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Can adults adapt to less sleep?

Can adults adapt to less sleep?

I am asking whether adults, especially in circumstances like a monastery or Zen center, can become able long-term to sleep only about 4 to 5 hours a night? So, that would mean: no children to care for, no heavy labor, lots of time spent meditating and doing other things that the body would find restful and undemanding…

Can the mind get along on much less hours of sleep than the usual adult? I am not asking about the absolute numbers, only if it can be reduced and sustained over years, or permanently?


A paper by Kaul et al. from 2010 suggest that meditation can indeed decrease the need for sleep. Meditation acutely improves psychomotor vigilance, and may decrease sleep need

Quote from conclusions:

These results suggest that meditation provides at least a short-term performance improvement even in novice meditators. In long term meditators, multiple hours spent in meditation are associated with a significant decrease in total sleep time when compared with age and sex matched controls who did not meditate. Whether meditation can actually replace a portion of sleep or pay-off sleep debt is under further investigation.


Can I Train My Body to Need Less Sleep? We Asked a Sleep Neuroscientist

Sacrificing shuteye can lead to increased productivity. So can you train yourself to need less sleep, and is it healthy?

Our society tends to admire those who refuse to go to bed. Leonardo Da Vinci, Thomas Edison and Margaret Thatcher &ndash all of whom famously needed just a couple hours kip a night &ndash are often cited as examples of how sacrificing shuteye can lead to increased productivity.

But the truth of the matter is, just as you can&rsquot choose to be able to paint like Da Vinci, you have little say in how much sleep your body needs. It&rsquos biologically hardwired. Between seven to eight hours a night is recommended, and for 97 to 99 per cent of the population regularly getting less than six will play havoc with your ability to function effectively. Still curious? This is what happens to your body when you can't sleep.

The other 1 to 3 per cent of that study? They are so-called &lsquoshort sleepers&rsquo, equipped with a mutated gene called hDEC2 which allows their body to get the rest it requires from just a few hours between the sheets each night. You&rsquove probably met one. They tend to be thin, optimistic, high-energy types. They are relentless. Frankly, they&rsquore exhausting.


Lack of sleep intensifies anger, impairs adaptation to frustrating circumstances

AMES, Iowa &ndash Losing just a couple hours of sleep at night makes you angrier, especially in frustrating situations, according to new Iowa State University research. While the results may seem intuitive, the study is one of the first to provide evidence that sleep loss causes anger.

Other studies have shown a link between sleep and anger, but questions remained about whether sleep loss was to blame or if anger was responsible for disrupted sleep, said Zlatan Krizan, professor of psychology at Iowa State. The research, published in the Journal of Experimental Psychology: General, answers those questions and provides new insight on our ability to adjust to irritating conditions when tired.

&ldquoDespite typical tendencies to get somewhat used to irritating conditions &ndash an uncomfortable shirt or a barking dog &ndash sleep-restricted individuals actually showed a trend toward increased anger and distress, essentially reversing their ability to adapt to frustrating conditions over time. No one has shown this before,&rdquo Krizan said.

Study participants were randomly split into two groups: one maintained their normal sleep routine and the second restricted their sleep by two to four hours each night for two nights. Those who maintained averaged almost seven hours of sleep a night, while the restricted group got about four and a half hours each night. The difference reflects sleep loss we regularly experience in everyday life, Krizan said.

To measure anger, Krizan and Garrett Hisler, an ISU doctoral student in psychology, had participants come to the lab &ndash before and after the sleep manipulation &ndash to rate different products while listening to brown noise (similar to the sound of spraying water) or more aversive white noise (similar to a static signal). Krizan says the purpose was to create uncomfortable conditions, which tend to provoke anger.

&ldquoIn general, anger was substantially higher for those who were sleep restricted,&rdquo Krizan said. &ldquoWe manipulated how annoying the noise was during the task and as expected, people reported more anger when the noise was more unpleasant. When sleep was restricted, people reported even more anger, regardless of the noise.&rdquo

Sleep effect unique to anger

It is well established that sleep loss increases negative emotions, such as anxiety and sadness, and decreases positive emotions, such as happiness and enthusiasm, Krizan said. He and Hisler measured these effects to more generally understand the relationship between sleep, anger and emotions. Krizan says they found sleep loss to uniquely impact anger, and not just result from feeling more negative in that moment.

