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Although some people still take pride in their ability to pull an all-nighter or get by on a few hours, the research that’s establishing sleep as a pillar of physical and mental health is piling up, like so many pillows. Experts say the relationship between the two is “bi-directional,” meaning that mental health disorders can contribute to poor sleep and, in turn, sleep disorders can exacerbate mental health conditions.
“Research is showing that people with mental health challenges like depression, anxiety, post-traumatic stress disorder, schizophrenia, and other disorders have a higher incidence of sleep disturbances and issues,” explains Dr. Rébecca Robillard, director of clinical sleep research at the University of Ottawa Institute of Mental Health Research (IMHR) at The Royal. “We know that those who have sleep issues tend to have more mental health burdens as well. And it’s clear now that there’s a kind of vicious cycle between the two.”
“If you’re having trouble sleeping or don’t feel rested after a night’s sleep for more than three months, I encourage folks to talk to their primary care practitioner,” says Dr. Diana McMillan, RN, a professor at the University of Manitoba’s College of Nursing. “Many conditions contribute to poor sleep, for example, an overstimulated thyroid, sleep apnea, or an enlarged prostate. Poor sleep can be a red flag for a health condition that needs attention.”
Short-term: The day after a poor night’s sleep, people often experience some cognitive impairment that could lead to slower reaction times and trouble focusing. People also often report feelings of emotional fragility, irritability, and trouble coping with stress. Many people compensate for a lack of sleep with calorie-rich foods to boost their energy—often without even realizing it. “Studies show that, when we’re sleep deprived, we’re more likely to be emotional on both the positive and the negative side,” says Dr. Rébecca Robillard, who also acts as co-chair of the Canadian Sleep Research Consortium. “Other studies show that this really stems from our biology.”
Long-term: Failing to get restorative sleep on a regular basis over a prolonged period is associated with an increased risk of cardiovascular disease, hypertension, Type 2 diabetes, memory problems, and a range of mental health disorders, notably depression and anxiety.
The mechanisms: Sleep supports several functions, including cell repair, hormonal regulation, and energy conservation. It also triggers the “glymphatic system” to open, which helps to clean metabolic waste out of our brains while we sleep. Manitoba sleep expert Diana McMillan likens this to a “pressure washer for the brain” and says, “If we’re not sleeping well, the glymphatic system is probably not doing as good a job as it might.”
“Even the saying ‘I’ll sleep on it’ reflects that there are a lot of processes that take place during sleep that help us cope and make sense of what we went through during the day,” says Robillard.
Reclaiming rest: How can we get better sleep?
Getting a good night’s sleep isn’t always within reach for everyone, but there is evidence that prioritizing sleep and establishing consistent routines is an important step towards getting a good night’s rest.
“Some of the wearables that people use, like the watch or, worse, the phones that people put on the side of the bed to find out how much deep sleep they’re getting, should be taken with a big grain of salt,” says Robillard. “If you feel like you slept better, you probably did.”
“The first-line treatment for insomnia should be Cognitive Behavioural Therapy for Insomnia,” says Robillard. “And this should be started before people start any kind of medications.”
In combination with practical advice about setting up ideal sleep spaces, CBT-I helps people reframe their beliefs, thoughts, and feelings about sleep. It also stresses the importance of maintaining a regular schedule—both bedtime and wake time—if possible.
Not everyone can afford to pay for therapy, so the Canadian Sleep Research Consortium is developing digital tools to make CBT-I more accessible.
There’s no shortage of opinions on the best way to start the day. One common bit of advice, though, is to always make the bed before leaving the house. Is it possible that a good morning routine can set you up for a more restful night?
“Sleep hygiene isn’t just about having a regular bedtime, it’s also about having a regular wake time,” says Dr. Megan Edgelow, an Occupational Therapist and associate professor at Queen’s University’s Faculty of Health Sciences.
“A lot of people I work with clinically who have mental health conditions are lacking a routine or not happy with their daily routine,” says Edgelow, who works with people who have trauma-related conditions, PTSD, anxiety disorders and depression. “Just working with people on how they use their time contributes to their health, identity, who they want to be, and things they want to be connected to.”
Although much sleep advice focuses on what individuals can do to get better sleep, there are systemic factors that interfere with people’s sleep that don’t necessarily have an easy fix. For example, many shift workers can’t always maintain a consistent sleep/wake schedule.
Some people who don’t work “nine-to-five” jobs experience Shift Work Sleep Disorder (SWSD), a condition that stems from schedules being at odds with circadian rhythms and causes insomnia and fatigue. SWSD is associated with a higher risk of metabolic disorders, including cardiovascular disease.
“Sleep is something to reflect on at the societal level,” says the University of Ottawa’s Dr. Rébecca Robillard. “The sleep research community is increasingly recognizing that telling people they need to sleep more and take care of their sleep doesn’t really resonate with a single mom who has two jobs and four kids.”
Robillard says we need to avoid “sleep shaming” and, instead, look for ways to reduce systemic barriers to restorative sleep. She suggests one of the first places to look would be our daylight saving time policies because the time change is associated with a surge of hospitalizations, many of which are associated with accidents and self-harm.
“To look after our country’s health, we need to make sure that people sleep well,” she adds. “This has so many ramifications for mental and physical health, so giving a chance for us all to access sleep should become a public health priority.”
On that end, at least, there is some good news, thanks to several organizations that are working on addressing these inequities and/or advocating for making sleep a more even playing field. In 2023, the Canadian Institutes of Health Research awarded $1,100,000 to the University of British Columbia so researchers could investigate public health interventions for sleep.
Christine Sismondo, PhD, is a reformed night owl, historian, and writer who loves nothing more than eight hours and is firmly on “Team Nap.” She’s the author of America Walks into a Bar, a deep dive into taverns as political spaces, and a contributor to the Toronto Star, The Catalyst, and other publications. When she’s not writing about drug policy, intersectional feminism, healthcare, or winning National Magazine Awards and Canadian Online Publishing Awards, Christine might be planning her next travel adventure.