There is a close link between insomnia and many mental health conditions. Many people with a mental health condition also experience insomnia. Insomnia may also increase the risk for mental health conditions.
Insomnia is a sleep disorder that causes people to have difficulty falling or staying asleep or to wake up too early. It results in people getting less sleep than they need to function efficiently.
A mental illness, or mental health condition, involves changes in a person’s behavior, thoughts, or emotions. Mental health conditions may cause distress and can affect how people are able to function day to day, including at work, with family, and in other social situations.
This article looks at the link between insomnia and mental health conditions. It also looks at the potential treatment options and how doctors diagnose insomnia.
According to the National Alliance on Mental Illness, it is rare for insomnia to be an isolated medical or mental health condition.
Insomnia is usually a symptom of another condition or a result of lifestyle or environmental factors, such as a work schedule or stress.
There is a strong link between insomnia and mental health conditions. According to the American Psychiatric Association, insomnia is the most common sleep disorder, and roughly 40–50% of people with insomnia may also have a mental health condition.
The following sections outline the connection between some mental health conditions and insomnia.
Depression
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Insomnia is also a risk factor for developing depression. Higher levels of insomnia and depression have links to a significant increase in intensity of suicidal thoughts.
Treating insomnia with cognitive behavioral therapy (CBT) in people with depression may lead to a significant reduction in depression scores and relapse.
Anxiety disorders
Many anxiety disorders have associations with insomnia. People with obsessive-compulsive disorder frequently experience poor sleep.
People with phobias may also experience problems with some aspects of sleep, including the time it takes for them to fall asleep and the quality of their sleep.
Up to two-thirds of people with social anxiety may experience insomnia. The degree of sleep difficulty a person has may also be an indicator of how severe the social anxiety disorder is.
Additionally, sleep disturbance is one of the criteria for diagnosing generalized anxiety disorder.
Schizophrenia
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Severe insomnia is an indicator for the prodromal, or initial, stage of psychosis. Insomnia is also a risk factor for a relapse of psychosis.
Identifying insomnia may help people realize that someone is at risk for psychosis, and treating insomnia may help prevent or treat psychosis.
Schizophrenia may cause sleep disturbances as a result of changes in the circadian rhythm, which regulates sleep. This may be due to factors such as less exposure to light as a result of psychosis or melatonin abnormalities.
Bipolar disorder
Sleep disturbances frequently occur in bipolar disorder, with insomnia being the most common. People may also experience:
- excessive daytime sleepiness
- nightmares
- sleep-talking
- sleepwalking
- obstructive sleep apnea
Getting enough sleep and maintaining regular circadian rhythms play an important role in providing stability in bipolar disorder, and sleep patterns may help predict a mood change.
Changes in sleep patterns may occur in any phase of bipolar disorder.
Post-traumatic stress disorder (PTSD)
PTSD and sleep problems commonly occur at the same time, and insomnia and nightmares are key symptoms of PTSD.
Around 50–70% of people with PTSD have recurring nightmares that may replicate or represent their traumatic experiences. People may experience insomnia due to a fear of having nightmares, a fear of sleep, or a fear of losing control.
Sleep disorders also contribute to the development and continuation of PTSD.
Doctors may use a range of examinations and questionnaires to diagnose insomnia. They may also perform examinations for any co-occurring mental health conditions.
To diagnose insomnia, a doctor may assess the following:
- the quality and amount of sleep a person is getting
- whether a person has excessive sleepiness in the daytime
- a person’s general sleep habits
- a person’s use of alcohol, caffeine, or drugs
- a person’s level of physical activity
- any symptoms of mental health conditions
- any existing medical conditions
- any medications or supplements a person is taking
A doctor may also perform a physical examination and use questionnaires that measure sleep and insomnia, such as the Insomnia Severity Index.
If a doctor suspects that a mental health condition or another medical condition is also present, they may carry out further tests to diagnose the co-occurring conditions.
Treating insomnia is an important part of treating mental health conditions. Ensuring good quality sleep can help in recovery from and prevention of mental health conditions.
Treatment may include:
- practicing good sleep hygiene, or sleep habits
- relaxation techniques, such as deep breathing and mindfulness, to help reduce anxiety around sleep
- sleep restriction, which reduces the amount of time a person spends lying awake in bed
- CBT, which can help people manage their thought patterns to reduce anxiety or worries around sleep
- light therapy, which may help regulate circadian rhythms
- regular exercise during the daytime, which can help improve sleep quality
- certain medications, such as psychiatric drugs, which may be suitable for some people in the short term
Herbal remedies, such as melatonin and valerian root, may help some people, but there is no solid evidence to support this.
Learn more about 26 self-care tips for insomnia here.
In addition to treatment for insomnia, people may need treatment for mental health conditions, which will vary depending on the type of condition they have.
Short-term insomnia that results from lifestyle factors such as travel or stress may resolve with improved sleep hygiene.
If people have insomnia that lasts longer than 3 weeks and does not improve with changes to sleep hygiene, they will need to see a healthcare professional to find out the cause and seek treatment.
CBT may be the
The U.S. Department of Veterans Affairs notes that CBT-I may be more effective than medication and have fewer side effects.
Sleep improves in 7 out of 10 people who complete CBT-I treatment. In people who experience nightmares, CBT-I may also help reduce the number of nightmares and the level of distress.
Treating sleep disorders may help people prevent and recover from both physical and mental health conditions.
Sleep disorders, such as insomnia, and mental health conditions closely relate to each other. Insomnia may be a risk factor for certain mental health conditions, and mental health conditions may disrupt typical sleep patterns.
When diagnosing insomnia, a doctor may also check for any symptoms of mental health conditions, as they commonly co-occur with insomnia.
Treating insomnia can be an important part of treating and preventing mental health conditions. Treatments may include practicing good sleep hygiene, undergoing CBT, and making lifestyle changes.