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“Sleep that knits up the raveled sleave of care,

The death of each day’s life, sore labor’s bath,

Balm of hurt minds, great nature’s second course,

Chief nourisher in life’s feast.”

— William Shakespeare, “Macbeth”

When I was in my first year of training as a clinician, one of the attending psychiatrists on an inpatient unit gave me a tip: if you want to know how someone is doing and only have a limited amount of time to assess the situation, see how they’re sleeping. I would learn over time, that where sleep is concerned, there really is no substitute: good sleep is a basic ingredient for our health and mental health, if we can find it. Sleep gives us clues into how we’re doing, and working to improve it can help improve our overall health and well-being and day to day performance. It may be daunting to consider, but adults have a need for about 7 hours of sleep per night, though research shows few of us get it.

Sleep disturbances of different types are hallmark symptoms of many mental health disorders, including depression — either sleeping too much, or waking up in the early morning but can’t fall back asleep — and mania — where a person experiences a decreased need for sleep. People with anxiety disorders can find night is a difficult time where anxious ruminations come, and won’t seem to leave.

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There are also many people with primary sleep disorders — a problem with sleep that isn’t caused by an underlying mental health problem. For example, a growing number of adults and even children are diagnosed with obstructive sleep apnea — a condition that causes a person to not breathe properly during sleep. In this case, a person may not know that they have a sleep problem at all — since they may fall asleep easily (sometimes, too easily) and sleep through the whole night, but may wake up feeling fatigued, or even more tired than when they went to bed. This is because they’re not getting consistent, restorative sleep which helps the brain to rest and recuperate.

Still, others have conditions such as restless leg syndrome (RLS), where their limbs won’t seem to settle down for a rest, keeping them awake or from falling into deeper phases of sleep.

Pain disorders, whether acute or chronic, can also impair sleep, and this in turn contributes to the development of co-occurring mental health problems so often seen with pain.

Consuming any amount of alcohol decreases the quality and length of sleep — which may seem surprising because alcohol is a “sedative.” This sleep disruption comes from a “rebound effect” that happens with alcohol and similar sedatives (like benzodiazepines), which can cause a person to feel keyed up after the sedation wears off.

Cannabis can also have surprising effects on sleep. Although it does appear that cannabis can sometimes help with pain and creates feelings of sedation and relaxation, it also changes the time that a person spends in different stages of sleep. In the long run (especially with heavy users, and when used over a long period of time), this can lead to less sleep overall, frequent waking, and side effects that last into the next day.

There are treatments for sleep disorders and sleep trouble that can show up as a symptom of medical or mental health problems. Some of these include: cognitive behavioral therapy for insomnia (CBT-I), psychotherapy and/or medications to treat underlying medical and mental health problems, sleep apnea treatments such as the use of a nighttime air flow device called a CPAP, and working to improve the body’s natural way of “settling down” into sleep by introducing routine, daily activities that cue the mind that it’s time to sleep (sometimes called “sleep hygiene”), and with certain kinds of relaxation exercises. For more information about sleep disorders and these types of treatments, see cdc.gov/sleep/index.html. In researching sleep information, take care to avoid articles and sites that have a bias — many sleep websites are trying to sell products and services. Whenever possible, discuss sleep issues with your medical providers.

Kurt L. White is the vice president of outpatient programs at the Brattleboro Retreat.


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