It started with mild anxiety.
Emily, who asked to be identified only by her first name because she was discussing her mental health, had just moved to New York after graduate school to start a marketing job at a large law firm.
She knew it was normal to feel a little anxious. But she wasn’t prepared for what came next: chronic insomnia.
Operating on only three or four hours of sleep, it didn’t take long for her anxiety to mount: At 25, she was “terribly nervous all the time. A shipwreck.”
When a lawyer in her office yelled at her one day, she experienced the first of many panic attacks. At a doctor’s suggestion, she tried taking a sleeping pill, hoping it could “reset” her sleep cycle and improve her mood. Did not work.
Americans are chronically sleep deprived: one-third of adults in the United States say they get fewer than 7 hours a night. Teenagers fare even worse: About 70 percent of high school students don’t get enough sleep on school nights.
And it has a profound effect on mental health.
An analysis of 19 studies found that while sleep deprivation impaired a person’s ability to think clearly or perform certain tasks, it had a greater negative effect on mood. And when the National Sleep Foundation conducted a survey in 2022, half of those who said they slept less than 7 hours each day also reported having symptoms of depression. Some research even shows that treating insomnia can help prevent postpartum depression and anxiety.
Clearly, sleep is important. But despite the evidence, there continues to be a shortage of psychiatrists or other doctors trained in sleep medicine, leaving many to train.
So what happens to our mental health if we don’t get enough sleep and what can be done about it?
How does poor sleep affect your mood?
When people have trouble sleeping, the way they experience stress and negative emotions changes, said Aric Prather, a sleep researcher at the University of California, San Francisco, who treats patients with insomnia. “And for some, that can have a feedback loop — feeling bad, ruminating, feeling anxious can bleed into our nights,” she said.
Carly Demler, 40, a stay-at-home mother in North Carolina, said she went I slept one night and never slept. From that point on, he would wake up at least once a week until 3 or 4 in the morning. This went on for over a year.
She became irritable, less patient and much more anxious.
Hormone blood testing and a sleep study at a university lab gave her no answers. Even after taking the Ambien, she stayed up most of the night. “It was like my anxiety was a fire that somehow jumped the fence and somehow ended up spreading into my nights,” she said. “I just felt like I had no control.”
Ultimately, it was cognitive behavioral therapy for insomnia, or CBT-I, that brought Ms. Demler the most relief. Studies have found that CBT-I. it’s more effective than sleeping pills in the long term: 80% of people who try it see improvements in their sleep.
Mrs. Demler learned not to “lay in bed and freak out.” Instead, she gets up and reads so she doesn’t associate her bedroom with anxiety, then goes back to bed when she’s tired.
“The feeling of gratitude that I have every morning when I wake up and feel well rested, I don’t think it will ever go away,” he said. “It was an unexpected silver lining.”
Adults need between 7 and 9 hours of sleep a night, according to the Centers for Disease Control and Prevention. Teenagers and young children need even more.
It’s not just the quantity. The quality of your sleep is also important. If it takes more than 30 minutes to fall asleep, for example, or if you regularly wake up in the middle of the night, it’s harder to feel rested, regardless of the number of hours you spend in bed.
But some people “tend to think they’re functioning well even if they’re sleepy during the day or have trouble focusing,” said Lynn Bufka, a clinical psychologist and spokeswoman for the American Psychological Association.
Ask yourself how you feel during the day: Do you find yourself more impatient or quick to anger? Do you have more negative thoughts or feel more anxious or depressed? Do you find it harder to deal with stress? Do you find it difficult to do your job effectively?
If so, it’s time to take action.
How to stop the cycle.
We’ve all heard how important it is to practice good sleep hygiene, using daily habits that promote healthy sleep. And it’s important to talk to your doctor to rule out any physical problems that need to be addressed, such as a thyroid disorder or restless legs syndrome.
But this is only part of the solution.
Conditions such as anxiety, post-traumatic stress disorder, and bipolar disorder can make it difficult to sleep, which can then worsen the symptoms of mental illness, which in turn makes it harder to get a good night’s sleep.
“It becomes very difficult to break the cycle,” Dr. Bufka said.
Certain medications, including psychiatric medications such as antidepressants, can also cause insomnia. If one drug is to blame, talk to your doctor about switching to another, taking it earlier in the day or reducing the dose, said Dr. Ramaswamy Viswanathan, professor of psychiatry and behavioral sciences at the State University of New York Downstate Health Sciences. University and the new president of the American Psychiatric Association.
The cycle can also afflict those without mental health disorders, when worry worsens sleep and lack of sleep worsens mood.
Emily, who worked at the big law firm, would worry so much about her inability to sleep that she wouldn’t even lie in bed.
“You really start to think I’m never going to sleep,” he said. “The adrenaline is so high you can’t do it.”
Finally came across “Say Goodnight to Insomnia” by Gregg D. Jacobs. The book, which uses CBT-I. techniques, helped Emily redefine the way she thought about sleep. She started recording her negative thoughts in a journal and then changing them to positive ones. For example: “What if I can’t sleep again?” it would become “Your body is made for sleep. If you don’t get enough rest one night, eventually you will.” These exercises helped her stop catastrophizing.
Once she started sleeping again, she felt “much happier.”
Now, at 43, nearly 20 years after moving to New York, she still relies on the techniques she learned and takes the book with her whenever she travels. If he’s not sleeping well away from home, “I take over sleeping for a few days if I have to,” he said. “I’m much more relaxed about it.”
