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Improve Sleep to Improve Mental Health

 

By Amol Rao

It’s midnight, you’re working on something due tomorrow. The coffee from earlier is wearing off and your eyes are complaining. Despite a promise to yourself, you’re getting to bed after midnight again. When was the last time you woke up feeling refreshed, like in those mattress commercials? Can’t recall. Your friend claims they ‘only need 4 hours of sleep to function’ so you’re aiming for 5 hours (recommended is 8 – 9 hours). You’ll catch up on sleep this weekend (hint: probably not).

Finally, you give up and head to bed; only to wake up feeling even worse?! Humans are special in many ways. We’re the only the animals that willfully forego sleep on a regular basis. We are so caught up in our daily lives – so drawn to our screens, stressed about work, or just too wired from stimulants that we regularly sacrifice sleep. A 2016 survey of 1,500 Canadians found that 67% of respondents wish they could get better quality sleep [1]. In the same poll, about 59% of respondents said they weren’t happy with the quantity of their sleep. Students aren’t doing much better. In a poll conducted by the IMS Magazine in 2016, about 40% of respondents reported being ‘unsatisfied’ or ‘very unsatisfied’ with their sleep. Although for many, poor sleep is not a choice, this widespread disruption of sleep has serious consequences.

Sleep and depression

The link between mental health and sleep has long been known to scientists. Originally, it was unclear whether sleep issues were causes or symptoms of mental health problems; the two often appeared together. A growing body of evidence suggests the relationship between sleep and mental health is quite complex and includes bi-directional causation. In short; sleep issues and mental health problems tend to reinforce each other.

One particular problem that appears with poor sleep is depression. A team led by Dr. Eisenberg at the University of Michigan found that depressive anxiety disorder was experienced by 15.6% of students, while suicidal ideation was experienced by 2% of students [6]. These are large numbers. Considering that U of T has 70,000 undergraduate students, it could be up to 10,000 students suffer from depression.

Although many factors contribute to depression which can include but not limited to socioeconomic status, genetic risk, major life events, illness and abuse. It’s the relationship between sleep and depression that should garner more interest among those seeking to improve student wellbeing. A review of 205 peer- reviewed articles published between 1964 and 2005 found that depression is the most common psychiatric disorder associated with insomnia [2]. Another review looked at whether insomnia in patients could predict the development of depression [4]. The authors concluded that ‘almost unambiguously, insomnia at baseline significantly predicted an increased depression risk at follow up...’.

This isn’t to say that bad sleep causes depression. However, since they often appear together it makes sense to consider both when trying to tackle either. And so, we should strive to tackle both issues concurrently rather than in isolation. Indeed, trying to improve mental health without addressing underlying sleep problems may prevent effective treatment. So what do we need to know about sleep?

What can a student do to improve sleep?

‘The most important thing a student can do is learn about sleep hygiene’, that’s according to Vineet Prasad, who’s currently a 2nd year student in Rehabilitation Science at the University of Alberta. Vineet’s interest in sleep stemmed from personal experience – he found that a few nights of poor sleep would make him irritable and unable to focus during the days. After learning about sleep hygiene, Vineet decided to help other students. Together with a small group, Vineet won a grant and successfully implemented a campaign to promote sleep across the University of Alberta’s campus. Their successful outreach campaign reached hundreds of students, through means such as pop-up stalls, health talks, brochures and online modules.

Sleep hygiene incorporates principles, habits and practices that are conducive to sleeping well on a regular basis. Some of these practices are easier than others. A few key principles are:

  • Avoid electronic devices or brightly lit areas before bedtime. If devices must be used, dim the screen and use free software which reduces blue light (i.e., flux);

  • Limit daytime naps. If naps must be taken, limit them to 30 minutes and no naps within several hours of bedtime;
  • Keep a consistent sleep and wake schedule;
  • Establish a regular bedtime routine which involves relaxation; 
  • Keep the room cool and dark.

A quick google for ‘sleep hygiene’ brings up lots of great advice. Most of these tips are well known – yet the sleep problem persists. One issue, is that many of the tips are just too difficult to follow, says Samantha Gubka. Samantha is currently completing a Masters of Occupational Therapy at the University of Alberta. In her practice, she tries her best to inform patients about the benefits of sleep, however she acknowledges that often the patient can’t stick to right practices. For example, is it realistic to expect people to avoid electronic devices for 2 hours prior to bed?

To combat this, students can work with a trained sleep professional – either a medical doctor, sleep physician, naturopathic doctor or occupational therapist. These services may be available on campus and the student can tailor general sleep hygiene practices to things that work for them. Medical professionals though are already stretched – dealing with more urgent issues. This is why university administrations need to step up and fill the gap that exists.

Universities must take the lead

Universities are well placed to widely disseminate sleep education in a way that individual medical professionals are not. Universities have a wide reach and can provide focus to things that are important in a proactive way.

The grant won by Vineet – was part of a program called Heroes for Health. This program funds student run projects that help the student community with physical, psychological and mental wellbeing. Universities across the country should offer such programs. This type of program – undertaken by students for students – can be more effective as students fully understand what their colleagues are going through. They can get the message out in the right way, and through the right channels.

Universities could also attempt to better manage student workload. Often, professors don’t know (and don’t want to know) student workload in concurrent courses. Professors assign work and deadlines primarily with regard to their course requirements. For students, this often results in conflicting deadlines or deliverables lumped together which then leaves no choice other than to sacrifice sleep.

Lastly, universities must make greater efforts to tie in sleep promotion programs with overall health and wellness programs that look at diet and exercise. There should be regular educational campaigns that promote sleep wellness. Regular restful sleep lays the foundation for mental and physical wellbeing, and small investments can result in large returns.

For too many in society, regular restful sleep is a rare luxury. Sleep disruption has serious long-term impacts on mental health. However, we have the tools and knowledge to make meaningful advances in improvements to sleep. Now universities and students need to work together to make this happen.

About the Author

Amol Rao completed a M.Eng. in Industrial Engineering. He is passionate about sleep. He is the founder of Somnitude Inc. (www. BlueBlockGlasses.com), a company which harnesses circadian science to improve sleep and health. Their line of blue light filtering glasses help people who can’t avoid light in the evening hours.

References

[1] Canadian Sleep Review 2016. Current Issues, Attitudes and Advice to Canadians.

[2] Tsuno, N., Besset, A., & Ritchie, K. (2005). Sleep and Depression. The Journal of Clinical Psychiatry, 66(10), 1254-1269. http://dx.doi.org/10.4088/JCP.v66n1008

[3] Benca, R. & Peterson, M. (2008) Insomnia and Depression. Sleep Medicine, Vol 9, Supplement 1, Pages S3-S9.

[4] Riemann, D. & Voderholzer, U. (2003) Primary Insomnia: A Risk Factor to Develop Depression?. Journal of Affective Disorders. Vol. 76, Issues 1 – 3 , Pages 255 – 259.

[5] Curcio et. Al. (2006) Sleep loss, learning capacity and academic performance. Sleep Medicine Reviews. Vol. 10, Issue 5, Pages 323 – 337.

[6] Eisenberg, D. et al. (2007) Prevalence and correlates of depression, anxiety, and suicidality among university students. American Psychological Association. Vol 77 (4), Oct 2007, 534 – 542.