The importance of getting adequate sleep cannot be overemphasised because it helps ensure our mental wellbeing.
MANY of us suffer from insomnia, the most common sleep disorder. At one point of our lives, we would have dealt with its symptoms — difficulty falling asleep, or waking up often during the night and having trouble going back to sleep, waking up too early in the morning, and feeling tired upon waking up.
Studies find that hectic and stressed lifestyles and the proliferation of electronic products triggers for insomnia. Short-term effects of insomnia may seem mild but in the long run, it affects the brain. Chronic insomnia can lead to physical and mental health issues, and even a greater risk of death.
According to British Mental Health Foundation, insomnia is inextricably related to mental health. Based on its survey, a person who faces ongoing insomnia is likely to deal with tiredness, irritability and difficulty concentrating.
Harvard Health says a good night's sleep helps foster both mental and emotional resilience, while chronic sleep disruptions set the stage for negative thinking and emotional vulnerability. A study published in the British Journal of General Practice states that sleep disturbances, particularly early morning awakening and an inability to fall asleep have been associated with anxiety and depression.
Another study by University of Oxford researchers says that sleep disruption is a driving factor in the occurrence of paranoia, hallucinatory experiences, and other mental health problems in young adults.
In Malaysia, approximately 35 per cent of the general population suffers from insomnia symptoms and 12.2 per cent have chronic insomnia.
Sunway Medical Centre clinical psychologist Jessie Foo Xiang Yi says sleep plays a vital role in good health and well-being. During sleep, the brain forms the pathways necessary for learning and creating memories.
Getting enough quality sleep can help protect your mental health, physical health and quality of life. Without adequate sleep, your mood is affected, you can’t focus and you are unable to pay attention. In children and teens, sleep also helps support growth and development.
“Insufficient sleep is associated with increased emotional reactivity and emotional disturbance, which eventually leads to more serious mental health problems and mental disorders.”
A RISK FACTOR
Professor Dr Laura Palagini, a psychiatrist at the Sleep Disorder Outpatients Clinic, University of Pisa, Italy, says the lack of quality sleep could impair our emotions and regulations which then lead to mental health issues. Of the many sleep disorders, insomnia is a risk factor of all psychiatric issues especially depression, bipolar disorder and anxiety.
She explains that the human circadian sleep timing is regulated by factors within the body as well as environmental factors such as sunlight and lifestyle.
The circadian rhythm is a natural, internal system that works to regulate feelings of sleepiness and wakefulness over a 24-hour period. Sleeping at night and being awake during the day is an example of a light-related circadian rhythm.
“When the circadian sleep timing is disrupted, it impairs the sleep process because it is one of the two mechanisms that regulates sleep.
“Quality sleep is one of the three pillars of good health along with a balanced diet and regular exercise but when you suffer from sleep disorders, it impacts health and can trigger psychological conditions such as depression, anxiety and psychosis. Ultimately, our well-being and quality of life are compromised,” says Dr Palagini.
Dr Palagini, who has over two decades of research experience in biological and clinical psychology and is an expert in sleep disorders, says insomnia can lead to an impairment in decision-making processes by interfering with cognitive function and regulation of emotion.
This, in turn, will cause the person to make risky decisions, become more aggressive and have impulsive behaviours.
She says insomnia is related to a greater severity of psychiatric disorders. Some people may have increased suicidal tendencies, emotional instability, impulsivity, aggressive behaviours and substance abuse disorders.
“Because of the high suicidal tendencies, the person would use a more lethal way to kill himself, such as using a gun or jumping off a building. This is because their capacity to make a normal decision is impaired due to chronic insomnia,” she said at the World Sleep Day roadshow organised by Amlife International in Kuala Lumpur.
Previously, she explained, people did not pay much attention to symptoms of insomnia, mainly because they thought it a normal human experience and not a serious medical issue. “But there is more awareness now on this issue and they realise that insomnia has to be treated. Especially for people who suffer from chronic insomnia in which the symptoms last for months and, sometimes, years. They should know there are various treatments for their condition.”
The issue of insomnia and mental health are complicated and interrelated. In some cases insomnia can lead to mental disorders, but in others, it is the other way round. Patients with depression, bipolar disorder, and attention deficit hyperactivity disorder (ADHD) are found to suffer from insomnia.
According to Harvard Health, the overlap between sleep disorders and various psychiatric problems is so great that researchers have long suspected both types of problems may have common biological roots.
Dr Palagini says due to the overlapping issues, treatments need to look at the underlying cause — whether the person suffers from mental health issues due to insomnia, or vice versa.
“If the person suffers from insomnia that leads to mental health, the target is to treat the sleeping disorder. But if he has mental issues that cause the insomnia, we have to treat both medical issues.”
Foo says that sleep and mental health disorders are interrelated, with each condition influencing the other. Poor sleep can contribute to the onset and severity of mental health disorders, and mental health problems can create and worsen sleep issues.
“As insomnia and mental health are interconnected, treatment would focus on both issues. When healthy sleeping habits are practiced, it can have a positive impact on the individual’s mental health. Likewise, when the individual works on ways to alleviate stress, it will also improve their sleep quality.
“Chronic insomnia has a negative impact on work and school performance, impairing concentration and motivation while increasing the risk of errors and accidents. If chronic insomnia remains untreated, sufferers are prone to health complications, including an increased risk for depression, hypertension and heart disease.”
Dr Palagini says there are several steps to ensure a good night’s sleep including fixing a regular time for bedtime and waking up, avoiding excessive alcohol four hours before bedtime and caffeine six hours before bedtime.
“Exercise regularly, but not right before bed, and use comfortable bedding. Find a comfortable temperature setting for sleeping and keep the room well ventilated. Block out all distracting noise and eliminate as much light as possible.”
Foo says relaxation techniques, such as breathing exercises, mindfulness, meditation and guided imagery, can help a person fall asleep and also return to sleep in the middle of the night.
“Cognitive behavioural therapy helps identify attitudes and beliefs that hinder a person’s sleep. This may include setting a time to review the day and plan for tomorrow. The therapy also helps to establish a healthy sleep pattern by changing the person’s behaviours. This includes creating a pro-sleep routine to achieve a strong connection between bed and successful sleep.”
CREATING AWARENESS OF SLEEP DISORDERS
AFTER two years of raising awareness about sleep disorders in Malaysia, sleep health specialist Amlife International has extended the campaign to other countries.
This year, from March to April, the campaign was held in Taiwan, Singapore and Indonesia, as well as Malaysia. During the campaign, Amlife had enlisted local healthcare professionals and international sleep experts who talk about sleep disorders, mental health issues related to sleeping disorders and tips and solutions for a good night’s sleep.
Amlife has been in collaboration with the World Sleep Society and several authoritative organisations in the sleep technology industry to advocate sleepcare initiatives.
While the focus of World Sleep Day 2018 is to address the increased rates of insomnia and other sleeping disorders within Asia Pacific, Amlife has also revealed the first published national sleep survey.
The survey conducted by Nielsen Malaysia, revealed that nine in 10 Malaysians suffer from sleep problems and the average Malaysian only gets approximately six hours sleep a night.
It is also found that sleep disorders lead to headache, fatigue, trouble thinking or concentrating, and shoulder and neck pain.