Complex mental health issues and sleep hygiene

We spend a third of our lives asleep, and there is a reason for that. Sleep plays an important role in both our physical and mental wellbeing.

Good quality sleep allows time for our body to repair and recover from the day, strengthens our immune system, and lets our brain process memories. Getting enough sleep helps us concentrate and stay alert during the day, and perform well in our studies and at work.

Good quality sleep puts us in a better position to manage our emotions and mood, cope better with stress, and reduces irritability. Achieving enough sleep also decreases our risk of developing mental health problems in the future.

Sleep and mental health

Sleep problems are significantly more common among people with mental health issues than the general population. Poor sleep is linked with the onset of mental health difficulties as well as the worsening of current symptoms. Additionally, symptoms of mental illness such as feelings of anxiety and depression make it harder for people to fall and remain asleep.

Some medications prescribed for mental health issues may also result in sleep disturbance – meaning a person may not sleep enough, may sleep too much, or have poor quality sleep.

Poor sleep has been linked to symptoms of depression such as feeling down, hopeless, irritable, and even to having thoughts of suicide. Poor sleep also impacts our ability to think clearly, remember things, and learn new information.

Did you know?

• Approximately 75% of people with depression report they have difficulty falling or staying asleep.
• Lack of sleep can trigger an episode of mania in people with bipolar disorder.
• For those with schizophrenia, sleep abnormalities are often the first warning sign of an episode of psychosis.
• Posttraumatic stress disorder (PTSD) often involves sleep disturbances such as nightmares, frequent awakenings, difficulty falling or staying asleep and restless sleep.

So, how much sleep should we be getting? The National Sleep Foundation recommends adults aim for 7–9 hours of sleep each night. However, studies show that one in three Australians are not reaching this goal.

The good news is that there are some simple things you can do to improve your sleep. “Sleep hygiene” is a term that describes a variety of practices and habits that promote good quality sleep. For people experiencing complex mental health issues, having good sleep hygiene is important for staying well.

Sleep hygiene

• Regular sleep and wake times. Having a set time that you go to sleep and wake up puts your body into a rhythm. Its best to keep these times the same on weekends too.
• Avoid nicotine, caffeine, and alcohol. Nicotine and caffeine (found in coffee, tea, coke, chocolate) act as stimulants that make it more difficult to fall asleep. Consuming alcohol can interfere with the quality of sleep. For better sleep, try to avoid these substances for at least 4-6 hours before going to bed.
• Bed is only for sleep. To help your body form an association between bed and sleeping, avoid doing activities such as watching TV, using your computer or phone, or eating, while in bed.
• Avoid daytime naps. To ensure you are tired enough to sleep at bedtime, try not to sleep during the day. If you do need a nap, make sure it’s for less than an hour and before 3pm.
• The right sleep environment. Create a space that is conducive to sleep. Factors to consider are temperature (a cool room with enough blankets to stay warm is ideal), noise level (keep things quiet by using earplugs if you’ve got roommates or other distracting sounds), and light level (use blackout curtains or an eye mask to ensure its dark enough).
• Get up if you can’t fall asleep. There’s nothing worse than lying in bed awake! So if you are not asleep after 20 minutes, get up and do a relaxing (or boring) activity until you feel sleepy, then return to bed and try again.
• Warm bath or shower. Studies show that a fall in body temperature is associated with sleepiness. Having a hot bath or shower 1-2 hours before bed allows you to become sleepy as your body cools down.
• Develop a bedtime routine. Performing a consistent ritual every night before bed reminds your body that its time to slow down. You can include whatever activities you find calming. Some people enjoy a warm (caffeine-free) drink, a hot shower or bath (as above), a relaxing activity such as reading or colouring, and even some gentle stretching or breathing exercises.
• Limit screen time. Blue light from electronic devices makes your brain think its daytime. It’s a good idea to stop using your computer, tablet, phone, or watching TV at least 30 minutes before bed.
• Exercise. Exercising during the day can help to reduce restlessness in the evening. However, try to avoid strenuous exercise in the 4 hours before bed, as your body needs time to wind down.
• Sleep diary. Recording your sleep patterns can provide useful information for a GP or psychologist to understand what is happening for you.
• Don’t watch the clock! If you are worried about the amount of sleep you are NOT getting, chances are you watch time tick by. Obsessing over the time can reinforce negative thoughts like “If I fall asleep now I will only get 5 hours of sleep. I won’t be able to cope tomorrow,” which increases anxiety and reduces your chance of falling asleep quickly.

Which of these sleep hygiene tips could you benefit from incorporating into your routine? Which are you already doing?

If you are concerned about your sleep difficulties or would like further advice, speak with your GP, psychologist, or other health professional. 

Sleep well!

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