Use sleep to treat mental health

By Ryan Wetzler, Psy.D.
January 1, 2007



Why do we sleep? What are the consequences of sleep disturbance? How might sleep disturbance impact the therapeutic process? What role can psychologists play in the identification and treatment of sleep disorders? Each of these questions represent important areas for future research and by no means can we address each of these questions adequately in a short article. We should never underestimate how these questions may play out in clinical practice, either promoting or inhibiting our effectiveness as clinicians.

The function of sleep is still a topic of much debate. Currently there are numerous theories depicting how sleep may play an important role in memory formation, energy restoration and even learning. Psychologists and other healthcare professionals have long known that sleep problems are frequently associated with a variety of physiological and psychological conditions. This relationship has recently been brought back into the spotlight.

Historical views of sleep have frequently seen sleep disturbance as an inevitable result of certain physical and mental health conditions. According to this view, sleep disturbance was seen as “secondary” to something else and hence the sleep problem itself was frequently ignored. Under this belief, once the “primary” condition was discovered and adequately addressed the sleep disturbance would take care of itself. Unfortunately, this is frequently not the case.

Many times sleep disturbance persists following treatment of the “primary” condition. For instance, insomnia is now considered a risk factor for development of depression, anxiety and substance abuse disorders. It may be time to change our perspective on sleep disturbance from a consequence to a cause and from “secondary” to co-morbid.

Sleep quality plays a critical role in maintaining, exacerbating or even causing a variety of mental health conditions. Sleep disorders such as insomnia, obstructive sleep apnea and others lead to significant disruptions in the normal sleep process. Such disruptions in sleep architecture are significant when you consider the impact they have on energy level, motivation, concentration, attention, quality of life and mood.

Put this together with the fact that nearly 85 percent of sleep disorders go unrecognized and we can begin to understand the significance of the problem at hand. To make matters worse, many healthcare providers are not well trained in the identification and treatment of sleep disorders. Even when sleep disturbance is identified, it is rarely given the attention it deserves. This lack of attention is surely not due to lack of treatment efficacy. Cognitive-behavior therapy has been found to be highly effective for the treatment of insomnia, yet there are currently far too few trained providers. Likewise, obstructive sleep apnea can be successfully treated with continuous positive airway pressure (CPAP). However, many sufferers cannot reap the benefits of such treatments due to failures in adequately screening for disordered sleep.

The role of psychologists in the management of sleep disorders is obvious. Considering that sleep disturbance may be seen as an exacerbating, maintaining or even a causal factor in mental health conditions, the identification and treatment of sleep disorders need to become a primary focus of any evaluation of depression, anxiety or substance abuse problems. It’s time to form relationships with your local sleep laboratories and sleep experts to ensure the adequate treatment of both the mental health condition and the possible underlying or co-morbid sleep disorder.

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Ryan Wetzler, Psy.D., is a clinical and sleep psychologist who is certified in the practice of behavioral sleep medicine by the American Academy of Sleep Medicine. He is director of the behavioral sleep medicine clinic at Sleep Medicine Specialists of Louisville, Ky. His e-mail address is: rwetzler@kysleepmed.com.

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