Have you ever noticed that you’re not quite yourself when you don’t get enough rest? If you’re like me, you are probably more easily irritated or even more emotionally labile when you don’t get quality sleep. Not getting enough sleep can definitely affect your mood and mental health. The reverse is true as well; your mental health can affect your ability to get restful sleep. It’s very common for people with anxiety, depression, bipolar disorder, schizophrenia, anorexia nervosa, bulimia nervosa, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and other mental health conditions to also have problems with insomnia. This isn’t just anecdotal evidence; research shows that there is a very strong connection between quality and quantity of sleep and your mental health.
The Mental Health – Sleep Connection
A lack of sleep negatively affects mental health because of sleep’s effect on inflammation. Let me explain. If you don’t sleep at all for two or more nights in a row, we will likely see an increase in your C-reactive protein (CRP), an important marker in the body that lets us know there is inflammation present. If, on the other hand, you get some sleep each night but not nearly as much as you need, and this occurs for somewhere between two and fourteen days, we will likely see your monocytes (a type of white blood cell) produce higher levels of interleukin-6. Interleukin-6 is a protein in the body that can act as a pro-inflammatory marker and is produced whenever there is acute or chronic inflammation. Moral of the story: we know that, all things being equal, not getting sufficient sleep increases inflammation within the body.
Here’s what this has to do with your mental health: research demonstrates that increased levels of interleukin-6 are associated with a variety of psychiatric disorders, including major depression, bipolar disorder, PTSD, OCD, and other disorders. In some cases, insomnia comes first; in other cases, the psychiatric diagnosis comes first but, essentially, sleep disturbances lead to an increase in interleukin-6, which leads to the onset or worsening of mental health concerns, which leads to an increase in sleep disturbances, and the cycle continues.
An Illustration of the Vicious Cycle
Research demonstrates that a lack of sleep increases a person’s risk of developing eating disorders such as anorexia nervosa, bulimia nervosa, binge-eating disorder, and nighttime eating syndrome. Unfortunately, having an eating disorder also increases the likelihood of experiencing sleep disturbances. In addition to these relationships, people who have eating disorders and don’t get enough sleep tend to report more severe symptoms and more difficulty functioning during the daytime than those who have eating disorders but do get enough sleep. A similar situation exists with anxiety, depression, and other mental health concerns; poor mental health leads to poor sleep quality (or vice versa) which leads to worsening sleep quality and worsening mental health, and those who don’t get enough sleep tend to report having more severe symptoms than those who do.
Genetics, Prescription Sleep Aids, and Mental Health
Many people take prescription medication such as eszopiclone (Lunesta) and zolpidem (Ambien) to help them sleep. The problem with this solution is that your body can build up a tolerance to these sedatives rather quickly and this can lead to chemical dependence. You then find yourself in a position where you initially had one problem (insomnia), but now you have two (insomnia and dependence / addiction).
To add to the difficulty of the situation, we are all unique, as far as our genetics are concerned, and some of us process medication differently than others. For example, most pharmaceutical medications are processed through a network of enzymes mainly found in the liver called the cytochrome P450 (CYP450) system. Lunesta is processed through a CYP450 enzyme called CYP3A4. Some people, myself included, are rapid metabolizers of the CYP3A4 enzyme. That means that when they take a medication that is processed by this enzyme, the body breaks it down very quickly, so they need to take higher dosages to get the same effect as a person who has normal activity at that enzyme.
What we see happening, then, is that people who have CYP450 enzymes that are more “hyperactive” than the average person are put on medication that is supposed to be processed by that enzyme. Because their bodies process the drugs more quickly than expected, they need higher and higher dosages in order to achieve the desired effect. The body builds up a tolerance to each increased dose and they need to take more, until they find themselves chemically dependent on the drug. If you’re a woman of childbearing age, this is also of concern because many of these drugs are not exactly recommended during pregnancy or while breastfeeding, as research in animal models suggests that sleep aids can lead to toxicity in the unborn child when taken during pregnancy and may be problematic during lactation as well.
Interrupting the Vicious Cycle
As you can imagine (or may know by experience), this is a very undesirable situation to find yourself in. In fact, it’s in everyone’s best interest (your doctor included) to interrupt this vicious cycle as soon as possible, before it progresses and snowballs into a mess: poor mental health, insomnia, chemical dependence, strained relationships, and worse. Here are some things that I recommend to break the cycle of insomnia and poor mental health:
- Address inflammation by adopting an anti-inflammatory diet that is rich in fruits and vegetables and severely limits the intake of processed foods and added sugar.
- Manage your mental health concerns and inflammation levels using holistic and integrative therapies that are less likely to lead to a chemical dependence
- Use integrative and holistic therapies to support your body’s ability to fall asleep on its own at appropriate times
- Incorporate positive sleep hygiene habits such as not watching TV in bed, making sure your room is as dark and as quiet as possible at nighttime, going to bed and waking up at the same time each day (even on the weekends), and avoiding drinking excessive amounts of liquid in the evening so that you are more likely to stay asleep once you do fall asleep
- Incorporate regular exercise in the morning or early afternoon into your daily routine in order to help your body feel tired at night and improve your quality of sleep
- If you must take medication for sleep, consider testing to determine the type of medication that is best suited for your individual genetics
- Under the guidance of a qualified medical professional, wean off of any medication that could contribute to a chemical dependence
If you need help, implementing any of these recommendations, schedule a complimentary consultation with me and we’ll see how we can work together to improve your sleep quality and mental health. -Dr. Janelle Louis ND