Now I Lay Me Down to Sleep: Circadian Dysregulation and Mental Health Disorders
A night shift job sounded perfect for me. I had always been a night owl and seemed to thrive on less sleep than others. What could possibly go wrong? By the end of my first shift, I realized my mistake. As I lay in bed at 9 am, the sun invaded the room through the edges of the drawn curtains. I had to be at work again in 11 hours, and as the minutes ticked by my panic grew. I counted sheep. I listened to a guided meditation podcast. Eventually I gave up. It wasn’t until 4 pm that I finally crashed, my body too exhausted to care about the glaring sun or the fact that it was nowhere near night. Three hours later I got up to do it again.
Weeks of night shift work turned into months, and my mood disintegrated a little each day. I was irritable, I was short with people, and I was so very sad. Then one day I couldn’t move. I was so tired and my body just said no. I called in sick and slept and slept and slept. When I woke up it was dark. I looked at the clock and calculated how much time I had before I was supposed to be at work again. 14 hours. I knew I couldn’t do it. I no longer had the capacity for panic, I just knew I wasn’t going to be able to get up. Or get dressed. Or leave the house. I couldn’t foresee those things happening for a while. I couldn’t foresee anything at all but an endless sadness.
Sleep is a remarkably restorative process that rejuvenates both the mind and the body. Circadian rhythms are built into our bodies, telling us when it’s time to sleep and providing natural regulation of sleep duration. When normal circadian patterns are disrupted, there can be serious consequences for both physical and mental health; sleep dysregulation can weaken the immune system, increase irritability and fatigue, and impair cardiovascular, metabolic, and cognitive function. It can also be a significant contributing factor in mental health disorders such as depression, anxiety, and bipolar disorder. As such, night shift work and other activities that interfere with sleep can presents real health dangers, particularly to people with a history of psychiatric distress.[1. https://www.mja.com.au/journal/2013/199/8/sleep-loss-and-circadian-disruption-shift-work-health-burden-and-management]
Mental Illness and Sleep
People with some mental health disorders such as depression or bipolar disorder may have inherently disordered circadian modulation, leading to too little or too much sleep.[2. http://www.ncbi.nlm.nih.gov/pubmed/24500332] Although sleep dysregulation is often seen as the result of depression or bipolar disorder, the relationship between sleep and mental health disorders is far more complex; abnormal sleep patterns may be a causal factor in mental health disorders, not only a symptom. The effects can be particularly significant for people living with bipolar disorder. It has long been acknowledged that lack of sleep can lead to hypomanic episodes, but it can also aggravate overall instability. A recent study found that poor sleep quality is a predictor of severity and frequency of both depressive and manic episodes in women.[3. http://www.sciencedaily.com/releases/2015/06/150630122408.htm] While the connection between sleep and mood episodes was not as strong for men, circadian rhythm disruption still has a strong impact on mental health disorder symptoms.
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Sleep as Self-Care
So how do you establish good sleep patterns when your body is working against you or when you are working a shift pattern that disrupts normal circadian modulation? These are some ideas you can incorporate in your self-care practices to improve both your mental and physical health:
- Avoid working night shift when possible. Your doctor can help you approach your employer about accommodation to ensure your health is preserved and your rights as an employee are respected.
- Eliminate light sources. Even the slightest light can interfere with the ability to fall asleep and experience true restfulness. This may require investing in blackout shades, ensuring your computer is turned off, discarding your alarm clock and using your mobile phone for alarms instead.
- Unplug. Put your phone in airplane mode or ‘do not disturb’ so you are not awakened by calls, texts, or notifications.
- Start winding down. Don’t consume caffeine, smoke, or exercise in the hours prior to going to bed, as these activities can keep you awake.
- Turn off the blue light. Discontinue computer use in the time leading up to sleep, as the light can negatively impact your ability to fall asleep by reducing melatonin levels.[4. http://www.scientificamerican.com/article/bright-screens-could-delay-bedtime/]
- Relax. Incorporate meditation techniques in your sleep preparation practice to relax, ease anxiety, and produce feelings of well-being that encourage both falling asleep and sleep quality.
- Get help. Ask your doctor to recommend natural or prescription sleep aids, even if only for a short time, to get you started.
If your sleep disturbances and mental health disorder are too severe to handle on your own, residential treatment can be an ideal setting to establish a consistent schedule within the context of a holistic therapeutic environment.
Creating a stable sleep pattern can enhance your emotional and physical well-being, and be a major step in gaining control of your mental health. By establishing circadian stability, you are able to tap into your body’s natural capacity for rejuvenation and self-healing. When combined with a comprehensive treatment program, sleep stability can help you find relief from painful and frustrating symptoms of psychological distress, and optimize your chances of recovery.
Bridges to Recovery offers complete, holistic care that helps our clients establish healthy lifestyles while gaining the insight and skills they need to move forward. We invite you to contact us at any time to learn more about our treatment program and how we can help you or your loved one suffering from a mental health disorder.