© 2021 Condor, All Rights Reserved

Sleep Manifestations In Psychiatric Illnesses, In Addition To Insomnia And Depression

Any doctor will agree that sufficient restful sleep is critical to our quality of life. A short, restless, and non-restorative sleep can have devastating effects on our long-term health, and even cause heart problems, type 2 diabetes and depression – a major psychiatric illness.

There is an obvious relationship between the quality of sleep and our mental health. A number of psychiatric conditions cause sleep problems, just as sleep disturbances can aggravate the symptoms of various mental illnesses such as depression, burnout, bipolarity and panic disorder, just to name a few.

Our experts prepared this content to show the correlation between psychiatric illnesses and sleep disorders. The objective is to present important information about the manifestations of sleep in psychiatric illnesses, since many people are unaware of such situations, and end up not seeking the necessary and indicated treatment.

Seeking medical treatment is essential when sleep disorders rob us of quality of life.

What is depression?

It is a chronic and recurrent psychiatric illness that affects more than 350 million people worldwide. Depression is primarily characterized by mood swings, deep sadness, hopelessness, bitterness, low self-esteem, and can be downright disabling. It is accompanied by sleep and appetite disturbances.

Popularly, we say “we are depressed” when we are very sad. Depression goes far beyond this momentary condition, because it is a psychiatric illness that can appear in a mild, moderate and severe degree, affecting all ages, including children. In serious condition, there is even the risk of suicide.

Depression has genetic factors in its cause and can be triggered by a biochemical dysfunction of the brain. But a person can be affected by the disease by childhood trauma, stress, alcoholism, consumption of illegal drugs and some systemic diseases (such as hypothyroidism).

The main symptoms are: weight change, psychomotor problems, tiredness, difficulty concentrating, excessive feelings of guilt, low self-esteem, altered libido, suicidal tendencies and deep sadness. Depressed people often experience insomnia or excessive sleepiness.

How can depression interfere with sleep?

As you already know, insomnia can be a symptom of depression, and recent scientific studies suggest that lack of sleep can cause this psychiatric illness. According to some studies, those who are affected by insomnia have twice the risk of developing depression, compared to those who sleep well.

According to the portal Verywell Mind, specialized in mental health, a study on the impact of lack of sleep on symptoms of depression, with 3,700 patients, presented a revealing result: participants who were treated with cognitive-behavioral therapy (CBT) for insomnia showed real reductions in depression, anxiety, paranoia, and nightmare episodes, and reported improved well-being. The same impact was not felt by those who received no treatment.

What is bipolarity?

Bipolarity, or bipolar disorder, alternates between episodes of depression and euphoria. It is a complex psychiatric disorder, with bouts of mania and hypomania that can be mild, moderate or severe, with varying frequency and duration. According to international diagnostic classification manuals, bipolarity presents itself in four ways:

• Type I bipolar disorder;

• Type II bipolar disorder;

• Unspecified or mixed bipolar disorder;

• Cyclothymic disorder.

The cause of bipolar disorder is not known, but it is known that there are genetic factors and changes in the brain and levels of various neurotransmitters. The signs of the disease can be confused with schizophrenia, depression, panic and anxiety syndrome, hence the need for specialized follow-up.

Among other symptoms, the affected person presents mood swings, deep sadness, general lack of interest, social isolation, tiredness, difficulty concentrating, forgetfulness and suicidal tendencies. There are also frequent sleep alterations, such as insomnia and irregular sleep and wake cycles and nightmare episodes.

Does non-restorative sleep affect bipolarity?

Yes. Decreased sleep can cause symptoms of mania and hypomania. According to a clinical review study published by ScienceDirect entitled “Sleep-Wake Disorder in Interepisodic Bipolar Disorder and High-Risk Individuals: A Systematic Review and Meta-analysis”, alterations in the sleep and wake cycle were the starting point for a manic episode in 25% to 65% of respondents.

Insomnia and irregular sleep and wake cycles are symptoms of the disease and have a significant importance in the course of the disease, in the results of treatment and in the quality of life of the bipolar person.

