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People diagnosed with mental illness often have related sleep problems. In most cases, a person’s sleep problem will progress in tandem with the underlying mental health disorder responsible for the disruption of sleep. Sleep problems often emerge early in the illness, before symptoms characteristic of the mental illness even begin to appear.

Most often, sleep problems related to mental illness involve one of two conditions:

• Insomnia. Condition in which a patient has trouble falling asleep or remaining asleep. Typically, patients with insomnia do not feel refreshed after a night’s sleep.
  
  
• Hypersomnia. Condition that causes people to feel extremely sleepy throughout the day. Patients with hypersomnia also often sleep for long periods at night and nap repeatedly during the day. However, this sleep does not leave the person feeling refreshed or more alert.

A large number of mental illnesses – ranging from the anxiety disorder post-traumatic stress disorder (PTSD) to postpartum depression – can cause sleep problems such as insomnia and hypersomnia. For example, all forms of depression are commonly associated with sleep problems. People who are depressed often experience bouts of insomnia that may cause them to have difficulty falling asleep, remaining asleep or falling back asleep after waking early in the morning. Less frequently, depressed patients may have problems with hypersomnia that cause them to sleep excessively.

Sleep consists of five stages, the first four of which are called non-rapid eye movement (REM) sleep. Stage 1 is the transition from being awake to sleeping, stage 2 is an intermediate level of sleep, and the third and fourth stages may be referred to as deep sleep or slow wave sleep. The fourth stage is also known as delta sleep, which is the deepest type of sleep. During delta sleep, growth hormone, which regulates cell division and protein synthesis necessary for growth, is produced. The fifth stage of sleep is called REM sleep. Dreaming occurs during this stage. Sleep is an active, complex process that involves the brain in multiple ways.

Mental illnesses often associated with sleep problems such as hypersomnia and insomnia include:

• Adjustment disorders. Conditions in which a person has an excessive reaction to a stressful life event, such as starting school or getting divorced. Insomnia often accompanies these conditions.
  
  
• Bipolar disorder. Condition in which periods of excitability (mania) alternate with episodes of depression. Hypersomnia is often associated with this condition.
  
  
• Generalized anxiety disorder. Condition in which a person displays frequent patterns of worrying about activities or events. Patients with this condition often report insomnia that makes it difficult to fall asleep and that may cause them to awaken with feelings of anxiety during the night.
  
  
• Panic disorder. Condition marked by recurrent episodes of intense fear and anxiety that may last for minutes to hours. Patients with this condition may experience panic attacks in the middle of the night that cause them to awaken and to then struggle to fall asleep afterward.
  
  
• Personality disorders. Conditions marked by inflexibility in perceiving, reacting to and relating to people and events. People with personality disorders often have impaired social skills. Insomnia often accompanies these conditions.
  
  
• Schizophrenia. People with this condition struggle to distinguish between real and unreal experiences. They may not think logically or have normal emotional responses to others. Insomnia often accompanies periods when symptoms related to schizophrenia intensify.
  
  
• Somatoform disorders. Condition in which patient complaints of persistent or chronic symptoms of physical illness are believed to be at least partially associated with a mental health condition. Insomnia often accompanies somatoform disorders.
  
  
• Seasonal affective disorder (SAD). People with SAD typically experience symptoms of depression in the winter months, but not in the spring or summer months. Sleep problems associated with SAD include oversleeping, difficulty staying awake during the day, disturbed sleep and, in some cases, waking exceptionally early in the morning.

The treatment for certain mental health disorders may predispose the patient to developing sleep problems. For example, prescription medications to treat anxiety disorders (e.g., benzodiazepines) interrupt the normal sleep cycle by increasing the amount of stage two sleep and decreasing the amount of sleep in stages three and four and REM sleep. The deeper sleep received during stages three and four is a necessary part of the restorative function of sleep.