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Insomnia, Mood, and Mental Health: Expert Advice for Wellbeing
May 6, 2020
Sleep is central to our health, but not always simple. Your body and mind need high-quality sleep to function well and, unfortunately, several issues can prevent or disturb good sleep.
In the short term, poor sleep damages our critical thinking, reaction times, and mood. Long-term sleep issues and disorders can cause serious health disorders, including heart disease. It’s further complicated because mental health issues and stress can lead to poor sleep, and poor sleep can lead to mental health issues.
While sleep is always important- it’s particularly topical as many of us are experiencing additional stress and work-life imbalances due to our current work from home environment. Paying close attention to our sleep patterns and maintaining quality “sleep hygiene” has become increasingly difficult for many – and ultimately more important than ever.
The sleep specialists at Weill Cornell Medicine understand the complexities of sleep and are experts in helping patients improve their sleep. Our physicians work with patients to help them achieve the best possible sleep and quality of life.
Weill Cornell Medicine, in conjunction with the 92Y, presented a full-day summit about mental health for the public. Throughout the day, experts from Weill Cornell Medicine shared their insights about mental health, mental illness, and other important topics — including sleep.
During one session, Dr. Maria Suurna joined Dr. Daniel Barone to answer some of the most important questions about sleep and wellbeing.
Dr. Suurna is an expert in sleep surgery at Weill Cornell Medicine, providing evaluation and surgical treatment for snoring and obstructive sleep apnea. Dr. Barone is the Associate Medical Director of the Weill Cornell Medicine Center for Sleep Medicine and the author of Let’s Talk About Sleep. As a neurologist and sleep specialist, he diagnoses and manages patients with a variety of sleeping disorders.
Why is sleep so complex?
Sleep science is a relatively new field of medicine and there is so much about sleep that is unknown to scientists and physicians. According to Dr. Suurna, doctors are still unsure why we sleep or how the stages of sleep affect us. “This is the stage we’re at in healthcare and medicine right now,” she asserted.
When it comes to poor or problematic sleep, there are so many factors that need to be considered to get a good understanding. “Everybody is different,” she explained. “Everybody’s environment is different. Your genetics and anatomy are unique. In many cases, multiple factors are coming together to cause an issue with sleep.”
Physicians are certain that we need between seven and nine hours of sleep per night. “We probably sleep, on average, about six and a half hours or so in America,” said Dr. Barone. “We sleep an hour less than we did a hundred years ago, which doesn't sound like much. But that's actually very big.”
What is insomnia?
Insomnia is one of the most common sleep problems. Insomnia is when someone has trouble falling asleep or staying asleep for a sufficient amount of time. Everyone experiences insomnia at some point in their lives. For some, unfortunately, insomnia becomes chronic — making it difficult to fall or stay asleep for more than three nights a week for several months.
In the short term, explained Dr. Barone, insomnia “affects cognition. We all know that if we don't sleep well, our memory goes and our reaction time goes. For example, the Monday after daylight savings is the number one day for car accidents in America because we’re already sleep-deprived, and then we take another hour off of it. What’s the first thing that goes? Our reaction time, our ability to make decisions quickly. That’s the short-term effect.”
“In the long term,” he continued, “we know that people who sleep poorly are at a higher risk for heart disease, diabetes, dementia, and other issues down the road.”
What causes insomnia?
Insomnia has many causes. Medical conditions, such as allergies, asthma, reflux, or pain, can cause difficulties sleeping. Medications can also prevent sound sleep, such as medicines commonly taken for heart disease or birth control.
Another underlying sleep disorder may cause insomnia. For example, insomnia can be a symptom of sleep apnea or restless leg syndrome.
If you frequently have difficulty falling or staying asleep, you do not need to accept poor sleep as a fact of life. Be sure to speak with a primary care physician about how you can improve your sleep or if you should seek the guidance of a sleep specialist.
Correlation with mental health
Insomnia is closely linked with mental health issues, specifically depression and anxiety. “There’s actually a bi-directional relationship between anxiety and depression with insomnia,” explained Dr. Barone.
When patients come to Dr. Barone complaining of insomnia or poor sleep, he asks them to describe a difficult night. “If someone has anxiety, they get into bed and ruminate, which makes it harder to fall asleep,” he described. “If somebody has depression, one of the classic signs is that they may wake up early in the morning or earlier than they want to. Now, when someone has anxiety or depression, as well as insomnia, anxiety, and depression make insomnia worse. Then when they have poor sleep, anxiety, and depression become worse. This becomes a vicious cycle.”
Dr. Suurna asserted that treating only the sleep disorder, whether sleep apnea or insomnia, doesn’t help those with underlying depression or anxiety. She said, “Some patients will focus on the sleep problems, thinking, ‘If we fix my sleep apnea, all my problems will go away.’ But the reality is that they don’t always do.”
Thankfully, there’s hope to break this cycle. By treating all disorders — including anxiety or depression and sleep disorder — sleep, mood, mental health, and quality of life all improve.
How can I improve my sleep?
For the majority of us, we have the power to improve our sleep without any medical intervention. There are many elements of sleep that we control to improve not only the number of hours of sleep, but also the overall quality.
Dr. Suurna suggested improving your sleep environment so that it’s as comfortable and conducive to sleep as possible and setting a consistent time for sleeping. Dr. Barone recommended keeping back-lit devices away for a few hours before trying to fall asleep.
“Also, alcohol and caffeine are pretty big obstructions to sleep quality,” she continued. “We know that even if a person gets seven or eight hours of sleep, if their sleep is disrupted due to the influence of drugs, alcohol, caffeine, some sort of noisy environment, or a bed partner who has sleep issues, that person tends to not function well.”
Both Dr. Suurna and Barone advocated for a strong focus on sleep hygiene. Dr. Suurna suggested that patients ask themselves several questions:
Am I giving myself enough time to sleep?
Do I go to bed at the same time?
Am I avoiding activities that predispose me to not fall asleep, such as watching TV, looking at my phone, using a computer, or other stimulating activity?
Dr. Suurna explained, “Because insomnia is hyperactivity or hyperstimulation during sleep, anything that makes you more stimulated when you are trying to fall asleep may lead to insomnia.”
Dr. Barone suggested reading a book with a lamp, praying, or meditating before your bedtime to help fall asleep.
Are there other things I can do to sleep better?
The first step is improving your sleep hygiene. The next step, according to Dr. Barone, is to try taking melatonin. “I recommend melatonin to a lot of my patients because they don’t want to try medication or they’ve heard about it and want to give it a shot,” he said. “It’s benign, and it’s not addictive.”
If this does not work, it means that it’s time to speak with your primary care doctor more about your sleep and mental health. Meeting with a psychiatrist and a sleep specialist will help you better understand your mental health, sleep, and overall well being. These specialists will then recommend other treatment options.
All of us at Weill Cornell Medicine understand that this is a difficult time for all New Yorkers. As experts in immunology, pulmonary medicine, and critical care medicine, we are working diligently to provide the greatest possible care to patients in need.
We are available to all New Yorkers who have questions or concerns. Please call our hotline at (646) 697-4000 for information about COVID-19 or read our patient guide.