What is Burnout?

Burnout Syndrome is a psychiatric illness caused by extreme exhaustion with regard to work. It is also popularly known as the burnout syndrome, precisely because of its intrinsic relationship with the work activity.

Burnout Syndrome is a result of the accumulation of stress, emotional tension, anxiety, nervousness and high workloads, and can trigger a deep depression in the patient. The main symptoms are excessive mental and physical tiredness, difficulty concentrating, irritability, headaches and pain all over the body, social isolation, high blood pressure and memory lapses, among others.

People affected by the disease suffer from sleep disorders, especially insomnia. It is common not to be able to sleep or to wake up in the middle of the night, with loss of sleep. The main categories affected by Burnout Syndrome are teachers, police officers, advertisers, firefighters, social workers and health personnel.

The relation between burnout and sleep

Faced with such stress, excessive mental fatigue, tension and anxiety, the person affected by this psychiatric disease tends to lose sleep, which intensifies all these symptoms. It’s a vicious cycle: the more insomnia, the more stress, and the harder it is to get out of this picture. A sequence of invigorating nights of sleep is essential for regaining the lost quality of life.

What is panic disorder?

A person affected by panic disorder (PD) has sudden and very intense anxiety attacks, causing fear and discomfort, often accompanied by physical symptoms. Crises happen without a defined time and context and can last, on average, from 15 to 30 minutes.

Among the main symptoms of panic disorder are rapid heart rate and breathing, chest pain, pallor, cold sweat, weak legs, chills, fear of dying, dizziness, nausea and even vomiting and fainting, at the heights of the crisis. It happens because of extreme stress.

How can panic disorder interfere with sleep?

According to the article entitled “Sleep in psychiatric disorders”, published on the Scielo Brasil portal, the main complaints of patients affected by panic disorder, in relation to sleep, are initial or maintenance insomnia, fragmented sleep and, above all, non-restorative. Research reveals, according to the article, that 70% of patients with this disorder complain of these sleep disorders.

There are also cases of apnea, night terrors and even gastroesophageal reflux during sleep. Many patients are afraid to go to sleep and are therefore reluctant to fall asleep.

What is attention deficit?

Attention Deficit Hyperactivity Disorder (ADHD) is a neurobiological disorder that appears mainly in childhood and can accompany the person over the years. Symptoms are inattention, restlessness and impulsiveness. According to the Brazilian Association of Attention Deficit (ABDA), attention deficit affects 3% to 5% of children worldwide, and in more than half of the cases it follows the person in adulthood, but with generally milder symptoms .

The sleep complaints of those suffering from attention deficit

The main sleep complaints of people with attention deficit are a reduced sleep load, difficulty waking up in the morning, fragmented and non-restorative sleep, respiratory problems during sleep, and also a lot of movement during sleep. Children with apnea have more symptoms associated with attention deficit syndrome, according to the article “Sleep in psychiatric disorders”, mentioned above. According to the content, when not medicated, patients may have increased daytime sleepiness.

What is schizophrenia?

According to the Instituto de Psiquiatria Paulista, 1% of the world’s population is affected by schizophrenia, an endogenous psychiatric disease characterized by visual and auditory hallucinations. esquizofrenia, doença psiquiátrica endógena, caracterizada por alucinações visuais e auditivas.

Among the symptoms are difficulty in taking care of personal hygiene, the appearance of not feeling emotions and not caring for reality, blank stare, delusions, hallucinations, disorganized thoughts and abnormal motor behavior.

There is no cure for the disease, and it is not known exactly what causes it. But there is genetic predisposition, family history, inflammation or autoimmune diseases, and excessive use of psychoactive drugs during youth and adolescence.

Schizophrenia and sleep

Psychotic agitation may be accompanied by long periods of lack of sleep, but when it improves, many schizophrenics experience insomnia. Nightmares are absolutely common, as is excessive movement of the lower limbs during sleep. According to psychiatric studies, apnea can aggravate schizophrenic symptoms. Antipsychotic medications generally increase sleep efficiency.

