Are you a severe night owl?

Do you tend to push sleep later and later?

Does your mind race at night when you lie down to sleep.

Sleep's Role in Mental Illness 

More studies are linking sleep disorders with light-sensitive circadian rhythm issues. Additionally, more and more studies are now realizing sleep’s role in mental disease—not only bipolar disorder but depression, generalized anxiety, eating disorders, SAD and alcoholism, for example—with each apparently warping REM or other sleep markers in characteristic ways.

Researchers Weigh In

Altered sleep isn’t just another symptom; it’s an integral part of the disease and a window into its neurobiology.” Studies are now indicating that briefly depriving severely depressed patients of sleep can dramatically brighten mood.  According to Michael Smith, Ph.D., a clinician and research director for Hopkins’ Behavioral Sleep Medicine Program. “It’s as good, temporarily, as the best antidepressant, and it shows sleep’s systemic role.”

But that word hasn’t gotten out, Smith explains, nor has an appreciation of behavioral sleep therapy—a focus of a new Hopkins program.

Part of Smith’s research explores behavioral therapy as it’s shaped for insomnia. It begins with evaluation via interviews, sleep diaries and monitoring. The information is then evaluated. Is the poor sleep a result of poor sleep habits? A faulty biological clock? A state of heightened arousal? With the latter, there’s a suggestion of a “broken homeostat,” a flaw in the brain’s input to hypothalamic sleep and arousal centers or within the centers themselves. Normal balance between the two is upset, tilting to the arousal side.

Then EEG studies are sometimes pulled in, Smith says, especially newer quantitative methods that point out specific brainwave patterns. When some patients come with unremarkable sleep studies, for example, digging into their “sleep microstructure” reveals subtle swells in brain activity. “My mind still races though I’m half asleep,” they’ll say.

There are different approaches in regards to therapy. Behavioral therapy combines light-box use, sleep restriction, specific sleep schedules and improving sleep hygiene are some tools used. The standard good sleep practices are also used. For instance, restricting caffeine, not lying down to bed until tired, if you are sleepless more than 10 minutes, leave the bed to read in a low light until drowsy, etc..

These approaches undeniably show that insomnia is neurobehavioral, Smith says. So do his SPECT images—they give visual proof that therapy partly corrects an insomnia-sparked drop in cerebral blood flow.

Because therapy can poses some risk to certain people experiencing mental illness as a underlying cause or contributory factor to the sleep disorder fine-tuning the treatment by a health professional may be needed. Both sleep restriction and light therapy can trigger manic episodes, so their use must be closely monitored.