The researchers also tested whether subjective sleepiness explained more intense feelings of anger. Sleepiness accounted for 50 percent of the experimental effect of sleep restriction on anger, suggesting individuals&rsquo sense of sleepiness may point to whether they are likely to become angered, Krizan said.

Future work

To demonstrate whether the experimental evidence in the lab extends to daily life, Krizan and Anthony Miller, an ISU doctoral student, are working on a separate study analyzing data from 200 college students who kept a sleep diary for a month. Krizan says each day students recorded their sleep and rated feelings of anger. The initial results show students consistently reported more anger than what is typical for them on days when they got less sleep than usual.

Based on the results, Krizan and Miller are now collecting data to test if sleep loss causes actual aggressive behavior toward others.


Medical myths: How much sleep do we need?

In this Special Feature, we hack into some of the myths that surround sleep duration. Among other questions, we ask whether anyone can truly get by on 5 hours of sleep each night. We also uncover whether sleep deprivation can be fatal.

Share on Pinterest Sleep is important, but how much is too much?

Although we all know sleep is vital to maintain good health, there are still many unanswered questions. And, over the millennia, a variety of myths and half-truths have developed and stuck.

This feature is the second and final part of our series that tackles sleep-related myths. Find the first part here.

This time, we focus on myths that surround how much sleep the average person needs. We also discuss naps, the effects of sleeping too little or too long, and sleep in the animal kingdom.

Article highlights:

As with many aspects of human biology, there is no one-size-fits-all approach to sleep. Overall, research suggests that for healthy young adults and adults with normal sleep, 7&ndash9 hours is an appropriate amount.

The story gets a little more complicated, though. The amount of sleep we need each day varies throughout our lives:

  • newborns need 14&ndash17 hours
  • infants need 12&ndash15 hours
  • toddlers need 11&ndash14 hours
  • preschoolers need 10&ndash13 hours
  • school-aged children need 9&ndash11 hours
  • teenagers need 8&ndash10 hours
  • adults need 7&ndash9 hours
  • older adults need 7&ndash8 hours

You can train your body to need less sleep

There is a widely shared rumor that you can train your body to need fewer than 7&ndash9 hours&rsquo sleep. Sadly, this is a myth.

According to experts, it is rare for anyone to need fewer than 6 hours&rsquo sleep to function. Although some people might claim to feel fine with limited sleep, scientists think it is more likely that they are used to the negative effects of reduced sleep.

People who sleep for 6 hours or fewer each night become accustomed to the effects of sleep deprivation, but this does not mean that their body needs any less sleep. Cynthia LaJambe, a sleep expert at the Pennsylvania Transportation Institute in Wingate, explains:

&ldquoSome people think they are adapting to being awake more, but are actually performing at a lower level. They don&rsquot realize it because the functional decline happens so gradually.&rdquo

&ldquoIn the end, there is no denying the effects of sleep deprivation. And training the body to sleep less is not a viable option.&rdquo

&ndash Cynthia LaJambe

However, it is worth noting that some rare individuals do seem to function fine with fewer than 6.5 hours&rsquo sleep each night. There is evidence that this might be due to a rare genetic mutation, so it is probably not something that someone can train themselves to achieve.

Generally, experts recommend people avoid naps to ensure a better night&rsquos sleep. However, if someone has missed out on sleep during previous nights, a tactical nap can help repay some of the accrued sleep debt.

Around 20 minutes is a good nap length. This gives the body ample time to recharge. People who sleep much longer than this could mean they descend into a deep sleep, and once awake, they feel groggy.

Daytime napping is relatively common in the United States, but taking a &ldquosiesta&rdquo is the norm in some countries. Naturally, our bodies tend to dip in energy during the early afternoon, so perhaps napping around that time is more natural than avoiding sleep until nighttime.

After all, the vast majority of mammals are polyphasic sleepers, which means they sleep for short periods throughout the day.

