Mental Illness and Sleep

We spend about one-third of our lives doing it. It is an important part of our daily routine. It is essential for our health and well being and is as essential to our survival as food and water. What is it? It is sleep, a naturally recurring state of mind and body characterized by altered consciousness, relatively inhibited sensory activity, reduced muscle activity and inhibition of nearly all voluntary muscles during REM (rapid eye movement) sleep and reduced interactions with surroundings. There are two types of sleep: REM and non-REM sleep and four sleep stages. During sleep, we cycle through non-REM and REM sleep stages. The four stages of sleep are:

  • Stage 1 non-REM sleep where we go from wakefulness to light sleep
  • Stage 2 non-REM sleep is a period of light sleep before we enter deeper sleep. Most of the repeated sleep cycles are in stage 2 sleep
  • Stage 3 non-REM sleep is the period of deep sleep that is needed to feel refreshed upon awakening

REM sleep usually occurs about 90 minutes after falling asleep and is the dreaming stage. REM sleep also provides us with the emotional and cognitive benefits of sleep

The circadian rhythm regulates sleep, hunger, and energy levels. It is known as the body clock and is about 24 hours long. This daily cycle influences brain wave activity patterns, cell repair and hormone levels. Changes in temperature and light levels can temporarily alter the circadian rhythm. The circadian rhythm also controls the secretion of several hormones that are involved in sleep, some make us feel sleepy at night and others give us a wake-up call in the morning. Two hormones worth discussion in more detail are melatonin and cortisol. Melatonin is released with darkness and tells our body it is time to sleep. Cortisol dips at bedtime and increases during the night, peaking just before waking turning on our appetite and energy.

How much sleep do children and teenagers need?
Whilst there is no ‘magic’ number of sleep hours that works for everyone, the American Academy of Sleep Medicine (AASM) provides helpful guidelines regarding how much sleep kids need at different stages in their development. Children age 3 to 5 years need about 10 to 13 hours of sleep daily. Children age 6 to 12 years old need 9 to 12 hours sleep daily, and teenagers requires 8 to 10 hours of sleep each night. Unfortunately, due to social media devices, on-line video games, dietary choices, homework assignments, and/or after school activities, children and teenagers are experiencing a noted decrease in sleep time. This sleep deprivation has a significant and detrimental effect on the physical and mental health and wellbeing of the child/teenager e.g. mood swings, cognitive problems, irritability, behavioural problems.

Children and teenagers need to sleep to keep the immune system working well, to maintain good mental and physical health, to enhance long term memory storage, to boost energy levels, learning, concentration and retention. Research shows that lack of sleep and tiredness can be a contributory factor to mental disorders such as depression and anxiety. Furthermore, poor sleep and exhaustion can exacerbate pre-existing mental disorders such as schizophrenia, bipolar disorder.

Blue Light and Sleep
Exposure to blue light affects the circadian rhythm by inhibiting the production of melatonin. Melatonin is a hormone that peaks at night to help with restful sleep and helps regulate the circadian sleep phase. Research has shown that sleep problems in children and teenagers is an important contributory factor to the onset of a mood disorder, anxiety disorder. Light is the strongest environmental influencer of the circadian rhythm and blue light via electronic devices prolongs the daily exposure of sleep thereby disrupting the sleep pattern. REM sleep (rapid eye movement) is necessary to maintain good physical and mental health e.g. provides emotional and cognitive benefits. Children/teenagers who do not achieve REM sleep become moody, irritable, school grades decline (including possible truancy), eating habits change with a focus on high fat, salty and sugary foods, high caffeine based soft drinks (stimulant) which in turn have a negative effect on general health and mental well being.

Mental Illness and Sleep
Studies show that sleep quality can be a barometer of mental health and sleep disorders often coexist with mental disorders such as:

  • Anxiety disorders
  • Panic disorder
  • Schizophrenia
  • Bipolar disorder
  • ADHD

Forty percent of people with insomnia and forty five percent of those with hypersomnia have a psychiatric condition. Also, studies have found there is a very high correlation between suicide, mental illness and insomnia. Mental illness/disorder and insomnia exacerbate the effects of each other creating a classic negative feedback loop, and once this loop gets started, it pushes people into a downward spiral.

Anxiety, Panic Disorder and Sleep
Anxiety is a reaction to stress, where the brain does not reset back to normal after the stressful event has ended. The brain/nervous system remains in constant alert and cortisol, the body’s stress hormone operates in inverse to melatonin, the hormone responsible for inducing sleep. The more stressed a child/teenager is, the tougher it is for his/her brain to produce adequate amounts of melatonin. Consequently, a child/teenager may experience insomnia, hyposomnia, nightmares, and nocturnal panic attacks. Approximately 44 to 71 percent of people with panic disorder experience nocturnal panic attacks. Treatment for sleep disorder in children/teenagers with anxiety is CBT-I, a specialized cognitive behavioural therapy for insomnia.

Schizophrenia and Sleep
It is estimated that approximately 30 to 80 percent of those living with schizophrenia also experience disturbed sleep. Sleep problems specific to schizophrenia are inconsistent sleep volume and abnormal sleep patterns due to delayed melatonin release and shifted circadian system. Treatment options include therapy and an antipsychotic medication such as clozapine.

Bipolar Disorder and Sleep
Sleep problems will vary depending on whether the child/teenager is experiencing depression or mania. The most common problems are insomnia, sleeplessness, hypersomnia, irregular sleep pattern, sleep apnea and delayed sleep phase syndrome (DSP) where the circadian rhythm is delayed leaving the child/teenager feeling like he/she is in a constant state of jet lag. Treatment options include CBT-I and sleep restriction/stimulus control techniques.

ADHD and Sleep
Children with ADHD experience higher levels of daytime sleepiness and are more than twice as likely to suffer from sleep disordered breathing. Periodic limb movement disorder (PLMD) and restless leg syndrome (RLS) are also more common in kids with ADHD resulting in less restful sleep. Unfortunately, medications used to treat ADHD can lead to sleep problems or worsen existing sleep problems. Treatment options include daily exercise, following a consistent schedule, avoiding caffeine and avoidance of blue light.

What Can Parents Do?

  • Ensure bed and bedding are comfortable, room temperature is not too hot or cold
  • Remove distractions e.g. Television, social media devices ideally should be turned off at least 1 hour before bedtime
  • Use bed for sleep only
  • Keep to a regular bedtime schedule
  • Promote healthy, winding down, pre-bedtime habits such as a warm bath, no caffeine beverages, dim lights, read story
  • Be aware of child/teenager’s sleep habits/problems e.g. sleep apnea, snoring and follow up with physician
  • Practice relaxation exercises, mindfulness
  • Talk with and listen to any concerns, fears, worries your child/teenager may have. Be supportive, non-judgemental and show love
  • Follow up at school if any problems such as falling asleep in class, late assignments, ‘zoning’ out
  • Work together as a family e.g. all social media devices are turned off at same time, etc.
  • Follow up with therapy and appointments, medicationsEncourage daily exercise, healthy diet

 

In my next Blog #32
I will discuss narcissistic personality disorder in children and teenagers

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