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August 14, 2014
by Cathy England, MA

Evaluation of Sleep Disorders as They Relate to Mental Illness

August 14, 2014 04:55 by Cathy England, MA  [About the Author]

A Common Problem

Sleep disturbances are common in the United States population.  Harvard Health Publications (2009), estimate that sleep problems are prevalent in at least 50% of patients receiving psychiatric treatment. This can be compared to the general population in which about 10% report sleep problems. What is not entirely clear is whether or not sleep disturbance is a symptom or a risk factor for mental health presentations.   Distinguishing between the two is important in being able to approach treatment planning and recommendations for the mentally ill. 

Sleep Disturbances and Mental Health Disorders, a Viscous Cycle.

Kellestad, et al. (2012), indicate that sleep disturbance is a presenting factor in 19 Axis I disorders listed in the DSM IV.  They also state that the relationship between sleep and mental health can be difficult to understand.  It may be that the two happen concurrently.  Sleep disturbance can affect quality of life on a number of levels.  According to Puterbaugh (2011), commonly affected areas of life are cognitive ability, memory and mood.  Of the many types of sleep disturbances, the most common appears to be insomnia which is the inability to sleep or to stay asleep.  One alarming statistic according to Szelenberger and Soldatos (2005) is that insomnia may increase the risk for suicide in some sufferers.  They indicate that although there are many mental health problems associated with sleep disturbance, that the most widely studied has been depression.

Many practitioners are quite concerned with the association between poor sleep cycles and Bipolar disorder.  During the manic phase, sleep is often elusive, while the depressive phase often brings on cycles of too much sleep or overwhelming grogginess.  Stabilizing the sleep/wake cycle of these patients is often one of the treatment goals (Liebenfuft and Suppes, 1999).  Many times, patients are first diagnosed with Bipolar Disorder as a result of complaints of overwhelming sleep problems.

Finding a Cause

According to the literature researched for this article, the general idea seems to be that more focus needs to be placed on getting to the root of the sleep issue.  Kellestad et al. (2012) find a direct link between levels of sleep disturbance and levels of mental health symptoms.  Puterbaugh (2011), goes on to indicate that some sleep problems in the mental health patient are self-inflicted, and that focusing on self-help measures and building of routine around sleep can make an impact on this problem.  He cites a common idea that 8 hours of sleep are the optimal goal for good health.

There are a number of steps that a mental health patient can take on their own in order to maintain good sleep outcomes.

  •       Caffeine-This stimulant is available for consumption in a variety of forms including coffee, soda, and chocolate. Many times people use caffeine to wake up in the morning due to fatigue from poor sleep the night before. However, it can carry throughout the day and affect sleep the following night.  This turns into a cycle that makes restorative sleep hard to accomplish.
  •        Physical Activity-Many therapists and doctors will recommend to patients that they should get a decent amount of physical activity during the day with the warning that this should not occur close to bedtime. Engaging in physical activity naturally expends energy that makes sleep come more easily when it is time.
  •       Sleep Hygiene-This refers to the practice of making the bedroom a place appropriate and used only for sleep or sex.  It is discouraged to engage in work activity, television viewing or even reading in the bedroom.  This is thought to help the body associate the bedroom with sleep.
  •       Relaxation-Many times, therapists will encourage progressive relaxation techniques to their patients.  This can be taught through teaching patients the techniques so that they can use them on their own. 
  •       Stimulant Medication-Common thought is that stimulant medication commonly used to treat attention deficit hyperactivity disorder should only be taken early in the day so that it has time to work through the body before it is time for sleep.
  •       Routine-Establishing a nighttime routine is good practice for those with sleep disturbance. Every patient may have a different routine, but doing so prepares the body for the fact that bedtime and sleep are next on the schedule.

Whether sleep issues are a symptom or a risk factor for mental illness, getting a good night’s sleep is good for physical and emotional health. The increase in reliance on computers and television, which give off sleep disturbing blue lights, may be culprits in sleep problems as well.  In the case of mental illness when brain chemistry is at fault, self-help techniques may not be as helpful.  But the patient should discuss this with their mental health professional as medications and therapeutic interventions may be needed.


Harvard Health Publications (2009).  Sleep and mental health. Retrieved from

Kallestad, H., Hansen, B., Langsrud, K., Ruud, T., Morken, G., Stiles, T. C., & Gråwe, R.,W. (2012). Impact of sleep disturbance on patients in treatment for mental disorders. BMC Psychiatry, 12, 179. 

Leibenluft, E., & Suppes, T. (1999). Treating bipolar illness: Focus on treatment algorithms and management of the sleep-wake cycle. The American Journal of Psychiatry, 156(12), 1976-81.

Puterbaugh, D. T. (2011). Searching for a good night's sleep: What mental health counselors can do about the epidemic of poor sleep. Journal of Mental Health Counseling, 33(4), 312-326

WALDEMAR SZELENBERGER, CONSTANTIN SOLDATOS(2005). Sleep Disorders in Psychiatric Practice. World Psychiatry, 4(3): 186–190.

About the Author

Cathy England, MA Cathy England, MA

Cathy holds a Master’s degree in Psychology and has 13 years of work experience in counseling and social work. Cathy is an advocate for mental health awareness and enjoys educating people about mental health and the ways that it impacts people and communities. Most of her experience has been in work with court dependent or delinquent adolescents and their families. Cathy has also worked as a volunteer as a Court Appointed Special Advocate (CASA) for children under court supervision.

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