In a large review of the effects of napping, the authors explain afternoon naps in people who are not sleep deprived can lead to &ldquosubjective and behavioral improvements&rdquo and improvements in &ldquomood and subjective levels of sleepiness and fatigue.&rdquo They found people who nap experience improved performance in tasks, such as &ldquoaddition, logical reasoning, reaction time, and symbol recognition.&rdquo

Not all naps are equal, however. There is a great deal of variation, such as the time of day, duration, and frequency of naps. One author explains:

&ldquoEpidemiological studies suggest a decrease in the risk of cardiovascular and cognitive dysfunction by the practice of taking short naps several times a week.&rdquo

The author also acknowledges that much more research is needed to understand how factors associated with napping influence health outcomes. Medical News Today recently examined the relationship between napping and cardiovascular disease in a Special Feature.

It is also important to note if an individual experiences severe tiredness during the day, this might be a sign of a sleep disorder, such as sleep apnea.

Scientists will need to conduct more research before they can finally put all the napping myths and mysteries to bed.

Because humans sleep, and our companion animals appear to sleep, many people assume all animals do the same. This is not true. The authors of a paper entitled &ldquoDo all animals sleep?&rdquo explain:

&ldquoSome animals never exhibit a state that meets the behavioral definition of sleep. Others suspend or greatly reduce &lsquosleep&rsquo behavior for many weeks during the postpartum period or during seasonal migrations without any consequent &lsquosleep debt.&rsquo&rdquo

They also explain that some marine animals, reptiles, fish, and insects do not appear to enter REM sleep.

Because sleep is not simply a lack of consciousness, but a rhythmic cycle of distinct neural patterns, it is a challenge to distinguish whether an animal sleeps or takes a rest.

&ldquo[F]ewer than 50 of the nearly 60,000 vertebrate species have been tested for all of the criteria that define sleep,&rdquo the authors explain. &ldquoOf those, some do not meet the criteria for sleep at any time of their lives, and others appear able to greatly reduce or go without sleep for long periods of time.&rdquo

Although many people struggle to get the amount of sleep they need to feel refreshed, some regularly sleep longer than their body needs. One might think this could endow these individuals with superpowers.

However, researchers identify a link between longer sleep durations and poorer health. For instance, one study , which followed 276 adults for 6 years, concluded:

&ldquoThe risk of developing obesity was elevated for short and long duration sleepers, compared to average-duration sleepers, with 27% and 21% increases in risk, respectively.&rdquo

This finding held even when the scientists controlled the analysis for age, sex, and baseline body mass index. Sleep duration might also impact mortality, according to some researchers.

A meta-analysis, which appears in the journal Sleep, concludes &ldquoBoth short and long duration of sleep are significant predictors of death in prospective population studies.&rdquo

There is no record of anyone dying from sleep deprivation. In theory, it may be possible, but as far as scientists can ascertain, it is improbable.

It is understandable why this myth may have taken root, though. Sleep deprivation, as many people can attest, can feel horrendous. However, the case of Randy Gardner demonstrates that extreme sleep deprivation is not fatal.

In 1965, when Gardner was just 16, he was part of a sleep deprivation experiment. In total, he stayed awake for 11 days and 24 minutes, which equates to 264.4 hours.

During this time, he was monitored closely by fellow students and sleep scientists. As the days rolled on, sleep deprivation symptoms worsened, but he survived. So why has this myth persisted?

The belief that sleep deprivation can kill might have its roots in a study from the 1980s. Rechtschaffen and colleagues found if they deprived rats of sleep with a particular experimental method, they would die after 2&ndash3 weeks.

In their experiments, the researchers placed rats on a disc suspended above water. They continuously measured their brain activity. Whenever the animal fell asleep, the disc would automatically move, and the rat would need to act to avoid falling in the water.

Despite the fatalities in Rechtschaffen&rsquos experiments, later research showed this is not the norm. Rats deprived of sleep using different methods do not die. Also, other researchers who used the disc method on pigeons found it was not fatal for these creatures.

Sleep deprivation is not painless for humans, though. Back in 1965, Gardner&rsquos parents were worried about their son. They asked Lieutenant Commander John J. Ross from the U.S. Navy Medical Neuropsychiatric Research Unit in San Diego to observe him. He describes a steady deterioration in function.

