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How Does Sleep Affect Mental Health?

Mental Health and Wellness

Sleep is the Key to Mental Wellness

When did we start regarding sleep deprivation as a superpower? Sleep has a massive impact on overall mental health, and if you are diagnosed or experiencing a mood disorder—including anxiety, depression, bipolar disorder, or others—too much or too little sleep may be a cause or symptom of an emotional disturbance.

Note: Depression and other mood disorders can have critical consequences. Always seek help if you find yourself experiencing intense or prolonged feelings of hopelessness, anxiety, or emptiness. If you or a loved one are experiencing suicidal thoughts or considering suicidal action due to lack of sleep or other factors, contact the National Suicide Prevention Lifeline at 1-800-273-8255 for immediate assistance.

How Sleep Affects Mental Health & Mood Disorders

Are sleep problems a cause or an effect of mood disturbances? Clearly both. Many patients report experiencing sleep disruptions preceding or during mood disturbances. Examples include, but certainly are not limited to:

  • Anxiety: Anxiety disorders can cause racing thoughts, elevated heartbeat, and panic attacks when trying to sleep, resulting in insomnia. Lack of sleep will increase fatigue, exacerbate concentration difficulties, and make managing the nervousness and overwhelming fear associated with these disorders challenging.
  • Bipolar Disorder: Bipolar disorder is characterized by intense highs and lows. When experiencing mania, you may be unwilling or unable to sleep. Depressions may result in extreme fatigue and too much sleep. These inconsistent sleep patterns lead to difficulty regulating emotions.
  • Depression: Depending on your diagnosed depressive disorder, you may experience insomnia or too much sleep. Both lead to heightened fatigue, brain fog, difficulty focusing, headaches, trouble maintaining an exercise routine, and challenges regulating emotional responses to various factors.

In addition to these disorders, too much sleep or insufficient sleep can have a noticeable impact on symptoms of adult ADHD, OCD, and other disorders. If you are experiencing new or worsening symptoms, improper sleep may be the culprit. But understanding how sleep affects mental health is only the beginning—now it’s time to make a plan to improve your sleep and enhance your quality of life.

How to Improve Your Sleep for Better Mental Health

Practice Good Sleep Hygiene

Sleep hygiene refers to healthy habits built to support better sleep. In our modern world, sleep hygiene means applying self-discipline and dedication. Consider these behaviors as you work to improve your sleep and positively affect your mental health through new habits:

  • Turn off and put away all screens and electronics at least thirty minutes before bed
  • Set and maintain a consistent bedtime
  • Use relaxation or grounding techniques before going to sleep
  • Avoid alcohol, tobacco, caffeine, and similar substances in the late afternoons and evenings
  • Get regular exercise and natural light exposure during the day

Monitor Your Sleep

Documenting the relationship between disrupted sleep and mood disturbances can be a way to determine if the two are linked. Current and easily accessible technology, such as smartwatches and other wearable devices, make it convenient to collect your heart rate variability (HRV) during sleep. You can use this data to find patterns and discover if a link exists between your sleep and oncoming mood disruptions, then examine your behaviors to create an actionable plan that minimizes pending psychiatric episodes.

Keep in mind that subjective self-reports of sleep may not always be a reliable tool for mental health monitoring. Many people get exasperated tracking their habits, and sleep physiologists have found that self-reporting often differs drastically from professionally conducted sleep studies. If you cannot address your sleep disturbances independently, seeking professional assistance is your best step.

Seek Professional Assistance & Follow a Personalized Medication Plan

If you are unable to improve your sleep on your own, working with a professional is your best option. Psychiatric sleep specialists have the knowledge and capabilities to analyze your self-collected HRV rates, conduct in-office sleep studies, and create personalized treatment plans to improve your sleep and quality of life. One part of your plan may include new or adjusted medication. Medication management carried out by a qualified team can consist of:

  • Lowering or raising does to ensure medication side effects are not causing too much or too little sleep
  • Making changes proactively in response to early changes identified in observed HRV patterns
  • Trying different medications to find the best solution for your unique symptoms
  • Simplifying your medication regiment
  • And more!

Weekly Sleep Tracker

West End Consultation Group is Here to Help You Sleep Better & Improve Your Mental Health

West End Consultation Group is dedicated to creating individualized pathways to wellness through mental health treatment. If you or a loved one is experiencing disruptions in sleep or worsening mood disorders, our board-certified team is here to support you. We work with adult patients throughout the Twin Cities and are prepared to help you discover how sleep affects your mental health. Contact us today to learn more about our services and get started on the road to better mental health.

