Why Sleep Loss and Mental Health Issues Can Be Part of the Same Vicious Cycle

You might imagine how this kind of irritable or on-edge temperament could also then make it difficult to drift off to sleep at night. In this way, the effects of sleep deprivation on mental health can, in turn, make good sleep all the more elusive, kicking off a vicious cycle.

“Mental health challenges frequently disrupt sleep cycles and are worsened by disrupted sleep cycles.” —Monica Amorosi, LMHC, CCTP, NCC, licensed trauma therapist

Indeed, mental health problems like anxiety and depression have a “reciprocal [or bidirectional] relationship with sleep,” says licensed trauma therapist Monica Amorosi, LMHC, CCTP, NCC. “Mental health challenges frequently disrupt sleep cycles and are worsened by disrupted sleep cycles.”

This strong feedback loop between mental health and sleep can make it both that much more difficult and important to get good sleep if you struggle with a condition like anxiety or depression. Below, experts break down this connection and offer advice for clocking more shut-eye—and supporting your mental well-being in the process.

How sleep deprivation negatively affects mental health

It’s hard to overstate the importance of sleep for so many elements of our health. When we sleep, our bodies engage in a variety of crucial processes, working to heal injuries and bolster our immunity; research also shows that sleep helps the brain clear away cellular debris that can otherwise lead to inflammation.

“Sleep is essential—it’s like air, water, and food,” says psychologist Ariel Zeigler, PhD. And yet, despite its importance, plenty of us aren’t sleeping enough. Around one third of U.S. adults typically get less than the recommended number of seven or more hours of sleep per night, according to the Centers for Disease Control and Prevention (CDC).

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If you’re in that camp, you might feel like you can cope just fine without much sleep, “particularly when you need to,” says Dr. Zeigler, “but in actuality, sleep loss impacts us both physiologically and psychologically,” whether we feel it or not. Just as not getting enough sleep can contribute to chronic diseases like heart disease and high blood pressure, diabetes, stroke, and kidney disease, it can also trigger or worsen a variety of psychological problems.

If you’re sleep-deprived, you may have trouble making decisions and controlling your emotions in reaction to negative information, and you may also feel more stressed. In one 2021 study using data from more than 200,000 people, participants who averaged six hours or fewer of sleep per night were about two and a half times more likely to have frequent mental distress compared to participants who slept more than six hours a night, on average. Remember the example of waking up irritable after a night of poor sleep? That’s the same relationship at play.

In that realm, sleep loss has also been shown to intensify angry feelings and negative affect, and a separate body of research has found that losing sleep can make you more likely to withdraw socially or engage in antisocial behavior, putting you more at risk for loneliness.

Taken together, these effects of sleep deprivation on mental health are also thought to contribute to the relationship between specific mental health conditions like anxiety and depression, and sleep.

The connection between sleep loss and anxiety

Being in an anxious state can make sleep harder to come by, which is one reason why sleep disturbances have long been associated with anxiety. If you suffer from anxiety and ruminate on tomorrow’s to-do list or the events of the previous day at night, then it can be difficult to get to sleep because anxiety turns your arousal systems on high alert, says Amorosi.

“Anxiety disrupts our nervous system by [keeping it] in periods of ‘activation’ more frequently and more intensely,” says Amorosi. “This increases the amount of stress chemicals like cortisol [flowing in the body], which keep our arousal systems turned ‘on’ for the sake of self-preservation.”

“If, for some reason, my brain is interpreting danger [as it is during an anxious episode], it will not let me go to bed.” —Amorosi

And that makes it harder to turn everything “off” at night. “If, for some reason, my brain is interpreting danger [as it is during an anxious episode], it will not let me go to bed because that is too scary,” explains Amorosi. An increase in stress can operate in a similar way, keeping the body in a “fight-or-flight” state that makes it tough to fall asleep.

The resulting lack of sleep can then worsen anxiety; just consider the effects of sleep on the amygdala noted above, and the ways in which sleep loss increases emotional reactivity. In turn, it’s easy to get stuck in the negative anxiety-and-sleep-loss feedback loop.

The connection between sleep loss and depression

As compared to anxiety, depression has long been shown to be associated not just with insomnia but also with hypersomnia, which is sleeping too much, says Dr. Zeigler.

While anxiety typically causes an overactive nervous system, depression can cause a person’s nervous system to shift between periods of under-activation and over-activation, says Amorosi. And depending on what state you’re in, hypersomnia or insomnia could be the result

On the one hand, if you’re under-activated and experiencing apathy, numbness, or just feel mentally shut down, you might sleep too much, which can throw your routine out of whack, says Amorosi. While behavioral activation or engaging in “mood-lifting behaviors” can reduce depressive feelings, if you’re sleeping too much, you may never get the chance to do such behaviors, she explains.