For instance, by day 2, Gardner found it more difficult to focus his eyes. By day 4, he struggled to concentrate and became irritable and uncooperative. On day 4, he also reported his first hallucination and delusion of grandeur.

On day 6, Gardner&rsquos speech became slower, and by day 7, he was slurring as his memory worsened. Paranoia kicked in during day 10, and on day 11, his facial expression and tone of voice became expressionless. Both his attention and memory span were significantly diminished.

However, he did not die and apparently, did not experience any long-term health issues.

Another reason why the myth that sleep deprivation can be fatal persists might be due to a condition called fatal familial insomnia. People with this rare genetic disorder become unable to sleep. However, when individuals with this disease die, it is due to the accompanying neurodegeneration rather than lack of sleep.

Although sleep deprivation will probably not kill you directly, it is worth adding a note of caution: being overtired does increase the risk of accidents. According to the National Highway Traffic Safety Administration, &ldquoDrowsy driving kills &mdash it claimed 795 lives in 2017.&rdquo

Similarly, a review published in 2013 concludes, &ldquo[a]pproximately 13% of work injuries could be attributed to sleep problems.&rdquo So, although sleep deprivation is not deadly in a direct sense, it can have fatal consequences.

Additionally, if we consistently deprive our bodies of sleep for months or years, it increases the risk of developing several conditions, including cardiovascular disease, hypertension, obesity, type 2 diabetes, and some forms of cancer.


Healthy sleep behaviors

Psychologists can help promote healthy sleep in other ways as well, such as by encouraging clients to recognize how insufficient or troubled sleep might be affecting them. "A lot of individuals who sleep poorly don't recognize how much their poor sleep is negatively affecting them," Scullin says.

In one notable example, Hans Van Dongen, PhD, now at Washington State University, and colleagues showed that after two weeks of being forced to cut back to just six hours of sleep per night, participants' cognitive function suffered—though they generally believed they'd adapted to the shorter sleep and didn't realize how much it changed their performance (Sleep, Vol. 26, No. 2, 2003). "When clinical psychologists encounter people who say they are sleeping poorly, but doing OK, I'd recommend a little dose of skepticism," Scullin adds.

Behavioral health experts can also research better ways to encourage people to adopt healthy nighttime behaviors, Grandner says. "Meeting the biological need for sleep is driven by choices, beliefs, attitudes, opportunities—all of the things that health psychologists have been talking about for ages. But sleep hasn't really been on their radar as much," he says.

Still, it's too soon to declare sleep a cure-all, Mander stresses. More longitudinal studies are needed to determine whether specific sleep interventions will translate to fewer cases of Alzheimer's and other diseases associated with aging. "There's a lot of interest in thinking about how sleep interventions may play a role for improving cognitive or physical health in aging, but we just don't know enough yet," he says.

On the other hand, there's no downside to making sure you consistently get a good night's rest, no matter what age you are. "There isn't a single organ system in the body that isn't affected detrimentally by sleep loss," Mander says. "If you disrupt sleep, you disrupt function everywhere. But if you can improve sleep, you might have a chance of improving everything."


Natural rhythms

Poor scheduling, combined with unhealthy attitudes about the need for sleep, can cause major problems for night workers. That’s because working at night runs counter to the body’s natural circadian rhythm, says Charmane Eastman, PhD, a physiological psychologist at Rush University in Chicago. The circadian clock is essentially a timer that lets various glands know when to release hormones and also controls mood, alertness, body temperature and other aspects of the body’s daily cycle.

Our bodies and brains evolved to relax and cool down after dark and to spring back into action come morning. People who work the night shift must combat their bodies’ natural rest period while trying to remain alert and high functioning. It doesn’t matter whether they get enough sleep during the daytime, she says. All the sleep in the world won’t make up for circadian misalignment.