Medical Disclaimer:

Please remember that all medical information provided in this post must be considered educational only. This blog should not be relied upon as a medical judgement and does not replace a medical professional’s judgement about the appropriateness or risks of a procedure or condition for a given patient. We will do our best to provide you with information that may help you make your own healthcare decisions. Please do not follow any instructions or information without first consulting with your physician or mental health provider.

Advocacy: My Statement for another term on the Minnesota Psychiatric Society Council

Advocacy

My Statement for another term on the Minnesota Psychiatric Society Council

Marie Olseth, MD

Having served on the MPS Council this past year, I have had the honor of advocating for psychiatrists and psychiatric patients.

I take the role seriously and I am not afraid to speak up and challenge the status quo.  My role as an MPS Council member is enhanced by other healthcare advocacy that I am actively involved in.

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Psychiatric Medications

Psychiatric Medications

Understanding how they work

By Marie Casey Olseth, MD

Many patients get referred to me after having tried multiple psychiatric medications, none of which provided effective relief of their symptoms. They are understandably frustrated and skeptical about seeing a new psychiatrist, let alone trying any new psychiatric medications.

The frustration may increase if they consult “Dr. Google” or ask non-medical professionals for information. Multiple factors must be considered before marking any decisions about prescribing psychiatric medications. That’s why I make it a priority to educate my patients on how I come to a decision about the medication- and the dosage- that I recommend. As a result, they feel more informed and more comfortable with the decision to start the medication.

Common Questions

The discussions are as varied and unique as the patients themselves, but some common themes do reoccur. Here are some examples.

“I already tried that medication and it didn’t work.”

In many cases, the patient was actually taking a psychiatric medication that would have been effective for the symptoms but had been prescribed at the incorrect dosage.

For example, one patient was recently referred to me after finding gabapentin ineffective in treating his anxiety. Further discussion revealed that he had been prescribed a dose that was sub-clinical- in other words, it should have worked, but he was not taking enough of it to be effective. He was skeptical of the recommendation to try gabapentin once again at an appropriate dose, but was later amazed at the relief it provided, essentially eliminating the formerly paralyzing impact of anxiety on his life. The correct dosage can make the difference in the effectiveness of some medications.

“2mg of Xanax everyday works fine. Why should I change it?”

Other referrals come from primary care physicians urging their patients to find safer alternatives to the higher-risk psychiatric medications they currently use. Many of these patients don’t want to eliminate the higher-risk medication- a controlled substance, for example- because they have developed an emotional attachment to and/or a dependency on the medication.

In many cases, the patient was initially prescribed the controlled substance with instructions to use it only “as needed” (sometimes written on the prescription pad or pill bottle label as PRN, for the Latin term pro re nata). The prescriber may have intended this to mean less than once each day, but, over time, some patients increase their intake to get more symptom relief, ultimately taking the medication multiple times daily.

Patients may not appreciate the many risks of certain medications and may not understand that their psychiatric symptoms could be managed with other, safer alternatives. I advise patients that, as psychiatrists, we have many tools in out medication toolbox to manage their symptoms. We draw upon our knowledge and experience to make recommendations regarding medications. Patients are often initially skeptical and nervous, but after they become comfortable with the recommendations and then transition to safer medications to manage their psychiatric symptoms, they are surprised at how effective the safer psychiatric medications are at managing their symptoms.

There are many examples of this, but using the Xanax case as an example, some patients who use Xanax multiple times each day are often surprised that their anxiety might be better controlled by some other medication. It was not until getting off Xanax that they realized how multiple doses contributed to daily discomfort and to intraday withdrawal symptoms as the effect of the medication wore off. Patients also tell me that their thinking was “foggy” while on Xanax, but that the medication we transitioned them to managed their anxiety without negative cognitive impacts.

As with any prescription medication, side effects may vary considerably from patient to patient. The treatment regimen that works perfectly for one individual may be ineffective for another, so it’s important to raise concerns with your provider.

“You are recommending two medications. I used to be on just one.”

A top priority in managing psychiatric conditions is to minimize “medication burden” – the negative impact that a drug causes on a person’s physical and cognitive health. Complications related to medication burden could be temporary, lasting only while the person takes the drug, or could result in cumulative, long-term effects.

