Your first step to a better mood

It started with mild anxiety.

Emily, who asked to be identified only by her first name because she was discussing her mental health, had moved to New York City just after college to start a marketing job at a major law firm.

She knew it was normal to feel a little tense. But she wasn't prepared for what came next: chronic insomnia.

With only three or four hours of sleep, it didn't take long for her anxiety to increase: at age 25, she was “extremely nervous all the time.” A wreck.”

When a lawyer from her firm yelled at her one day, she had the first of many panic attacks. At a doctor's suggestion, she tried taking a sleeping pill, hoping it might “reset” her sleep cycle and improve her mood. It did not work.

Americans are chronically sleep deprived: a third of adults in the United States they say they get less than seven hours a night. Teenagers do even worse: approximately 70 percent of high school students don't get enough sleep on school nights.

And it has a profound effect on mental health.

An analysis of 19 studies found that although sleep deprivation worsened a person's ability to think clearly or perform certain tasks, it had a greater negative effect on mood. And then the National Sleep Foundation one questionnaire in 2022, half of those who reported sleeping less than seven hours per weekday also reported having depressive symptoms. Some research even indicates that addressing insomnia can help prevent postpartum depression and anxiety.

Clearly, sleep is important. But despite the evidence, there stays that way a shortage of psychiatrists or other doctors trained in sleep medicine, leaving many to educate themselves.

So what happens to our mental health when we don't get enough sleep, and what can be done about it?

How does poor sleep affect your mood?

When people have sleep problems, it changes the way they experience stress and negative emotions, says Aric Prather, a sleep researcher at the University of California, San Francisco, who treats patients with insomnia. “And for some, this can have a feed-forward effect – bad feelings, worry and stress can permeate our nights,” he said.

Carly Demler, 40, a stay-at-home mother in North Carolina, said she was going went to bed one night and never fell asleep. From then on, she was awake until 3 or 4 a.m. at least once a week. This lasted more than a year.

She became irritable, less patient and much more anxious.

Hormone blood tests and a sleep study in a university laboratory gave her no answers. Even after taking Ambien, she stayed awake most of the night. “It was like my anxiety was a fire that somehow jumped the fence and eventually spread into my nights,” she said. “I just felt like I had no control.”

Ultimately, it was cognitive behavioral therapy for insomnia, or CBT-I, that brought Ms. Demler the most relief. Studies have discovered that CBT-I. is more effective than sleep medications in the long term: As much as 80 percent of people who try it see improvements in their sleep.

Mrs. Demler learned not to “lie in bed and panic.” Instead, she gets up and reads to avoid associating her bedroom with anxiety, then goes back to bed when she's tired.

“The feeling of gratitude that I have every morning when I wake up and feel well rested, I don't think it will ever go away,” she said. “That was an unexpected silver lining.”

According to the American newspaper, adults need between 7 and 9 hours of sleep per night Center for Disease Control and Prevention. Teenagers and young children need even more.

It's not just about quantity. The quality of your sleep is also important. For example, if it takes you longer than 30 minutes to fall asleep, or if you regularly wake up in the middle of the night, it's harder to feel rested no matter how many hours you spend in bed.

But some people “tend to think they are functioning well even when they are sleepy or have difficulty concentrating during the day,” says Lynn Bufka, a clinical psychologist and spokeswoman for the American Psychological Association.

Ask yourself how you feel during the day: do you notice that you are more impatient or get angry easily? Do you have more negative thoughts or feel more anxious or depressed? Do you find it more difficult to deal with stress? Do you find it difficult to do your work efficiently?

If so, it's time to take action.

How to stop the cycle.

We've all heard how important it is to practice good sleep hygiene, practicing the daily habits that promote healthy sleep. And it's important to talk to your doctor to rule out physical problems that need to be addressed, such as thyroid disease or restless leg syndrome.

But this is only part of the solution.

Conditions such as anxiety, post-traumatic stress disorder, and bipolar disorder can make it harder to sleep, which can then worsen the symptoms of mental illness, which in turn makes it harder to sleep well.

“It becomes very difficult to break the cycle,” said Dr. Bufka.

Certain medications, including psychiatric medications such as antidepressants, can also cause insomnia. If a drug is the cause, talk to your doctor about switching to a different drug, taking it earlier in the day or reducing the dose, said Dr. Ramaswamy Viswanathan, professor of psychiatry and behavioral sciences at the State University of New York Downstate Health. Sciences University and the new president of the American Psychiatric Association.

The cycle can also affect people without mental disorders, when worry worsens sleep and a lack of sleep worsens mood.

Emily, who worked at the big law firm, was so concerned about her inability to sleep that she didn't even want to go to bed.

“You really start to believe, 'I'm never going to sleep,'” she said. “The adrenaline runs so high that it's impossible to do it.”

Eventually she came across “Say Goodnight to Insomnia” by Gregg D. Jacobs. The book that uses CGT-I. techniques helped Emily reshape the way she thought about sleep. She started writing down her negative thoughts in a journal and then turning them into positive ones. For example: “What if I can never fall asleep again?” would become: 'Your body is made for sleep. If you don't get enough rest one night, you will eventually.” These exercises helped her stop catastrophizing.

When she started sleeping again, she felt “much happier.”

Now, at age 43, almost twenty years after moving to New York, she still relies on the techniques she learned and takes the book with her whenever she travels. If she doesn't sleep well outside the home, “I catch up on a few days of sleep if necessary,” she said. “I'm much more relaxed about it.”