That’s especially dangerous for people whose jobs require them to be on high alert and make split-second, life-or-death decisions during the night, such as medical personnel or police officers. It’s common for police departments, for example, to require rookies and lower-ranking officers to bear the brunt of night shifts. They’ll often work a few days during normal daytime hours, then either work an extra-long shift that carries on until the morning, or take a day off, rest, then work a full night shift. But that seesaw scheduling approach is a doubly bad idea, says John Violanti, PhD, an organizational psychologist who was a New York state trooper for 23 years. Not only are these highly stressful, performance-draining shifts being foisted upon the least experienced officers, but the young officers aren’t given time to adjust their sleep schedules for night work. Also, many officers seek night shifts to get overtime pay, he says. According to Vila’s research, roughly 40 percent of the nation’s 861,000 police officers work more than 12 hours a day — and a similar proportion suffer from a sleep disorder such as insomnia or excessive sleepiness.

Working against a person’s natural sleep cycle causes such sleep disorders, as well as fatigue. Fatigue, in turn, worsens moods, decreases cognitive abilities and reflexes, and makes people more vulnerable to disease, says Vila. That resulting crankiness and warped perspective can interfere with one’s ability to make sound decisions and manage people effectively, and can increase the frequency of negative encounters.

That’s not a recipe for good decisions, says Vila, especially when officers must make decisions about whether to use deadly force — often in ambiguous, fast-paced, high-risk situations. Neither is it safe for more routine activities, such as driving. "When you’re drowsy, local parts of the brain shut down for milliseconds or seconds at a time, then come back online," he says.

Night work and fatigue may also contribute to the risk of heart disease and cancer, according to research by Violanti, Vila and colleagues (Policing, Vol. 30, No. 2). Working with 98 Buffalo, N.Y., police officers, the researchers looked for metabolic syndrome — a combination of symptoms that contribute to poor heart health and diabetes, including large waist circumference, elevated triglyceride levels, high cholesterol, high blood pressure and high levels of glucose when not eating. They found that the officers who most frequently worked the 8 p.m.-to-4 a.m. shift had the highest prevalence of metabolic syndrome symptoms. Those who commonly worked that shift and also averaged fewer than six hours of sleep were four times more likely than other officers to have metabolic syndrome.

Vila and Violanti hope their findings will spur changes in shift scheduling, both for the public’s safety and the officers’.

Of course, police officers aren’t the only night-shift workers suffering from circadian misalignment. A number of studies have found that fatigue due to prolonged work hours or being called into work in the middle of the night can result in lapses in judgment and impaired motor skills among medical workers. For instance, a 2008 article in the American Journal of Surgery (Vol. 195, No. 2) reports that, when performing "surgery" on a virtual patient, well-rested surgeons were significantly smoother in their hand motions and made fewer errors than did their sleep-deprived counterparts.

Fatigue is also risky for the physicians themselves, other research has found. A 2005 report published in the New England Journal of Medicine (Vol. 352, No. 2) found that medical interns whose shifts lasted longer than 24 hours were more than twice as likely to have a car crash and five times as likely to have a driving near-miss after leaving work as interns who worked shorter shifts.

In fact, any worker who must drive while tired — whether it’s on the job or driving home after a night shift — is at risk. In 2004, the National Institute for Occupational Safety and Health reported that car crashes are the top cause of occupational fatalities, accounting for 22 percent of work-related deaths between 1992 and 2001. In 7 percent of those cases, drowsiness or falling asleep while driving was cited as a primary factor in the crash. But other factors such as driver inattention, speeding and running off the road can also be influenced by fatigue, the institute found.

Another report from 2004 found that workers across a variety of occupations who worked 12-hour night shifts were more likely than their day-shift-working colleagues to experience physical fatigue, smoke and abuse alcohol.


7 Tips to Shift Your Sleep Schedule

Need to get up earlier for work or a workout? To return to your routine after traversing time zones? Or just want to get your day started before the sun comes up?

Below, Stephanie Silberman,Ph.D, a clinical psychologist, sleep specialist and author of The Insomnia Workbook: A Comprehensive Guide to Getting the Sleep You Need, provides tips on how to reset your sleep cycle.

1. Make adjustments in increments.

The best way to successfully shift your sleep cycle is to do it gradually, in 15-minute increments, according to Silberman. If you have less time to prepare for your new schedule, try 30 minutes, she said. (But no more than that.)