But on the other hand, if you’re in a period of over-activation (much like anxiety), or you’re feeling under-activated but also anxious about not being able to improve your mood, you could struggle to fall or stay asleep, says Amorosi, which is why depression can also lead to insomnia.

Much like with anxiety, sleep difficulties prompted by depression can, in turn, worsen depressive symptoms. Indeed, lack of sleep has been shown to make it tougher for folks who deal with repetitive negative thinking (a common trait of depression) to disengage from negative emotional stimuli, which researchers suspect has to do with the negative effect of sleep loss on our attentional control.

Even changes in sleep that can affect your overall sleep quality have been shown to increase depression risk. In a 2018 study analyzing data from over 90,000 people in the UK Biobank, researchers found that those whose sleep and wake times were largely inconsistent also showed higher risk of developing major depressive disorder and lower subjective happiness (which, again, could circuitously make good sleep that much harder to get).

How to get better sleep when you’re struggling with mental health

Optimizing your sleep can work wonders for your mental well-being—but that’s easier said than done when your mental state is making good sleep tough to come by.

It’s important to note that if you suspect you have a mental health condition like anxiety or depression that's affecting your sleep, it’s a good idea to talk with a healthcare provider, says Dr. Zeigler. They can both help you rule out any physical sleep problems (like sleep apnea), which could be worsening your sleep and mental health, and otherwise develop a plan to tackle both.

After all, mental health conditions can make it feel difficult to do things as small as washing your face in the morning, says Dr. Zeigler. So the thought of revamping your sleep routine might feel incredibly daunting, if not impossible, without the help of a professional like a psychiatrist, who can also assess whether you may be a candidate for either sleep or psychiatric medication, or sleep-specific therapy like cognitive behavioral therapy (CBT) for insomnia.

At the same time, you can take certain steps to minimize the impact of mental health issues on your sleep, and get the kind of sleep that, in turn, supports your mental health. Read on for the experts' suggestions.

1. Engage in mindfulness strategies before bed

If you’re having a hard time getting to sleep, the lead-up to bedtime can come with some additional anxiety. That’s why creating a peaceful, consistent nighttime routine is so important, says Dr. Zeigler.

It can be helpful to set a timer to go off an hour or so before your bedtime to remind yourself to begin that routine—and then plan to turn off electronic devices at least 30 minutes before your bedtime.

Some mindful ways to unwind include meditating, reading, listening to an audiobook or music, taking a hot shower, and drinking a hot cup of tea. There’s a lot of advice out there, but it's most important to do what works for you and what you can stick with, says Dr. Zeigler.

Soothing breathwork can also help you achieve a state of calm and “trick your brain into feeling safe and therefore sleepy,” says Amorosi.

2. Designate your bedroom for sleep

You’ve likely found yourself working, scrolling through TikTok for hours, or doing anything other than sleeping in your bed at one point or another. But Dr. Zeigler cautions that “your bed should be for sleep and sex only.”

Associating your bed with non-sleep activities is one of the most common bad habits that can interfere with your sleep quality, making it harder to fall or stay asleep.

In fact, it’s not even a good idea to lie in bed awake for prolonged periods of time, so if you’re struggling to fall asleep for more than 30 minutes, Dr. Zeigler suggests getting out of your bed, moving to another room, and doing a calming activity until you get sleepy. “We should not be lying for hours awake in bed because that conditions our brain to say, ‘Okay, when I'm in the bed, I'm allowed to be awake,’” she says.

If you’re someone who wakes easily at a slight noise, it’s smart to invest in a white noise machine to drown out any other potential noises and hopefully avoid any middle-of-the-night awakenings altogether.

It’s also important to make your bedroom feel as comfortable as possible, whether that’s with a special blanket, stuffed animal, or something else, says Amorosi. “We want to set ourselves up to feel safe for sleep so that our brains will actually allow us to shut down,” she says.

3. Have self-compassion

If you’re having sleep troubles that are starting to impact your mental health (or mental health issues that are leading to sleep deprivation), embracing self-compassion and repeating positive affirmations before bed can ultimately help you approach bedtime in a more forgiving way, says Dr. Zeigler.

“If you're telling yourself, ‘I'm so anxious, I can't sleep, and every time I do, I wake up in the middle of the night—I'm the worst,’ you're going to start to internalize that,” says Dr. Zeigler. And the last thing you need when struggling with sleep is a new layer of sleep-related anxiety with which to contend. “[We need to normalize] that sleeping can be hard even for the best of us,” she says.

—medically reviewed by Angela Holliday-Bell, MD