My patients often come to me with complaints about sleep. My job is to nail down the precise complaint and to identify why they aren’t sleeping well. We often talk about sleep quality, meaning when you are asleep, is it deep restful sleep and does it last for the recommended number of hours nightly? In some cases, you can be a “good sleeper,” but the problem is not getting consistent sleep.
When I use the term consistent sleep, I mean a pattern that ensures that you are going to sleep every night for the appropriate number of hours. The key words are “every night.” Conceivably you could have no problem falling asleep or staying asleep, but rather have trouble, due to work or other issues, going to bed every night consistently.
Of course, students are often good sleepers, but they pull all-nighters studying, which means they’re not getting consistent sleep, or they text until the wee hours of the morning. A caregiver of a loved one, who is kept up by the needs of the patient or awakened repeatedly to address pain issues or a medication schedule, would also miss out on consistent sleep.
Sleep problems correlate to a number of health problems. Not getting enough sleep can impact heart health and weight, and studies suggest that the impact can also extend to mental health.
A 2017 study published in the journal The Lancet discussed the effects of improved sleep on mental health. Oxford Access for Students Improving Sleep or OASIS, a single-blind randomized controlled trial involving more than 3,700 students from 26 universities in the UK, found that sleep interventions (in this case the digital CBT used was Sleepio helped to reduce insomnia, paranoia and hallucinatory experiences. Currently this is considered the largest randomized trial to date showing the impact of psychological intervention on sleep and its resultant positive impact on mental health parameters.
In a January 2017 column in U.S. News & World Report, sleep researchers discussed the impact that lack of consistent sleep (inadequate sleep) can have on one’s mental health. Getting consistent sleep night after night is linked to reducing risk factors for developing more serious mental illness and affective disorders, according to Elizabeth Kensinger, a professor of Psychology at Boston College and the director of the school’s sleep lab. She also conjectured that getting a good night’s sleep consistently would likely reduce the risk of anxiety disorder.
I think most of us have experienced how on edge we feel after several nights’ of missed sleep or inadequate sleep. Problems can seem bigger, you’re more apt to lose your patience, and you’re certainly more likely to have trouble focusing on complex tasks. New moms often complain of feeling foggy and they are certainly at risk of developing mild depression if they experience tremendous gaps in consistent sleep. If you already have mental health issues, then lack of consistent sleep has the potential to intensify anxiety states and could complicate post-traumatic stress disorder, according to Dr. Karl Doghramji, director of the Jefferson Sleep Disorders Center at Thomas Jefferson University in Philadelphia.
Lack of consistent sleep and poor quality sleep have been implicated in diminishing a driver’s reaction time, which can mean an escalated risk of having or causing an accident. It can also heighten suicidal ideation.
In a society that values constant activity and getting things done at warp speeds, the need for consistent and adequate sleep can often be misconstrued and thought of as a “period of doing nothing.” I’ve written extensively on how crucial sleep is to physical and mental health, to daily function and to optimal performance. Experts like me recognize that consistent sleep is vital, because it’s a period during which the brain is not being asked to handle massive new amounts of information, but rather is analyzing and imprinting the information of the day, uninterrupted. The reason why you may have a breakthrough idea or see new possibilities is because you’re not sleep deprived, i.e., your brain was able to process vital pieces of information and allow you to have a lightbulb moment.
According to the U.S. Centers for Disease Control and Prevention (CDC), at least one in three individuals doesn’t get adequate sleep. Adequate sleep involves meeting the goal of enough hours of restful sleep, night after night, consistently.
There is some variability among adults with regard to the number of hours of sleep that you may need to function optimally. But in my mind everyone needs to be consistent in getting that period of sleep, every night. I’ve discussed the challenges that people with irregular shift work, like nurses, face. Doctors in residency, who are on call for long periods and then try to catch up on sleep, are another group. They and other professional groups lack consistent sleep patterns. These groups are certainly vulnerable to occupational errors and may be at risk of mental health vulnerabilities.
It’s important to note that many anxiety disorders are associated with sleep difficulties. Sleep problems actually occur more frequently in people with psychiatric conditions, compared to the general public. Obsessive-compulsive disorder (OCD) is often associated with poor sleep. The lack of consistent sleep then has the potential to create a vicious cycle of worsening OCD symptoms and behaviors. This bi-directional phenomenon can make treatment challenging.
A September 2017 column in Business Insider discussed how poor sleep (quality and consistency) can “ramp up our insecurities.” Lack of consistent sleep can skew thoughts towards downbeat, fearful things, and cause brain processing to repeat this negative loop. The net result can be dark moods, anxiety, feeling blue and feeling irritable. Unfortunately, the longer we remain in this inconsistent sleep pattern, the more our minds remain troubled and this directly fuels further sleep issues.
It can take serious commitment to a healthy, consistent sleep schedule — possibly several weeks — in order to begin to really appreciate mental health impact, though after several consistent days most people will notice a difference. Depending on the duration of mental health challenges, how long anxiety or depression has been present and the presence of other clinical factors, mental health regulation once sleep is restored is individualized. Certainly, both insomnia and nightmares are considered modifiable risk factors for suicide.
So how do you commit to a consistent and healthy sleep pattern?
- Value the importance of sleep and make it a nightly priority
- Go to sleep at the same time nightly and wake up the same time daily, even on weekends
- Follow the rules of good sleep hygiene
- Learn how to optimize your sleep if you work night shift
- See a sleep specialist if you are unable to sustain a consistent sleep habit so that they can help you identify problems and provide a personalized therapeutic approach
See more helpful articles:
Eli Hendel, M.D., is a board-certified internist/pulmonary specialist with board certification in Sleep Medicine. An Assistant Clinical Professor of Medicine at Keck-University of Southern California School of Medicine, and Qualified Medical Examiner for the State of California Department of Industrial Relations, his areas include asthma, COPD, sleep disorders, obstructive sleep apnea, and occupational lung diseases. Favorite hobby? Playing jazz music. Find him on Twitter @Lung_doctor.