Insomnia & Mental Health

“We see an epidemic of wakefulness intruding into our sleep and dreams as insomnia.  We mistake the jittery buzz of counterfeit energies for natural vitality. Half-awake in our sleep and half-asleep in our waking, we are never completely at rest and seldom fully conscious.”

Healing Night, Rubin Naiman, PhD

Sleep loss problems are thought to have adverse effects on the body’s inflammatory processes, digestive hormones, stress chemicals, immune system function, insulin regulation and blood pressure (Stein, 2005).  Short sleep duration is also associated with coronary artery calcification, obesity, diabetes, colon and breast cancer, heart disease and stroke (King, 2008).  But it is the corrosive effect of sleep loss on mental health and well being that is the major concern of Sleep Counseling.  Even in healthy subjects, sleep deprivation has been shown to cause emotional instability and pathological psychiatric patterns (Anderson, 2007).

Henry Ford Hospital research director asserts the prevalence of chronic insomnia in children and adolescents is similar to adults, and emerging data show morbidity associated with insomnia in childhood and adolescence to include school, social and substance abuse problems (NSF, 4/12/2010).  Allison Harvey, PhD, at UC Berkeley cites empirical evidence indicating that sleep disturbance may be one causal pathway that leads to relapse in bipolar disorder (Harvey, 2008).  A recent Harvard study measuring reduced levels of GABA in insomnia subjects speculated that anxiety, depression and insomnia may all share a similar underlying physiology (“Brain GABA Reduced,” 2008).

Patients with persistent and untreated insomnia are at up to six times the risk for new onset or recurrent episodes of major depression.

Dr. Michael Perlis, Director of the UPenn Behavioral Sleep Medicine Program asserts that the evidence with respect to psychiatric illness is clear and compelling.  Patients with persistent and untreated insomnia are at up to six times the risk for new onset or recurrent episodes of major depression.  There is also good evidence that insomnia is a risk factor for the development and/or recurrence of anxiety disorders and substance abuse (Perlis, 2004, 2009).

A 2001 University of Michigan study compared relapse rates following alcoholism treatment of subjects with and without insomnia.  Sleep maintenance insomnia had the highest correlation with relapse and, overall, post treatment relapse was greater among those with insomnia.  Brower, et al, concluded that sleep and insomnia assessments during treatment could potentially prevent relapse and improve recovery (Patrick, 2009).

Less than one-third of patients have initiated discussion with their physician about their sleep problems, and less than two-thirds have ever been asked about their sleep by a physician.

The 2009 National Sleep Foundation (NSF) poll found that less than one-third of patients have initiated discussion with their physician about their sleep problems, and less than two-thirds have ever been asked about their sleep by a physician.  When sleep problems are discussed with physicians, the result is often a prescription for sleep medication.  In 2005, 43 million prescriptions for sleep meds were written contributing to the alarming three-fold increase in the use of prescription sleep aids by 18 to 24-year-olds between 1998 and 2006.  During this same period, prescribed sleeping pill use among adults under the age of 45 increased by 50 percent.

Also during this same period, several studies showed the superior efficacy of Cognitive Behavioral Therapy for Insomnia (CBT-I) versus AmbienCR and Lunesta–together accounting for nearly two-thirds of all the sleep medication taken! A recent study headed by Dr. Daniel Kripke and reported in the New York Times revealed alarming associations of popular sleep medications with dramatically higher mortality rates–sometimes after taking fewer than 20 pills per year!

Dr. Kripke’s “dark side of sleeping pills”  and information about specialized training in CBT-I from Dr. Michael Perlis can be accessed under “Links & Resources” on the main menu.