Give yourself at least three or four nights to get comfortable with the new schedule. If it&rsquos going well, on the fourth or fifth night, shave off another 15 minutes.

Keep in mind that feeling groggy when you get up is normal. As Silberman said, &ldquoMost people don&rsquot wake up full of energy.&rdquo So expect that you&rsquoll feel sleepy for about 20 to 30 minutes.

2. Be consistent all week.

The key to changing your sleep schedule is consistency. That means sticking to the same sleep and wake time throughout the week, including weekends.

If you want to sleep in on the weekends, Silberman suggested giving yourself an extra hour (two hours max). You may get less sleep on Saturday, but you&rsquoll be back on track for Sunday, she said.

3. Keep your room dark at night and light in the morning.

&ldquoOur circadian rhythms are influenced by light and darkness,&rdquo Silberman said. Unfortunately, because of daylight savings, it&rsquos still bright out at 8 p.m., which makes switching into sleep mode tough.

So, at night, close your blinds and curtains, and use a night light for reading. In the morning, &ldquoFlip on all the lights to jumpstart your body,&rdquo she said.

4. Wear sunglasses.

&ldquoWear sunglasses in the afternoon and early evening to naturally [make yourself more sleepy],&rdquo Silberman said. Sunglasses trick your brain into thinking it&rsquos bedtime.

5. Get up if you can&rsquot sleep.

&ldquoDon&rsquot lie in bed tossing and turning, especially if you&rsquore wired,&rdquo Silberman said. Instead, get up and do something either boring or relaxing, she said. If you can&rsquot stop thinking or worrying about something, get it out of your mind by writing it down, she said.

6. Stop pressing the snooze button.

While it might be rough to get up earlier, snoozing doesn&rsquot help. &ldquoIn general it won&rsquot be the best quality of sleep,&rdquo Silberman said. She said to set your alarm to the time you actually want to wake up.

7. Follow sleep hygiene rules.

If you&rsquore having trouble falling asleep, stop drinking caffeine within 12 hours of your bedtime or exercising within four to five hours, Silberman said. Give yourself an hour to unwind, she said. During that time, don&rsquot do anything stressful or stimulating (such as use electronics).

You can learn more about Silberman at her website and follow her on Twitter, where she shares links to articles on sleep.


Summary

What is successful aging and what is pathological aging are questions that continue to prove a challenge to scientists and lay people around the world. With the population of the world living longer, late adulthood is an important area of research and exploration. In every area of late-life development, there are important improvements, continuities, and declines. Continued research and development will allow us to understand the mechanisms and processes to understand biological, psychological, and social aging. Although we have focused on the period of later life between ages 60 and 75, it is important to note that there is much variability in the timing and extent of gains and losses during this time period. Moreover, the transition to the “old-old” period, which is usually considered to begin between 75 and 80 years of age, is also marked by large inter-individual differences in functioning.


Influence of Stress on Health Behaviors

The survey also explored the relationship between stress and health behaviors like sleep, exercise and eating — behaviors that people say are important to them but that the survey showed are negatively affected by stress. Survey findings illustrate that when people are living with high stress, it appears that they are less likely to sleep well, exercise and eat healthy foods.

  • Stress and sleep: When adults do not get enough sleep, 21 percent report feeling more stressed. On average, teens report sleeping far less than the recommended amount — 7.4 hours on school nights and 8.1 hours on non-school nights, compared with the 8.5 to 9.25 hours recommended by the National Sleep Foundation. Nearly 1 in 5 teens (18 percent) say that when they do not get enough sleep, they are more stressed and 36 percent of teens report feeling tired because of stress in the past month.
  • Stress and exercise: Though people say they experience positive benefits from exercise, such as a better mood and less stress, few say they make the time to exercise every day. The survey found that more than one-third of adults (37 percent) and 1 in 5 teens (20 percent) report exercising less than once a week or not at all. Teens who report high stress during the past school year also say they spend an average of 3.2 hours online a day, compared with two hours among those reporting low stress levels during the past school year.
  • Stress and eating: Twenty-seven percent of adults say they eat to manage stress and 34 percent of those who report overeating or eating unhealthy foods because of stress say this behavior is a habit. Of the 23 percent of teens who report skipping a meal in the past month due to stress, 39 percent say they do this weekly or more.