The goal is to help patients manage their psychiatric condition with minimal medications.

Reducing medication burden often involves reducing the number of medications. Other times, it involves replacing one high-risk medication with two safer medications that, taken together, can manage the same symptoms.

Psychiatric medications as “training wheels”

Many patients want help, but do not want to take psychiatric medications. The goal is to help patients manage their psychiatric condition with minimal medications. Some psychiatric conditions are chronic and severe and do indeed require long-term use of medications. But many patients manage their psychiatric illness with a time-limited course of medications, using the drugs as “training wheels” to treat a condition while simultaneously attending regular therapy appointments to develop new skills. Ongoing therapy is similar to utilizing a personal trainer to motivate and train you, except that, in this case, the therapists work to optimize your mental health. The therapist coaches you on changing cognitive an behavioral patterns, moving from patterns that cause and reinforce psychiatric illness to patterns that promote optimal mental health.

I sometimes follow a 70/30 rule in prescribing, dosing the psychiatric medications to achieve 70 percent relief of the symptoms. This decreases the symptoms enough for a person to be comfortable enough and to have enough emotional strength to work on their symptoms in therapy. Eliminating all psychiatric symptoms with medications may remove incentives to regularly rehearse the skills and behaviors taught in therapy. For some patients, this 70/30 rule provides sufficient management of psychiatric symptoms without removing the incentive. With diligence to developing and utilizing skills taught in therapy, psychiatric medications may eventually be decreased.

How do these medications work?

Our understanding of mental illness and treatment is still evolving, as is our understanding of all illnesses and their treatments. What is known and understood regarding the brain processes of mental illness and the impact of psychiatric medications on brain chemistry is quite fascinating but may seem daunting to those outside the scientific and medical communities. I try to present some basic concepts about how medications can impact the brain before discussing the rationale of choosing one particular medication instead of another.

One approach is to compare the brain’s communication system to our personal communications with other people through emails. Our brain cells, or neurons, employ neurotransmitters (serotonin, dopamine and norepinephrine, to name a few) to communicate with other neurons, just as we use Hotmail, Gmail, or Yahoo to communicate with other people. Various psychiatric illnesses involve a disruption in these “brain emails.” The messages may not reach the intended target brain cells, or the incoming messages may overpower the neuron’s “inbox.” In either case, these disruptions can interfere with the brain’s normal mechanisms to manage anxiety, depression, stress, and other factors that affect our mental health.

Psychiatric medications can correct these disruptions in the brain’s messaging system. Some antidepressants, for example, may be used to increase the serotonin email communication between the neurons. Other psychiatric medications may optimize the dopamine or norepinephrine emails between brain cells. Various psychiatric medications with accomplish their “fix” of these email disruptions in different ways.

Summing up

Psychiatric medications can work effectively with the brain’s chemistry to manage and control symptoms and relieve suffering, but it’s critical to consider multiple factors in prescribing a particular medication, and to continue seeking alternatives if the first medication proves ineffective. These sample discussions underscore the need to help patients to understand how medications work and to engage them more fully in treatment decisions. It is an approach that my patients have come to value in seeking psychiatric care.

Mary Casey Olseth, MD, is a board-certified psychiatrist practicing at the West End Consultation Group in St. Louis Park.

May 2017 Survey Results

Medical Disclaimer:

Please remember that all medical information provided in this post must be considered educational only.  This blog should not be relied upon as a medical judgement and does not replace a medical professional’s judgement about the appropriateness or risks of a procedure or condition for a given patient.  We will do our best to provide you with information that may help you make your own health care decisions. Please do not follow any instructions or information without first consulting with your physician or mental health provider.

“To Just Be a Normal Mom” Overcoming Ruminations in OCD

Mental Health and Wellness

What a joy to hear from my patient today that she is able to “just be a normal mom.” She had struggled with ruminations for years of thoughts that she would harm others. She couldn’t enjoy closeness with her children as she was afraid she would harm them. I can’t imagine how horrible that would be for a mother. Ruminations of harming others is actually a common rumination for people with OCD. It has been a joy to successfully treat my patients with this illness so they can start enjoying and experiencing normal interactions with the ones they love.

Medical Disclaimer:

Please remember that all medical information provided in this post must be considered educational only.  This blog should not be relied upon as a medical judgement and does not replace a medical professional’s judgement about the appropriateness or risks of a procedure or condition for a given patient.  We will do our best to provide you with information that may help you make your own health care decisions. Please do not follow any instructions or information without first consulting with your physician or mental health provider.