What is stress?

Don’t confuse stress with tiredness, even deep tiredness. Many people say they are stressed after a hard day at work or after a hard-to-achieve challenge. This is exhaustion, extreme tiredness. Stress is a physiological mechanism in the body that releases a series of chemical mediators (popularly called adrenaline), increasing heart rate and blood pressure. It is caused by the accumulation of small everyday problems that can harm our health.

High dose and repetitive stress can lead to an angina attack, which can even lead to a heart attack. It also causes muscle pain throughout the body, especially in the cervical region of the spine, and even skin changes. In fact, stress is not categorized in the international classification of illnesses, but it is a common presence in doctors’ offices, especially psychiatrists.

Hypertension, coronary lesions and cardiac hypertrophy can be a consequence of stress. It is worth pointing out that high levels of stress favor the use of drugs, alcohol, depression, anxiety and somatization. Doctors consider a restful good night’s sleep essential to reduce and even end stress, alongside, of course, other attitudes, such as having fun, having fun, exercising, eating well and resting.

Stress disrupts your sleep

One of the signs of stress is sleep disturbance. It is very common for a stressed person to oversleep or, conversely, to sleep for a very short period. And this brings other symptoms, such as mood swings, tiredness, muscle tension, attention and concentration problems and anxiety and depression, among others.

Is insomnia a disease?

One in three Brazilians suffer from insomnia, according to the Brazilian Association of Sleep Medicine. It is one of the best known sleep disorders, caused by psychophysiological factors such as anxiety, stress and excessive worry. Mental health problems, among others, are risk factors.

How can insomnia interfere with sleep and your health?

According to neurologists, insomnia happens from an imbalance in areas of the brain that contribute to the maintenance of the sleep/wake cycle, altering sleep. Chronic, untreated insomnia poses serious risks to our mental health in the medium and long term.

Insomnia is considered a sleep disorder when it happens at least three times a week, regularly, no matter if on consecutive days or not. The disorder is a gateway to mental health problems (such as depression and anxiety), cardiovascular, respiratory and even musculoskeletal diseases.

In fact, there is a direct relationship between the quality of sleep and the efficiency of the body’s defenses in fighting numerous diseases. Insomnia has a direct and negative effect on this efficiency, greatly reducing our resistance.

Actigraphy: cutting-edge technology in the treatment of sleep disorders

Most often similar to a wristwatch, the actigraph is a modern device used to monitor activity and rest cycles. The objective is to gather a series of important information for the study of the sleep and wakefulness rhythm. Actigraphy, also called actimetry, is a state-of-the-art technology allied to the treatment of sleep disorders.

The patient must wear it attached to the wrist, in the non-dominant arm, throughout the study period. During all this time, the actigraph will collect, record and compile all the person’s movements using accelerometers. Even more modern actigraphs have temperature and light sensors, which allow for even deeper analysis.

The actigraphy will identify sleep disturbances and circadian rhythmicity, providing the assistant physician with the patient’s time in bed, sleep episodes occurring throughout the day and a series of other data that will be essential for the diagnosis and treatment of the problem. Actigraphy is also used by psychiatrists to study sleep.


Sleep disturbances and alterations happen in most psychiatric illnesses. In general, patients complain of insomnia, and when they are able to sleep, nightmares are common. The main complaints refer to the difficulty in going to sleep (initial insomnia), the maintenance of sleep and the difficulty in establishing restful sleep.

Doctors agree that there is a clear association between psychiatric disorders and sleep disorders. A person with sleep apnea, for example, has higher levels of anxiety, tiredness and other symptoms, such as headache and pain in the cervical spine, for example.

There is no doubt that restful sleep has an extremely beneficial effect for people, especially for those suffering from a psychiatric illness. Restful sleep is even capable of reducing the amount of medication administered by the doctor. Mental illnesses and sleep disorders have a direct cause and effect relationship, so it is essential to treat them.