“Parents and other adults can play a critical role in helping teens get a handle on stress by modeling healthy stress management behaviors,” says Anderson. “When spending time with teens, we can encourage them to exercise, eat well, get the sleep they need and seek support from health care professionals like psychologists to help them develop healthier coping mechanisms for stress sooner rather than later.”

To read the full Stress in America report, download graphics and view the new video “Stress in America: Conquering Your Stress,” visit APA's Stress in America Press Room.

For additional information on stress, lifestyle and behaviors, visit APA's Help Center. Join the conversation about stress on Twitter by following @APAHelpCenter and #stressAPA.


Sleep and mental health

Sleep and mental health are closely connected. Sleep deprivation affects your psychological state and mental health. And those with mental health problems are more likely to have insomnia or other sleep disorders.

Americans are notoriously sleep deprived, but those with psychiatric conditions are even more likely to be yawning or groggy during the day. Chronic sleep problems affect 50% to 80% of patients in a typical psychiatric practice, compared with 10% to 18% of adults in the general U.S. population. Sleep problems are particularly common in patients with anxiety, depression, bipolar disorder, and attention deficit hyperactivity disorder (ADHD).

Traditionally, clinicians treating patients with psychiatric disorders have viewed insomnia and other sleep disorders as symptoms. But studies in both adults and children suggest that sleep problems may raise risk for, and even directly contribute to, the development of some psychiatric disorders. This research has clinical application, because treating a sleep disorder may also help alleviate symptoms of a co-occurring mental health problem.

The brain basis of a mutual relationship between sleep and mental health is not yet completely understood. But neuroimaging and neurochemistry studies suggest that a good night's sleep helps foster both mental and emotional resilience, while chronic sleep deprivation sets the stage for negative thinking and emotional vulnerability.

Key points

  • Sleep problems are more likely to affect patients with psychiatric disorders than people in the general population.
  • Sleep problems may increase risk for developing particular mental illnesses, as well as result from such disorders.
  • Treating the sleep disorder may help alleviate symptoms of the mental health problem.

How sleep affects mental health

Every 90 minutes, a normal sleeper cycles between two major categories of sleep — although the length of time spent in one or the other changes as sleep progresses.

During "quiet" sleep, a person progresses through four stages of increasingly deep sleep. Body temperature drops, muscles relax, and heart rate and breathing slow. The deepest stage of quiet sleep produces physiological changes that help boost immune system functioning.

The other sleep category, REM (rapid eye movement) sleep, is the period when people dream. Body temperature, blood pressure, heart rate, and breathing increase to levels measured when people are awake. Studies report that REM sleep enhances learning and memory, and contributes to emotional health — in complex ways.

Although scientists are still trying to tease apart all the mechanisms, they've discovered that sleep disruption — which affects levels of neurotransmitters and stress hormones, among other things — wreaks havoc in the brain, impairing thinking and emotional regulation. In this way, insomnia may amplify the effects of psychiatric disorders, and vice versa.

Psychological effects of sleep deprivation

More than 70 types of sleep disorders exist. The most common problems are insomnia (difficulty falling or staying asleep), obstructive sleep apnea (disordered breathing that causes multiple awakenings), various movement syndromes (unpleasant sensations that prompt night fidgeting), and narcolepsy (extreme sleepiness or falling asleep suddenly during the day).

Type of sleep disorder, prevalence, and impact vary by psychiatric diagnosis. But the overlap between sleep disorders and various psychiatric problems is so great that researchers have long suspected both types of problems may have common biological roots.

Depression. Studies using different methods and populations estimate that 65% to 90% of adult patients with major depression, and about 90% of children with this disorder, experience some kind of sleep problem. Most patients with depression have insomnia, but about one in five suffer from obstructive sleep apnea.

