What's the link between sleep and psychiatric conditions? Doctors explain 'intricate relationship'

Struggling with sleep, or not sleeping at all, is not something to overlook.

According to doctors, insomnia, especially chronic insomnia, develops from a combination of biological, psychological, and environmental factors, and one thing's for sure: it's usually a sign of something deeper at play.

Psychiatrist-sleep specialist Dr. Rose Anne C. Roque told GMA News Online that insomnia is one of the "most common symptoms of psychiatric conditions."

"There is a very intricate relationship between mental health and sleep. More recent studies now support the theory that the relationship is bidirectional. They both affect each other and one can lead to the other," she said.

St. Luke's expert in Adult Neurology and Sleep Medicine, Dr. Nikki Perez, said that the initiation of insomnia and its development into a chronic condition are "multifactorial."

"Predisposing factors extend across the entire biopsychosocial (biological, psychological, social) spectrum," she said.

Link to neurodivergence

M.I.N.D.S. director Edgardo Juan L. Tolentino, MD, FPPA, told GMA News Online that sleep difficulties are "significantly more common among neurodivergent individuals."

However, "Not every neurodivergent person experiences insomnia, and not every person with insomnia is neurodivergent."

Adults with ADHD frequently report difficulty falling asleep, delayed sleep schedules, inconsistent sleep routines, among others.

Dr. Tolentino said several factors contribute to this.

"First, ADHD is associated with differences in attention regulation and arousal systems. Many individuals describe their minds becoming most active precisely when external distractions disappear. Second, time blindness and difficulty maintaining routines may make consistent sleep schedules harder to sustain," he said.

"Third, ADHD commonly co-occurs with anxiety, which can further disrupt sleep. Interestingly, some patients report sleeping better once their ADHD is appropriately treated because their minds become less chaotic and more regulated," he added.

Sleep disturbances are also highly prevalent among autistic individuals, Dr. Tolentino said.

Potential contributing factors include differences in melatonin production and circadian rhythms, heightened sensory sensitivity, increased anxiety, difficulty transitioning between activities, and greater sensitivity to environmental disruptions such as noise, light, temperature, or textures.

READ:

• While Everyone Sleeps
• Why do people get insomnia? Doctors explain what happens in the brain when we can't sleep
• Why more people are getting diagnosed with psychiatric conditions, according to doctors

Intervention strategies

Sleep can be a huge struggle to initiate for neurodivergent individuals who have a "heightened sense," according to board-certified behavioral analyst EJ Mangilit.

In an interview with GMA News Online, Mangilit said that in this day and age especially, "stimuli is readily available."

"You have your phone, you have devices, and all these other preferred activities that are readily available," he said. "So the likelihood of you engaging with them versus engaging in behaviors that promote calmness and relaxation is less likely."

In order to correct behavior-induced insomnia, Mangilit said a whole lot of discipline and conscious effort is required.

The first step, he added, is to set strict sleep times.

"It's making a conscious effort of understanding... 'When I try to sleep, what competes with it?' And if you can pinpoint that stimuli, you remove it away at the time period that you need to go to sleep," he said.

"I'm not saying don't use it. Just don't use it during the time that you decided, 'Hey, this is my sleep time."

Another advice he gave is to make the bedroom an environment that you would associate with rest and sleep — that means no working or exercising or playing while in bed.

"So if we can separate the environment from all the stimuli that competes with sleep, then it's going to be very, very helpful," he said.

However, as other experts have established, there's more than one possible factor contributing to insomnia.

Mangilit said it's recommended that the patient first check on biological and psychological factors before considering behavioral intervention. —CDC, GMA News