The aim of this report is to raise awareness about the importance of sleep and its crucial role for our health, both physical and mental, just like diet and exercise. In Part I of this report, we provide information about sleep, why we need to sleep, and what happens during sleep.
In Part II, we review the literature on sleep problems and explain what can happen if we don’t sleep properly. In Part III, we describe ways in which we can improve our sleep and explain possible treatments for those who find achieving good quality sleep difficult. The primary focus of this report is sleep and mental health; both how mental health can affect our sleep, and how sleep can affect our mental health.
This research report on sleep and mental health was published for Mental Health Awareness Week in 2011.
We spend approximately a third of our lives asleep. Sleep is an essential and involuntary process, without which we cannot function effectively. It is as essential to our bodies as eating, drinking and breathing, and is vital for maintaining good mental and physical health. Sleeping helps to repair and restore our brains, not just our bodies.
During sleep we can process information, consolidate memories, and undergo a number of maintenance processes that help us to function during the daytime. Sleep is crucial to the health of individuals within the UK and to the public health of the UK population.
We all need to make sure we get the right amount of sleep, and enough good quality sleep. There is no set amount of sleep that is appropriate for everyone; some people need more sleep than others. Our ability to sleep is controlled by how sleepy we feel and our sleep pattern. How sleepy we feel relates to our drive to sleep. The sleep pattern relates to the regularity and timing of our sleep habits; if we have got into a pattern of sleeping at set times then we will be able to establish a better routine, and will find it easier to sleep at that time every day.
Sleep is a more complex process than many people realise, much of it is still a mystery to scientists. During sleep, the body goes through a variety of processes and sleep stages. Good quality sleep is likely to be the result of spending enough time in all of the stages, including enough deep sleep which helps us feel refreshed.
Poor sleep over a sustained period leads to a number of problems which are immediately recognisable, including fatigue, sleepiness, poor concentration, lapses in memory, and irritability.
Up to one third of the population may suffer from insomnia (lack of sleep or poor quality sleep). This can affect mood, energy and concentration levels, our relationships, and our ability to stay awake and function during the day.
Sleep and health are strongly related, poor sleep can increase the risk of having poor health, and poor health can make it harder to sleep. Common mental health problems like anxiety and depression can often underpin sleep problems. Where this is the case, a combination approach to treating the mental health problem and sleep problem in tandem is often the most effective.
It is essential for us to better understand the sleep process in order to ensure that we get a regular amount of good quality sleep. Sleepio, co-founded by Professor Colin Espie, Director of the University of Glasgow Sleep Centre, is a new organisation that is dedicated to raising awareness of the importance of sleep. Sleepio collected data from a large-scale, national survey on sleep habits; some of these revealing new data appear throughout this report.
We can all benefit from improving the quality of our sleep. For many of us, it may simply be a case of making small lifestyle or attitude adjustments in order to help us sleep better. For those with insomnia it is usually necessary to seek more specialist treatment. Sleep medication is commonly used, but may have negative side effects and is not recommended in the long-term. Psychological approaches are useful for people with long-term insomnia because they can encourage us to establish good sleep patterns, and to develop a healthy, positive mental outlook about sleep, as well as dealing with worrying thoughts towards sleeping.
One of the most widely used and successful therapies is Cognitive Behavioural Therapy (CBT). This is useful even for people who have had insomnia for a long period of time. A full course of such a therapy with a sleep specialist is potentially costly, and is most appropriate for people with severe sleep problems. Still, some CBT principles can be appropriate and easily practiced for anyone who is experiencing a sleepless night.
- Sleeping poorly increases the risk of having poor mental health. In the same way that healthy diet and exercise can help to improve our mental health, so can sleep.
- There is no universal answer to the question of how much sleep a person needs. This varies from person to person. What is important is that people find out how much sleep they need and ensure that they achieve this.
- The consequences of poor sleep should be taken seriously in healthcare, education, family life, and society at large.
We recommend that:
- The importance and benefits of sleep for both mental and physical health should be highlighted in national and local public health campaigns, including in schools and workplaces. New and easily accessible resources should be made available advising people on what they can do themselves to improve their sleep.
- The Royal College of GPs should provide up to date, evidence-based training and information for its members on the importance and benefits of sleep for physical and mental health. GPs should also have access to a diagnostic tool for use in recognising sleep problems in primary care settings.
- The new Public Health Outcomes Framework should include a specific outcome on reducing sleep problems across the whole population. Sleep should also be reflected in new national mental health outcome indicators, including improving sleep for people who experience significant sleep problems requiring specialist help.
- The National Institute of Health and Clinical Excellence (NICE) should develop guidance for the management of insomnia using non-pharmacological therapies, to complement existing guidance on using pharmacological therapies.
- People with sleep problems should be recognised within the Improving Access to Pyschological Therapies (IAPT) programme, especially regarding access to Cognitive Behavioural Therapy (CBT). IAPT staff should be suitably trained on sleep issues.
- Further research should be carried out to establish the effectiveness of low cost, non-intrusive CBT-based interventions for sleep problems, such as self-help books and online courses,