The factors that could be making insomnia worse are varied. Photo: Getty
The 2004 movie The Machinist gives us a striking depiction, albeit a fictional one, of the psychological effects of chronic insomnia.
When people don’t have enough sleep, their memory and concentration are impaired in the short term. They are also less able to regulate their emotions.
If sleeping difficulties continue, longer-term psychological effects can include anxiety, depression, mania and psychosis. Indeed, Christian Bale’s character in The Machinist has increasingly vivid visual hallucinations and paranoid delusions as his insomnia deepens.
The relationship between insomnia and mental disorders is complex. It’s not just a case of, ‘Which comes first, the insomnia or the mental disorder’? Insomnia and mental disorders are inter-related in ways we don’t yet fully understand.
Insomnia is, by far, the most common disorder of sleep. An estimated 12-15 per cent of Australian adults at any one time meet criteria for insomnia.
People with insomnia have frequent and ongoing difficulties in falling and staying asleep, and/or going back to sleep after early waking. Insomnia not only affects people’s quality of sleep, but how they function the next day.
Many of the factors that trigger insomnia and help maintain its negative long-term effects are psychological or behavioural. These include:
Insomnia is not a mental disorder in the same way that, say, depression and anxiety are mental disorders. Insomnia is a recognised sleep disorder that nonetheless has close links to a wide variety of mental disorders.
Around half of all people diagnosed with insomnia also have an associated mental disorder. The most common ones associated with insomnia are depression, anxiety, bipolar disorder, post-traumatic stress disorder, and substance-related disorders.
Insomnia can have a terrible impact on a person’s quality of life. Photo: Getty
We don’t (yet) know why we see such high levels of mental disorders in people with insomnia. But there are several leading theories, including:
Further complicating the picture is evidence showing insomnia can occur before someone develops a mental disorder, or afterwards. Researchers call this a “bidirectional” relationship.
We can’t say one causes the other. We can only say there is a clear link between them.
This link means diagnosis and treatment of one can have implications for diagnosis and treatment of the other. For instance, if you don’t adequately treat insomnia, this can worsen symptoms of someone’s mental disorder, increasing both the severity and risk of relapse.
A type of talking therapy known as cognitive behavioural therapy for insomnia (CBTi) aims to change the unhelpful thoughts, feelings, emotions and behaviours that contribute to insomnia. And, in many cases, successful treatment of insomnia with CBTi can also treat someone’s mental disorder (and vice versa).
CBTi is particularly effective at treating insomnia plus depression, substance use or post-traumatic stress disorder. But it is less effective at treating insomnia plus psychosis or bipolar disorder.
There’s much we don’t know about the link between insomnia and mental disorders. Last year an international panel of experts outlined the research needed to plug the knowledge gaps. Recommendations included:
Results of this research will have profound implications for accurate diagnosis of both insomnia and mental disorders, and their treatment. The aim is to reduce the burden when these conditions occur together, both for individuals and society more broadly.
If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14. Free information about insomnia and mental health is available from the Sleep Health Foundation.
Ben Bullock is Senior Lecturer, Psychology, Swinburne University of Technology
This article is republished from The Conversation under a Creative Commons licence. Read the original article.