Kurt L. White: Good sleep a basic ingredient for physical, mental health | Health

“Sleep knitting the torn sleeve of sorrow,

The death of everyday life, the bath of sore work,

Balm of hurt thoughts, the second course of great nature,

main nourisher at the feast of life.”

– William Shakespeare, “Macbeth”

When I was in my first year as a clinician, one of the treating psychiatrists on an inpatient ward gave me a tip: if you want to know how someone is doing and have limited time to assess the situation, look at how they sleep. I learned over time that when it comes to sleep, there really is no substitute: good sleep is a fundamental ingredient in our health and sanity, if we can find it. Sleep gives us clues as to how we’re doing, and working to improve it can help improve our overall health and well-being, as well as our ability to perform on a daily basis. It might be daunting to think about, but adults need about 7 hours of sleep a night, although research shows few of us get it.

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Sleep disorders of various types are hallmark symptoms of many mental health disorders, including depression — either sleeping too much or waking up early in the morning but not getting back to sleep — and mania — in which a person has a decreased need for sleep. People with anxiety disorders may find that the night is a difficult time when anxious ruminations come and don’t seem to go away.

There are also many people with primary sleep disorders — a sleep problem that isn’t caused by an underlying mental health problem. For example, a growing number of adults, and even children, are being diagnosed with obstructive sleep apnea — a condition that causes a person to not breathe properly while they sleep. In this case, a person may not even know they have a sleep problem — as they may fall asleep easily (sometimes too easily) and sleep through the night, but may wake up exhausted or even more tired than they did before they went to bed. This is because they don’t get consistent, restorative sleep, which helps the brain rest and recover.

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Still others have conditions like Restless Legs Syndrome (RLS) in which their limbs won’t settle to rest, keeping them awake or falling into deeper stages of sleep.

Pain disorders, whether acute or chronic, can also interfere with sleep, and this in turn contributes to the development of co-occurring mental health problems so often seen with pain.

Consuming alcohol in any amount decreases sleep quality and duration—which may seem surprising given that alcohol is a “depressant.” This sleep disorder comes from a “rebound effect” seen with alcohol and similar sedatives (like benzodiazepines), which can cause a person to feel jittery after the sedation wears off.

Cannabis can also have surprising effects on sleep. While it appears that cannabis can sometimes help with pain and induce feelings of calming and relaxation, it also alters the time a person spends in different stages of sleep. Over the long term (particularly in heavy users and with prolonged use), this can result in less sleep overall, frequent awakenings, and side effects that last into the next day.

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There are treatments for insomnia and sleep disorders that may present as a symptom of medical or mental health problems. Some of these include: cognitive behavioral therapy for insomnia (CBT-I), psychotherapy and/or medications to treat underlying medical and mental health issues, sleep apnea treatments such as using a nocturnal airflow device called a CPAP, and working to enhance the body’s natural way, “Settling yourself into sleep” by introducing routine, daily activities that alert the mind that it’s time to sleep (sometimes referred to as “sleep hygiene”) and with certain types of relaxation exercises. For more information about sleep disorders and these types of treatments, go to cdc.gov/sleep/index.html. When researching sleep information, be sure to avoid articles and websites that are biased – many sleep websites try to sell products and services. Discuss sleep problems with your doctor whenever possible.

Kurt L. White is Vice President of Outpatient Programs at Brattleboro Retreat.

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