The Case of the Sleep Deprived

This week's blog is by fabulous Fran, our secretary.

Have you felt engulfed by mood swings with a diminishing attention span and slowed thinking due to a late night Netflix binge and an early wardround start?

The power of sleep loss is felt across a spectrum of affective processes from basic emotional function (responsiveness, understanding expression), through to high order and complex emotional proceedings involved in loneliness, character and behaviour [1]. Sleep plays a fundamental role in the effective functioning of nearly all systems of the body, so a persistent lack of sleep (such as in the case of insomnia), creates significant risks to physical and mental health [2]. It is therefore unsurprising that sleep problems are often a symptom of psychiatric disorders, with growing evidence showing the relationship between the two is a lot more complex. A subset of psychiatric disorders which have the most important relationship with sleep include: Major Depressive Disorder (MDD); Bipolar Disorder; Generalized Anxiety Disorder (GAD); Post-Traumatic Stress Disorder (PTSD) and Schizophrenia [3].

There are several ways sleep and psychiatric disorders are interconnected, often marked by a bidirectional causality [3]:

1. Treating sleep disturbances can have important effects on the outcome of treatment of psychiatric conditions [3].

In a 40-year longitudinal follow-up of medical students, it was noted that those who had baseline insomnia were at higher risk for the subsequent development of MDD. It was also demonstrated that insomnia treatment with cognitive behavior therapy in patients with depression resulted in a significantly greater decrease in depression scores, decreased relapse, and improved remission rates [4].

2. Some treatments for psychiatric disorders may trigger disturbances of sleep [3].

Patients with schizophrenia are often prescribed antipsychotics which may cause sedation but also, chronic insomnia [4].

3. Sleep deprivation may have therapeutic effects for some psychiatric disorders but may aggravate others [3].

One study showed that the frequency of anxiety in obstructive sleep apnoea (OSA), a common sleep disorder in patients, is higher than in the general population. Additionally, OSA patients are more likely to present with anxiety and depression than any other typical symptoms [5]. In contrast, previous studies have shown rapid antidepressant effects from sleep deprivation for roughly 40-60 percent of individuals. Although how effective the treatment is and how to achieve the best clinical results has not been fully elicited [6].

Adults require 7-9 hours of sleep each night [2]. I’m sure the sleep deprived medical student would fall short of this. And even more so would a person with a psychiatric disorder. Research has shown how connected sleep, sleep deprivation and psychiatric disorders are. Despite this, patients' chronic difficulty in getting good sleep is a non-specific occurrence that is often overlooked [7].

It is argued that insomnia and mental health conditions show a bidirectional relationship, with typically the strongest pathway being disrupted sleep as a causal factor in the occurrence of certain psychiatric problems [2] [3] [7]. Therefore, intervening in sleep disorder at an early stage might be a preventive strategy for the onset of clinical psychiatric disorders.

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[1] Ben Simon E, Vallat R, Barnes CM, Walker MP. Sleep Loss and the Socio-Emotional Brain. Trends Cogn Sci. 2020; 24(6):435-450.

[2] Suni E. Sleep deprivation. Sleepfoundation. 2021. [Accessed online] Available from: https://www.sleepfoundation.org/sleep-deprivation

[3] Krystal AD. Psychiatric disorders and sleep. Neurol Clin. 2012; 30(4):1389-413

[4] Khurshid KA. Comorbid Insomnia and Psychiatric Disorders: An Update. Innovations in clinical neuroscience. 2018; 15(3-4), 28–32.

[5] Rezaeitalab F, Moharrari F, Saberi S, Asadpour H, Rezaeetalab F. The correlation of anxiety and depression with obstructive sleep apnea syndrome. J Res Med Sci. 2014; 19(3):205-10

[6] Giedke H, Schwärzler F. Therapeutic use of sleep deprivation in depression. Sleep Med Rev. 2002; 6(5):361-77

[7] Freeman D, Sheaves B, Waite F, Harvey AG, Harrison PJ. Sleep disturbance and psychiatric disorders. Lancet Psychiatry. 2020; 7(7):628-637