Test Your Knowledge

When patients have both a mental illness and a sleep problem, both should be addressed because each can precipitate or exacerbate the other.  At times, treating the mental illness may result in a substantial improvement in the sleep problem, too.

For example, patients who are diagnosed with depression often benefit from a combination of psychotherapy and the use of antidepressant medications. Once the depression is successfully treated, the sleep problem may disappear.

However, if a patient’s complaints are primarily focused on sleep problems, one of two diagnoses may be made according to the criteria established by the American Psychiatric Association (APA): insomnia related to another mental disorder or hypersomnia related to another mental disorder.

Insomnia related to another mental disorder is diagnosed in patients who have difficulty falling asleep, remaining asleep or achieving restful sleep over a period of at least one month. The disturbance must be related to a type of mental health disorder and must cause significant impairment in social, occupational or other areas of functioning. It must be severe enough that it requires specific attention in addition to the attention paid to the mental disorder.

Finally, the insomnia cannot be better accounted for by another sleep disorder, and cannot be due to the use of certain substances or existence of certain medical conditions. This condition is diagnosed in between 35 and 50 percent of patients whose chronic insomnia is evaluated by a sleep study at a sleep disorder center, according to the APA.

Hypersomnia related to another mental disorder is diagnosed when over a period of at least one month, patients experience excessive sleepiness marked by prolonged sleep or daytime sleep that occurs nearly every day. The disturbance must be related to a mental health disorder and cause significant impairment in social, occupational or other areas of functioning. It also must be severe enough that it warrants specific treatment in addition to the attention paid to the mental disorder. The hypersomnia must not be more clearly related to another sleep disorder and must not be caused by simply not getting enough sleep, in order to meet the APA criteria.

Finally, the hypersomnia cannot be due to use of certain substances or existence of certain medical conditions. This condition is diagnosed in fewer than 5 percent of patients whose hypersomnia is evaluated by a sleep study at a sleep disorder center, according to the APA.

In some cases, symptoms of insomnia or hypersomnia may continue even after a mental illness has been treated effectively. In such situations, a new diagnosis of primary insomnia or primary hypersomnia may be made.

Finally, some sleep problems thought to be linked to a mental health condition are actually associated with physical illness. For example, patients with an overactive thyroid (hyperthyroidism) may experience chronic insomnia. Successfully treating the physical illness usually alleviates the associated sleep problem.