Getting Back to Life After Depression

Mental Health and Wellness

A depressive episode or reoccurring depression symptoms can seriously impact our day-to-day lives. Recovery times vary widely, and finding a way to get back to life after depression can be difficult. By learning the signs that a depressive episode is occurring and making a personalized recovery plan, you can get your life back as soon as possible.

Note: If you or a loved one are experiencing intense and/or prolonged feelings of emptiness, hopelessness, or suicidal thoughts, please contact the National Suicide Prevention Lifeline at 988 for immediate emergency assistance. Help is only a phone call away.

Signs of a Depressive Episode

The onset of depression can be gradual and insidious, and you may not realize that an episode is occurring until it is over. We often associate depression with symptoms such as crying or suicidal thoughts, and while these occur for some people, depression is also characterized by disconnecting from emotions. Symptoms can vary depending on many factors but may include:

  • Anhedonia, or the inability to feel joy or pleasure
  • Irritability, frustration, or a short temper
  • Changes in activity level
  • Changes in sleep patterns, such as insomnia or sleeping more than normal
  • Changes in appetite, including weight gain or loss
  • Headaches and physical symptoms
  • And many others.

Recognizing an incoming depression can go a long way to getting your life back sooner as you can make necessary interventions and treat symptoms accordingly.

Tips for Getting Back to Life After Depression

Identify Your Values & Priorities

Explicitly naming and identifying aspects of your life you value, prioritize, or would like to prioritize more can help you with getting back to life after depression. These things can be small, such as having a comfortable pillow for sleeping, or large, like appreciating your partner for supporting you during difficult times. Of course, depression can sometimes make it hard to identify these things, so use these tips to find the parts of your life that bring you joy, contentment, or excitement:

  • Make a daily list of five things you’re grateful for in your life
  • Intentionally take part in activities or groups that used to cause enjoyment
  • Notice negative thoughts (“My friend doesn’t like me”) and replace them with neutral ones (“My friend and I aren’t as close as we once were, but she still makes sure I’m okay.”
  • Keep a journal to find patterns in negative thinking
  • Seek professional help from a board-certified psychiatrist or therapist

Consider Lifestyle Changes

Sometimes depression and depressive episodes can be linked to certain circumstances, such as an unfulfilling job, a relationship ending, or others. In these cases, lifestyle changes can go a long way in aiding depression recovery. While making your depression recovery plan, consider incorporating these ideas into your lifestyle:

  • Finding a new job or career, or identifying ways to improve your current professional position
  • Starting a new hobby with tangible results, such as gardening, baking, or a craft
  • Establishing an exercise routine you enjoy, such as walking, yoga, or team-based sports
  • Setting attainable goals, such as paying a bill, studying, walking the dog each day, or others

While these lifestyle changes will not cure a depressive disorder, they can help create a more active routine and encourage healthier behaviors, minimizing some symptoms when a depressive episode occurs.

Pursue Professional Assistance

If changing your lifestyle and being more mindful does not help alleviate depressive symptoms, or if you notice your depression worsening in severity or frequency, it may be time to seek professional assistance from a certified psychiatrist. Trained experts can assist you in getting back to life after depression through short and long-term treatment plans, which may include:

  • Creating a personalized medication management plan
  • Identifying if your depression is a symptom of another disorder, such as PMDD, SAD, PDD, or others
  • Establishing a recovery strategy specific to your circumstances
  • Using cognitive behavioral therapy (CBT) in tandem with psychiatric treatment
  • And many other approaches!

West End Consultation Will Help Get Your Life Back

You deserve happiness, enjoyment, and pleasure in your day-to-day routine, and West End Consultation Group is here to help. Depression is experienced differently by different individuals, and no matter your symptoms, you deserve to experience the good moments of your life. Our Twin Cities board-certified team is in your corner, so give us a call at 952-856-8452 or request an appointment today.

Medical Disclaimer:

Please remember that all medical information provided in this post must be considered educational only. This blog should not be relied upon as a medical judgment and does not replace a medical professional’s judgment about the appropriateness or risks of a procedure or condition for a given patient. We will do our best to provide you with information that may help you make your own healthcare decisions. Please do not follow any instructions or information without first consulting with your physician or mental health provider.

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