Why sleep could be the key to tackling mental illness

By Russell Foster

We are only beginning to unravel the genetic and biochemical basis of mental illness – a vague term including conditions as diverse as anxiety, depression, and mood and psychotic disorders. With millions of people suffering from such conditions, it is crucial that we find ways to improve diagnosis and treatment. But an increasing body of scientific evidence is now suggesting that we should turn our attention to one of our most basic functions: sleep.

Studies suggest that disrupted sleep such as insomnia could actually help us predict episodes of mental illness and that fixing sleep problems may help treat them. Despite this, the effects of sleep on mental illness have been largely ignored in the clinic so far. But how is sleep and mental health actually linked in the brain? To understand this, let us first consider the biology of sleep and circadian rhythms.

Circadian rhythm and health

There have been over a trillion dawns and dusks since life began some 3.8 billion years ago. The physiology, metabolism and behaviour of organisms, including us, are aligned to this daily cycle through internal clocks which enable us to effectively “know” the time of day. This clock also stops everything happening at the same time and ensures that biological processes occur in the appropriate order. For cells to function properly they need the right materials in the right place at the right time.

Thousands of genes have to be switched on and off in order and in concert. Proteins, enzymes, fats, hormones and other compounds have to be absorbed, broken down, metabolised and produced in a precise time window to allow important processes such as growth, reproduction, metabolism, and cellular repair. These take energy and all have to be timed to best effect by the millisecond, second, minute and hour of the 24-hour day.

 

Why do we sleep and what happens if we don’t.

Circadian rhythms are innate and hard-wired into the genomes of just about every living thing on the planet. In humans, our physiology is organised around the daily cycle of activity and sleep. In the active phase, when energy expenditure is high and food and water are consumed, organs need to be prepared for the intake, processing and uptake of nutrients.

During sleep, although energy expenditure and digestive processes decrease, many essential activities occur including cellular repair, toxin clearance, memory consolidation and information processing by the brain.

Disrupted sleep and circadian rhythm can have major impact on emotion, cognition and physical health. Author provided

Disrupting this pattern, as happens with jet-lag, shiftwork, and mental illness breaks down the internal synchronisation of the circadian network and our ability to do the right thing at the right time is greatly impaired. This can have a major impact on our health, with some of the effects described in the table above.

Sleep disruption in mental illness

The relationship between mental illness and sleep and circadian rhythm disruption was first described in the late 19th century by the German psychiatrist Emil Kraepelin. Today, such disruption is reported in as many as 80% of patients with schizophrenia, and is increasingly recognised as one of the most common features of the disorder.

Yet despite its prevalence in mental illness, sleep disruption has been largely ignored, dismissed as a consequence of either social isolation, lack of employment, anti-psychotic medication. However, our team has explored this assumption and showed that sleep and circadian-rhythm disruption in patients with conditions such as schizophrenia persists independently of anti-psychotic medication and that it cannot be explained on the basis of social isolation or lack of employment. These results led us to suggest that mental illness and sleep disruption may share common and overlapping pathways in the brain.

The sleep and circadian timing system is the product of a complex interaction between multiple brain regions, neurotransmitters and hormones. As a consequence, abnormalities in any of these neurotransmitter systems will likely have an impact on sleep and circadian timing at several levels.

Similarly, psychiatric illness arises from abnormalities in the interacting circuits and neurotransmitter systems of the brain, many of which will overlap with those regulating sleep and circadian rhythms. Viewed in this way, it is no surprise that sleep disruption is common across the mental illness spectrum, or that disruption of circadian biology might worsen a fragile mental health state. Very significantly, many of the health problems caused by sleep disruption are common in mental illness, but have almost never been directly linked to the disruption of sleep.

These insights enable us to make important predictions. For example, genes linked to mental illness should play a role in sleep and circadian rhythm generation and regulation and genes that generate and regulate sleep and circadian rhythms should play a role in mental health and illness.

To date a surprisingly large number of genes have been identified that play an important role in both sleep disruption and mental illness. And if the mental illness is not causing disruption in sleep and circadian rhythm, then sleep disruption may actually occur just before an episode of mental illness under some circumstances.

