What is the connection between sleep disturbances and mental health?
Poor, interrupted sleep or insufficient sleep can have serious consequences for children, teens and adults. Inadequate sleep can cause a decrease in concentration, reaction time and processing information into memory. It can increase memory lapses, accidents, mood problems and behavior problems. It is commonly thought that sleep disturbances are a symptom of mental health problems such as depression. Recent research done at the University of Rochester sleep clinic indicates that sleep problems such as insomnia may lead to chemical changes in the brain that actually bring on depression. Furthermore, treating the insomnia may be useful in preventing or shortening a depressive episode. Another study revealed that senior citizens who were experiencing sleep problems were far more prone to depression, and seniors with insomnia were 17 times more likely to continue with depression than those who slept well.
How many times have parents banned sleepovers after dealing with a short-tempered or tearful child who has not had enough sleep the previous night? Now imagine the effects of shortage of sleep on a long-term basis. Chronic poor sleep has been shown to result in daytime tiredness, difficulties in focusing attention, increased irritability and low frustration level. These are all symptoms of attention deficit and hyperactivity disorder (ADHD) which clearly negatively impact school and social performance. In some cases, however, a sleep disturbance might be the cause of school problems. In addition, true ADHD might be worsened by sleep deprivation. Children who are being evaluated for any mood disorder, behavior problem, attention or hyperactivity difficulty should first be thoroughly screened for sleep disturbance.
Individuals require different amounts of sleep, but typically children 1-5 need 12 to 15 hours. A recent study revealed that this age group actually got much less sleep than the recommended amount. The average school age child needs about 9 hours nightly to wake spontaneously in the morning, a sign of adequate sleep. Adults need about seven to nine hours nightly, but often are getting only five or six hours nightly. The effects of our overscheduled, over-stimulating society have reduced nightly sleep from the nine-hour average in 1910 to seven hours today.
Surprisingly, teens need about nine hours of sleep to maintain optimal daytime alertness. Studies show that many sleep six hours a night or less, which naturally results in irritability, moodiness, daytime sleepiness and resultant lower grades. The teen years are particularly difficult because of both the teens' growing independence and a change in their biological clock, which comes with puberty. Their internal clock causes them to become sleepy two hours later than in pre-adolescence. When they stay up even later to socialize or study, their internal clock begins to be affected. This can lead to daytime sleepiness, late rising and attempts to make up a sleep deficit on weekends, which increases the dysfunction of their internal clock.
One way for parents and individuals to judge sleep needs is to look for signs of poor quality or quantity by monitoring such signs as spontaneous waking, daytime sleepiness and irritability. It is especially helpful to complete a sleep diary for one or two weeks, noting the above markers to aid in diagnosis and treatment. Parents can also observe sleep occasionally to check for restless or fitful sleep. Restless sleep may reduce the quality of sleep and is sometimes caused by upper airway problems. Children and adults with sleep apnea often snore and have interruptions in breathing. This condition, in addition to others such as sleepwalking and restless leg syndrome, needs to be evaluated by a physician, with a possible referral to a sleep clinic.
Paying attention to good sleep hygiene is one method of addressing possible sleep disturbances. Sleep hygiene is the development of behaviors surrounding bedtime that increase the likelihood that an individual will get restful sleep more consistently. The most important feature of sleep hygiene is maintaining a regular sleeping and waking pattern seven days a week. The U.S. National Institutes of Health suggest the following guidelines to help you or your child get enough sleep. These strategies can be easily adjusted for both teens and adults who experience difficulties.
Build a bedtime routine that includes setting a regular bedtime each night and sticking to it.
Establish a relaxing bedtime routine, such a giving your child a warm bath or reading a story.
Make after dinner playtime relaxing. Too much activity close to bedtime can keep children awake.
Avoid big meals close to bedtime.
Avoid anything with caffeine, including chocolate, within six hours of bedtime.
Set the bedroom temperature so that it is comfortable.
Make sure the bedroom is dark, using a small nightlight if necessary.
Keep the noise level low.
Avoid napping during the day, which can disturb the normal pattern of sleep and wakefulness.
Exercise can promote good sleep. Vigorous exercise should be taken in the morning to late afternoon.
Ensure adequate exposure to natural light. Light exposure helps maintain a healthy sleep-wake cycle.
Try to avoid emotionally upsetting conversations and activities before trying to go to sleep. Don't dwell on or bring problems to bed.
Associate bed with sleep. It's not a good idea to use the bed to watch TV, listen to radio or read. Have a buffer time between TV or computer use and bedtime, which allows for winding-down time before sleep.
Review any medications, including ADHD medications, asthma medicine and decongestants, which may be interfering with sleep quality, with your physician.
A good sleep hygiene routine is the first logical step in addressing any sleep disturbance. Research is showing that children and teens with behavior and psychological problems can be helped by addressing sleep problems in conjunction with other interventions. Any age group can benefit from modifications in environment and sleep schedule, and a significant number of sleep problems can improve with these changes. For more information, access the following websites: www.nationalsleepfoundation.org, www.americansleepassociation.org.