best night’s sleep. You might be surprised to learn that your sleep is intimately connected to your mental health — especially to conditions like depression and anxiety.

First, what is “quality” sleep?

First, let’s define what qualifies as “quality” sleep. That’s a phrase people toss around a lot, but how do you know whether you are or aren’t getting quality sleep at night? 

Quality sleep means:

  • Falling asleep within 30 minutes
  • Remaining asleep for most of the time you are in bed
  • No more than one nighttime awakening
  • If sleep is interrupted, you can go back to sleep in less than 20 minutes

If you do not get enough quality sleep, you may notice the consequences in your day-to-day life and even in your long-term health. 

Lack of quality sleep can lead to the following problems:

  • Mood swings
  • Daytime sleepiness
  • Confusion
  • Decreased reaction time
  • Difficulty with attention
  • Poor problem solving  
  • Trouble coping with stress
  • Type 2 diabetes
  • Heart disease
  • High blood pressure
  • Obesity
  • Sleep apnea
  • Restless leg syndrome

Related: 7 reasons you’re having trouble sleeping

Why mental health matters

Good sleep starts with your mindset. If your mental health is not in check, your sleep is likely going to be affected in some way. Some people report not being able to “shut off” their brain or waking up and not being able to go back to sleep. 

The first step to improving sleep begins with an internal reflection about your anxiety level and overall mental health. Do you experience or feel any of the follow symptoms?

  • Feeling on edge or tense
  • Feeling unusually tired or restless
  • Difficulty concentrating because of worry
  • Fear that something awful will happen
  • Feeling down or hopeless
  • Feeling that you might lose control 
  • Thoughts of hurting yourself
  • Often waking up very early in the morning and being unable to get back to sleep
  • Daytime sleepiness
  • Tingling sensation in your legs with a strong urge to move your legs 
  • Stop breathing briefly during sleep 

What causes insomnia?

Insomnia often has multiple factors such as poor mental health, underlying health conditions and/or medication side effects. 

Many people do not get quality sleep due to psychological distress of various kinds, including generalized anxiety disorder and major depressive disorder. Insomnia is then perpetuated by anxiety about not sleeping — and so begins an exhausting cycle. Interrupted sleep and nightmares are also very common in patients with posttraumatic stress disorder, or PTSD. 

But wait, there’s good news! A licensed professional counselor can help reveal any underlying sources of anxiety and depression that may be causing your insomnia. If mental health is treated with a combination of cognitive behavioral therapy and appropriate medications, most people see sleep disturbances improve.  

Related: Is stress keeping you up at night?

What to do if you have insomnia

It is important to practice good sleep hygiene on a regular basis. In our fast-paced world of high stress and high demand, it is common to sacrifice sleep — but most adults need 7-8 hours of quality sleep each night.

Did you know these simple sleep hygiene habits can make a significant difference in your sleep quality?

  • Set a bedtime alarm and a wakeup alarm for the same time every day, even on weekends.
  • Exercise for 30 minutes at least 5 days per week.
  • Do not take naps.
  • Avoid drinking alcohol or caffeine close to bedtime.
  • Do not eat large meals close to bedtime.
  • Spend 30 minutes in the sunlight every day. 
  • Read before bed.
  • Take a hot bath with lavender.
  • Remove all screens at least 1 hour before bed.

If those methods don’t remedy your sleep woes, it might be time to seek additional help. If you’re having trouble sleeping, talk to your primary care physician first. He or she can help guide you on the right path, whether that be medication, counseling, lifestyle changes or another type of treatment. 

If you think any of your prescription medicines may be causing you to have difficulty falling or staying asleep, notify your doctor. Seek counseling if you know you have associated anxiety, depression or PTSD. If others have noticed that you snore or stop breathing during sleep, check with your physician about getting a sleep study to test for sleep apnea. 

Next time you are lying awake in bed for longer than 20 minutes, get up and do a relaxing activity until you feel sleepy. Take time to reflect on your personal life and make an association with what may be contributing to your insomnia. Make sure to practice good sleep hygiene every night and work with your primary care physician to take good care of your mental health. 

Don’t have a primary care physician? Find one near you today.

About the Author

Brighton Miller, DO, is a family medicine physician on the medical staff at Baylor Scott & White All Saints Medical Center – Fort Worth. Make an appointment with Dr. Miller today.

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