Sleep abnormalities have indeed been identified in individuals prior to mental illness. For example we know that sleep disruption usually happens before an episode of depression. Furthermore, individuals identified as “at risk” of developing bipolar disorder and childhood-onset schizophrenia typically show problems with sleep before any clinical diagnosis of illness.

Such findings raise the possibility that sleep and circadian rhythm disruption may be an important factor in the early diagnosis of individuals with mental illness. This is hugely important, as early diagnosis offers the possibility of early help. It is also plausible that treating the actual sleep problems will have a positive impact upon the level of mental illness. A recent study managed to reduce sleep disruptions using cognitive behavioural therapy in patients with schizophrenia who showed persecutory delusions and found that a better night’s sleep was associated with a decrease in paranoid thinking along with a reduction in anxiety and depression. So the emerging data suggests treating sleep problems can be an effective means to reduce symptoms.

So where do we go from here? It is now abundantly clear that sleep problems in mental illness is not simply the inconvenience of being unable to sleep at an appropriate time but is an agent that exacerbates or causes serious health problems. Understanding the nature of sleep disruption in mental illness, and developing evidence-based therapeutic interventions using cognitive behavioural therapy, appropriately timed light exposure and some exciting new drugs to stabilise circadian rhythms is a major focus of the work currently being undertaken in Oxford.

The ConversationIt is time we began to take seriously the importance of sleep across all sectors of society, and particularly in mental illness. Treating sleep problems in mental illness will not only improve the health and quality of life for countless individuals and their caregivers, but will also have a massive impact on the economics of health care.

Explore Further:

If you’d like to explore medication-free options to support better sleep and address insomnia, including light therapy glasses to help restore balance to the circadian rhythm, then you’ll find them here
To view our complete range of products, chosen to support health, wellbeing and peak performance, simply go to our home page, here

About the Author and source materials:

Russell Foster is Professor of Circadian Neuroscience, University of Oxford. This article was originally published by the online academic discussion journal “The Conversation” and is reproduced here under CC copyright licences rules. To view the original article, together with all the active links contained in the text, please see here

How To Be Happy: 10 Strategies

 

We are living in tough times. It seems, in this world of the 24/7 news cycle, and constant streams of information, it is easy to feel overwhelmed. And if any proof of this were needed, then here’s one statistic: Anti-depressant use is at an all-time high – according to the US Government Statisticians who published the National Health and Nutrition Examination Survey, a whopping one in every 10 Americans are taking some type of antidepressant, and a full 23% of American women in their 40’s and 50’s rely on them daily. The figures are probably pretty similar here in the UK too. There are those who say this is a good thing, because depression has been under-diagnosed and under-treated in the past, but other critics say that aggressive pharmaceutical marketing may be, in part, responsible for the 400% rise in antidepressant prescription use in recent years, and antidepressant usage certainly does not come without significant risk and side effects.

What if there is some middle ground? What are the secrets used by people who seem to be “happy”? Wellm here are 10 strategies that actually seems to work in helping you to feel better, and take control of your mental health.