Insomnia and other sleep problems also increase the risk of developing depression. A longitudinal study of about 1,000 adults ages 21 to 30 enrolled in a Michigan health maintenance organization found that, compared with normal sleepers, those who reported a history of insomnia during an interview in 1989 were four times as likely to develop major depression by the time of a second interview three years later. And two longitudinal studies in young people — one involving 300 pairs of young twins, and another including 1,014 teenagers — found that sleep problems developed before major depression did.

Insomnia and other sleep problems affect outcomes for patients with depression. Studies report that depressed patients who continue to experience insomnia are less likely to respond to treatment than those without sleep problems. Even patients whose mood improves with antidepressant therapy are more at risk for a relapse of depression later on. Depressed patients who experience insomnia or other sleep disturbances are more likely to think about suicide and die by suicide than depressed patients who are able to sleep normally.

Bipolar disorder. Studies in different populations report that 69% to 99% of patients experience insomnia or report less need for sleep during a manic episode of bipolar disorder. In bipolar depression, however, studies report that 23% to 78% of patients sleep excessively (hypersomnia), while others may experience insomnia or restless sleep.

Longitudinal studies suggest that insomnia and other sleep problems worsen before an episode of mania or bipolar depression, and lack of sleep can trigger mania. Sleep problems also adversely affect mood and contribute to relapse.

Anxiety disorders. Sleep problems affect more than 50% of adult patients with generalized anxiety disorder, are common in those with post-traumatic stress disorder (PTSD), and may occur in panic disorder, obsessive-compulsive disorder, and phobias. They are also common in children and adolescents. One sleep laboratory study found that youngsters with an anxiety disorder took longer to fall asleep, and slept less deeply, when compared with a control group of healthy children.

Insomnia may also be a risk factor for developing an anxiety disorder, but not as much as it is for major depression. In the longitudinal study of teenagers mentioned earlier, for example, sleep problems preceded anxiety disorders 27% of the time, while they preceded depression 69% of the time.

But insomnia can worsen the symptoms of anxiety disorders or prevent recovery. Sleep disruptions in PTSD, for example, may contribute to a retention of negative emotional memories and prevent patients from benefiting from fear-extinguishing therapies.

ADHD. Various sleep problems affect 25% to 50% of children with ADHD. Typical problems include difficulty falling asleep, shorter sleep duration, and restless slumber. The symptoms of ADHD and sleeping difficulties overlap so much it may be difficult to tease them apart. Sleep-disordered breathing affects up to 25% of children with ADHD, and restless legs syndrome or periodic limb movement disorder, which also disrupt sleep, combined affect up to 36%. And children with these sleeping disorders may become hyperactive, inattentive, and emotionally unstable — even when they do not meet the diagnostic criteria for ADHD.

Sleep and mental health lifestyle changes

In some respects, the treatment recommended for the most common sleep problem, insomnia, is the same for all patients, regardless of whether they also suffer from psychiatric disorders. The fundamentals are a combination of lifestyle changes, behavioral strategies, psychotherapy, and drugs if necessary.

Lifestyle changes. Most people know that caffeine contributes to sleeplessness, but so can alcohol and nicotine. Alcohol initially depresses the nervous system, which helps some people fall asleep, but the effects wear off in a few hours and people wake up. Nicotine is a stimulant, which speeds heart rate and thinking. Giving up these substances is best, but avoiding them before bedtime is another option.

Physical activity. Regular aerobic activity helps people fall asleep faster, spend more time in deep sleep, and awaken less often during the night.

Sleep hygiene. Many experts believe that people learn insomnia, and can learn how to sleep better. Good "sleep hygiene" is the term often used to include tips like maintaining a regular sleep-and-wake schedule, using the bedroom only for sleeping or sex, and keeping the bedroom dark and free of distractions like the computer or television. Some experts also recommend sleep retraining: staying awake longer in order to ensure sleep is more restful.

Relaxation techniques. Meditation, guided imagery, deep breathing exercises, and progressive muscle relaxation (alternately tensing and releasing muscles) can counter anxiety and racing thoughts.

Cognitive behavioral therapy. Because people with insomnia tend to become preoccupied with not falling asleep, cognitive behavioral techniques help them to change negative expectations and try to build more confidence that they can have a good night's sleep. These techniques can also help to change the "blame game" of attributing every personal problem during the day on lack of sleep.

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