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Ask the experts…mental health and sleep

Ask the experts…mental health and sleep

Sleep and mental health have a ‘chicken and egg’ relationship It’s only natural in this current climate to find things confusing, scary and difficult. With clear indications that the Covid-19 pandemic has had a significant impact on the nation’s mental health, it’s never been more important to address stress, anxiety and depression – and the

Woman sleeping on white bed
Sleep and mental health have a ‘chicken and egg’ relationship

It’s only natural in this current climate to find things confusing, scary and difficult. With clear indications that the Covid-19 pandemic has had a significant impact on the nation’s mental health, it’s never been more important to address stress, anxiety and depression – and the role that sleep plays in our development and management of issues. 

One in four of us will develop a mental health issue at some point in our lives, while the average Brit gets just six hours 19 minutes sleep a night. That’s 100 minutes under the recommended eight hours every night…which adds up to 11 hours – or a whole night – of missed sleep a week. 

With that in mind, we teamed up with The Sleep Council to host an online clinic to look at the relationship between sleep and mental health. 

Our expert panel included Lisa Artis, Head of the Sleep Council and independent sleep expert, Dr Neil Stanley. Below are some of the best questions and answers from the clinic:

How long does it take for a lack of sleep/insomnia to unravel mental health? 

Dr Stanley: Poor sleep, in the short term, can lead to feelings of tiredness and low mood/anxiety, but these should disappear once you start sleeping better again. Although sleep and mental health problems are closely linked, it is not necessarily the case that one will lead to the other. You may want to try Cognitive Behavioural Therapy for Insomnia to help improve your sleep.

Is insomnia is a symptom of depression or does depression trigger insomnia? 

Dr Stanley: It is very much a chicken and egg situation. Depression and poor sleep arise in the same area of the brain and a problem with one may cause a problem with the other. Treating the depression may over time lead to improved sleep, but improving sleep may have a quicker effect in improving the depression. Cognitive Behavioural Therapy for Insomnia is a non-medicine way of improving sleep that has been shown to reduce symptoms of depression. There are digital versions of CBT-I available on the NHS in England and your GP should be able to refer you to it. Of course, appropriate treatment for depression should be sought.

Can low concentrations of antidepressants to treat insomnia? What side effects can they trigger?

Dr Stanley: Many doctors prescribe a number of different antidepressants with the idea that they may help sleep. Unfortunately, there is little scientific evidence to support their use in this manner.

Depending on the antidepressant, side effects can include:

  • feeling agitated, shaky or anxious
  • feeling and being sick
  • indigestion and stomach aches
  • diarrhoea or constipation
  • loss of appetite
  • dizziness
  • not sleeping well (insomnia), or feeling very sleepy
  • headaches
  • low sex drive
  • difficulties achieving orgasm during sex or masturbation
  • in men, difficulties obtaining or maintaining an erection (erectile dysfunction)
  • dry mouth
  • slight blurring of vision
  • constipation
  • problems passing urine
  • drowsiness
  • dizziness
  • weight gain
  • excessive sweating (especially at night)
  • heart rhythm problems, such as noticeable palpitations or a fast heartbeat (tachycardia)

I live with 24/7 tinnitus which stops me from sleeping – my medication doesn’t help. What do you advise?

Lisa: I would suggest that you go back to your GP and inform them the medication is no longer working. They may be able to suggest alternatives. From what you say, there’s probably a lot of anxiety going on at bedtime with the tinnitus which is also stopping you from sleeping.

On top of that, you could seek further support from the British Tinnitus Association https://www.tinnitus.org.uk/all-about-tinnitus

I would continue to put other strategies in place like a consistent bedtime schedule, keeping the bedroom environment cool, dark and quiet – and using it only for sleeping and intimacy, making sure you’re sleeping on a comfortable bed and avoiding alcohol and caffeine in the evening. Try to keep active, avoid clock watching throughout the night and make sure you expose yourself to natural light first thing in the morning – these can all strengthen the body clock.

I fall asleep quite quickly around midnight but almost without fail I wake up within two hours. Help!

Lisa: It would be interesting to know what time you are waking up – are you consistently getting up at the same time all the time or some days you waking up at 7am and others at 11am?

You also don’t mention how long this has been going on for and if something triggered why this started happening. This is something that is worth exploring. You could also consider keeping a sleep diary for two weeks to get a picture of your sleep and lifestyle habits.

If you’ve been struggling to stay asleep for at least three times a week for three months, then I would suggest you would benefit from Cognitive Behavioural Therapy (CBT) for Insomnia. You can be referred through your GP for this as there are some free services available on the NHS or you can pay privately.

Do you have any advice for night terrors and sleep paralysis conditions? 

Lisa: Rather than going into more on night terrors and sleep paralysis, have a read through these articles on sleep paralysis and night terrors. They both have tips on how to help including keeping a consistent bedtime routine.

Both conditions can be linked to anxiety and stress, sleep deprivation and irregular sleeping patterns so it’s worth exploring more about your sleep habits in general.

What mental health issues are linked to excessive energy? 

Excessive energy can be a symptom of an anxiety disorder like Generalised Anxiety Disorder (GAD), social anxiety disorder and panic disorder – and sleep can be affected by it. It may be worth you seeing your GP to rule out any underlying anxiety issues.

There are things you can do to help too like exercising regularly, stopping smoking (if you do), cutting down on alcohol and caffeine and using relaxation techniques or mindfulness to help calm your mind and body before bed. You could also try writing down any thoughts or a to-do list before you go to bed – this can help stop a racing mind.

If you feel that you’re full of energy generally, the chances are you are sleeping fine. However, if you wake up and are still feeling exhausted by midday, you may not be sleeping well.

You can read more about The Sleep Council sleep and mental health clinic here. Thank you to our experts who so kindly gave their time to answer questions.


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Susan E. Lopez

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