National Sleep Awareness Week

May 13, 2024
written by:Claire Brandon, M.D.

Any wellness article, skin care product, advice column you pull today, likely makes some mention of sleep, likely a lot of mention about sleep. Sleep is so incredibly important for many processes in our body and is an important part of discussion around health, but these days in my practice and mental health as a whole, it remains something tough to treat. Insomnia of course is a very big issue, but excessive sleepiness is also a significant condition that get a little less talk. Today, let’s think about true definitions of sleep, when you should see a specialist (and what kind), and what treatment could look like. 

What is Insomia?

Insomnia is a sleep disorder characterized by difficulty falling asleep, staying asleep, or both, despite having the opportunity to get a full night’s sleep (i.e. nothing is waking you such as having a cough or a crying baby). When someone is struggling with falling a sleep or having sleep onset insomnia, they are struggling to initiate sleep when they go to bed, often spending a prolonged period tossing and turning before falling asleep. Feelings of frustration, restlessness and anxiety can arise easily as you finally have a chance to rest, maybe after being tired all day and now suddenly it feels like your brain is wide awake. 

There are also people who struggle with staying asleep either alone or in conjunction with sleep onset insomnia. Often it is described as waking up during the night and having difficulty returning to sleep. People with sleep maintenance insomnia may awaken multiple times throughout the night or wake up too early in the morning and find it hard to go back to sleep. Again this is in context of being able to get a good night of sleep without environmental disruption, like a resident being on call and awakening to their pager going off! The memories stay strongly with me!

Finally, there is a phenomenon called early morning awakening: Individuals with early morning awakening insomnia consistently wake up earlier than desired and find it difficult to fall back asleep, resulting in feeling unrefreshed and fatigued during the day (we’ll discuss more in excessive daytime sleepiness).

Acute insomnia

Insomnia can be acute (short-term) or chronic (long-term). Acute insomnia is often triggered by specific events such as stress, changes in environment, or temporary disruptions in sleep schedule. It typically resolves on its own once the triggering factor is addressed. Chronic insomnia, on the other hand, persists for at least three nights per week for three months or longer and may require more comprehensive treatment.

There are many possible symptoms of insomnia, but the main one I like to focus on is whether or not someone feels refreshed and rested when the wake up in the morning. This is really key because it goes to the most common trigger of what propagates insomnia: napping, over-caffeinating, and building anxiety around sleep. Anxiety and insomnia are unfortunately bidirectional. When you don’t sleep well you feel more anxious, and if you’re more anxious it’s tough to turn off your brain to rest. So treatment of your anxiety would be very important.

Depresion and Insomia

When I’m working with patients who struggle with depression, I often see that insomnia is one of the first symptoms that show up and one of the last to go away. Extremely rude, but that’s the way it is. In that case, treating your depression would be extremely important because although it doesn’t go away immediately, it certainly will get you on the right track. 

There are also behavioral changes to make. You cannot expect yourself to be doom scrolling on instagram until 5 minutes before your bedtime and then expect to fall right asleep if you’re suffering with insomnia. It’s important to ensure you have an environment conducive to sleep. If it’s tough to get this in the actual environment (maybe you live in NYC like I do and there is pervasive light), then you can create it by using a sleep mask, ear plugs, noise machine, and or black out curtains. 

Here are a few of my favorite things for creating the environment:

Portable Blackout Curtains (they use suction cups so you can bring them when you travel)

MZOO Sleep mask (or any contoured sleep mask)

If you are struggling and looking for more formalized treatment, look for something called Cognitive Behavioral Therapy for Insomnia (CBT-i). There are of course medications that I sometimes prescribe that aid in sleep onset, but for the most part I would say they cause more problems than not, especially long term as they can actually disrupt your quality of sleep. 

Excessive daytime sleepiness, what is it?

Around 25% of Americans struggle with excessive daytime sleepiness (EDS). As opposed to insomnia which can be a primary condition, excessive daytime sleepiness is more likely a symptom of a bigger issue, and is defined by a persistent and overwhelming need to sleep during the day, even after what you might consider adequate nighttime sleep. It can significantly interfere with daily activities, impairing cognitive function, mood, and overall quality of life. 

Most common Causes

Some more common causes of this condition are worth looking at in order to ensure they’ve been ruled out for you, but this is by no means an exhaustive list. Conditions such as:

  • Obstructive sleep apnea
  • Narcolepsy
  • Restless legs syndrome

These can disrupt nighttime sleep and lead to daytime sleepiness. In obstructive sleep apnea, for example, repeated pauses in breathing during sleep result in fragmented sleep and poor sleep quality, leading to daytime fatigue and sleepiness. Sleep apnea can also result in significant medical issues including heart and lung conditions and high cortisol levels, contributing to mental health issues and weight gain.

You might be tired all the time because you are actually not getting enough sleep on a regular basis. Whether this is due to lifestyle factors, work schedules, or other reasons, it can result in excessive daytime sleepiness. Chronic sleep deprivation can accumulate over time and impair daytime alertness. Unfortunately, there is no way to “make up” for a bad week of sleep on the weekends and the goal would actually be to try to be as consistent as possible with your sleep no matter what day of the week. Disruptions to our circadian rhythms can also be an issue, such as shift work sleep disorder or jet lag. This is one of the few times I advocate for taking a sleep medication, especially if the shift will be short term so that you can re-regulate your sleep patterns in a more expedited way. 

Medical Conditions that Can Contribute to Daytime Sleepiness

It’s worth knowing that there are some medical conditions, such as thyroid disorders, diabetes, autoimmune conditions, and chronic pain conditions, that can contribute to daytime sleepiness. Medications used to treat these conditions may also have sedating effects, which though necessary, can make things worse.  It’s important to have correct expectations about your amount of fatigue based on the medical condition and medications you’re on so that you don’t feel perpetually frustrated that you don’t feel as well rested as you did prior to having your condition. That is not to say that it cannot get better, but that it is a process and with some level of inflammation in your body, sleep and fatigue can always be complicated. 

Conclusion

As we discussed above with insomnia, mental health disorders can impact sleep and therefore they can impact excessive daytime sleepiness as well. To name a few, depression, anxiety, PTSD, and bipolar disorder can affect sleep quality and lead to daytime sleepiness. Disrupted sleep patterns due to medications, coping skills, and stress can all contribute to daytime fatigue.

And of course, one of the at times more controllable factors is our lifestyle. Factors such as excessive alcohol consumption, use of stimulants or sedatives, poor diet, lack of physical activity, and excessive screen time before bedtime can disrupt sleep and contribute to daytime sleepiness.

So as we can see, sleep and mental health are closely intertwined, with each influencing the other in a complex interplay. Addressing sleep disturbances is an important aspect of managing mental health disorders, and improving mental health can also lead to improvements in sleep quality. Treatment approaches for insomnia often include cognitive-behavioral therapy for insomnia (CBT-I), medication management, and addressing underlying mental health issues. If you’re struggling with sleep, there are things to do, reach out to your primary care doctor or talk to your psychiatrist about it, you deserve good sleep!

Claire Brandon, M.D.

Dr. Brandon is a dual board-certified psychiatrist in both adult psychiatry and consultation-liaison psychiatry (treatment of psychiatric illness in medically ill adults). She completed her residency and fellowship training at Mount Sinai Hospital in New York City and did a second fellowship in public psychiatry at New York University in New York City

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