  • Learn to enjoy the ride: Happy people realise that happiness is not a “destination” to be obtained, but rather, an attitude during the journey of life. There will be times when things are easier, and times when things are more difficult, but accepting that you will never fully arrive at a destination of happiness helps you to understand that the happiest people are the ones that are least focused on their own attainment of happiness. They are just along for the ride.
  • Focus on the good and not the bad: Simple as it may sound, unhappy people are generally unthankful people. Granted, it’s sometimes difficult to think of something to be thankful for, but practice gratitude, even for the little things, really seems to help. Try keeping a diary or a list of all of the good things in your life. Thinking about these things daily will help you to stay on track and resist becoming stuck and worried about the difficult circumstances in your life – it’s helps keep the current hardships in context.
  • Keep your expectations realistic: It’s important to determine what you want from life, and why you want it, and try to identify the source of your expectations. Are you trying to obtain the unobtainable “ideal” sold to you in movies, the media, your parents? Happy people are able to keep in mind the difference between the slick, shiny fantasy and realistic expectations for their life.
  • Be willing to forgive: If you hold unforgiveness in your heart toward those who have hurt you, you are ultimately only hurting yourself. Choosing to forgive those people who do not deserve or ask for our forgiveness can work to break the power they continue to hold over you. If you’re a religious or spiritual person, ask God to help you find forgiveness for those who have done you wrong, and be willing to let it go. Where forgiveness is concerned, it is also crucially important to go easy on yourself too. Be willing to forgive yourself your own failures. If you have wronged someone, consider asking for their forgiveness when you feel strong enough – making it right with them will help make it right for you too.
  • Be Generous: Studies continue to show that happiness comes from giving of our time, energy and money to a cause bigger than ourselves. Volunteer. Get involved. You will likely find that taking the focus off yourself and instead, focusing on others will help you achieve greater balance once again.
  • Slow down and enjoy life: Happy people know how to pace themselves, to take a break now and then. If you are a type-A, always-on-the-go kind of person, then schedule time into your diary for a rest. Spend time with your family and friends, rediscover an old interest or hobby, or even take up a new one. People who are hyper-focused on one particular part of their life often end up neglecting their mind’s and body’s true needs, which include a need for rest and relaxation.
  • Change what you don’t like: Again, this may seem simple, but if you are living with regrets, take action to change. If you don’t like your job, do whatever it takes to get training and skills to find the job you will like. If you regret that you never learned to run a mile, then start running! Do you regret not making more friends, or never marrying? Get out and find someone. It’s not easy and you may need to build yourself up for this but, as a strategy to get you feeling happier, it really is that simple.
  • Choose your attitude: The old adage holds true here, “fake it ‘til you make it.” Every day, wake up and choose to have an attitude that’ll help you be and feel the way you’d like to be. Give it your best acting performance, regardless of the way you might feel. Choose to control your emotions, rather than let them dictate to you. If you don’t particularly feel happy, smile anyway. A smile on your face will affect how others around you perceive you, and will cause them to treat you more positively, ultimately improving your mood and attitude. Studies have shown that the physical act of forced smiling releases endorphins in our brains, even when our mood is not necessarily happy.
  • Stop looking for shortcuts: Your mum and dad were right here. The best way to be successful and happy in this life is to work hard, get your education, and pursue your dreams, both big and small. Nobody owes you anything in this life. It is up to you, and you alone, to make your life what you wish it to be.
  • Make a difference: Generally speaking, people who are happiest are those who fill their lives with significance, and leave the world a better place than they found it. Your contribution doesn’t need to be massive, but it will count, both to you and to those around you.

…and in short: Even from the depths of the darkest places you might find yourself in, you will still be called upon to make daily decisions about all sorts of things: What to think, how to behave, what to eat, whether to go out or not, and these decision points are where you can start to take back control of your life again. Even the tiniest of changes you decide to make away from your usual decision will count… and will begin the process of getting you back into the light again. So what are you waiting for? There’s no time like the present, so just go for it!

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To view our range of medication-free options to help manage the symptoms of stress, anxiety and low mood states, please click here. If, instead, you’d like to explore our main website more generally, then a good starting point is our home page, here

Credits: This article is adapted for UK/Europe readers from an original article by Danielle Dent-Breen which first appeared on 20th June 2017 in the health news portal EmaxHealth. To view the original article and related links, please click here  The illustration is published here under CCL rules.

Here’s a mental health workout that’s as simple as ABC

By Ziggi Ivan Santini, Rob Donovan and Vibeke Jenny Koushede

While we take physical workouts very seriously, there is much less said about the “workouts” that help us remain mentally agile and healthy. But just as with physical health, there are simple and practical ways that can help everyone to enjoy good mental health.

Our research has led us to a method for promoting mental health and wellbeing within communities, which follows a simple model that can be adopted by anyone. An earlier study showed that people intuitively know what enhances their mental health, but they don’t think about it on a daily basis. Unlike their physical health, people rarely consider what they could or should be doing for their mental health.

At present, the focus in mental health campaigns is on treatment for mental disorders, the removal of stigma from talking about mental health problems, early intervention and the reduction of risk factors which lead to illness. But the burden of mental illness continues to rise – it is thought that an estimated 50% of people in OECD countries will experience mental illness in their lifetime, so there is a need to raise awareness in communities and to promote simple and practical steps to achieving and maintaining good mental health.

By building on research into what people can do to improve their mental health, we have developed an “ABC” model that can be easily adopted in everyday life. Known as “Act-Belong-Commit”, the approach promotes keeping active, building stronger relationships with friends, family and community groups, and committing to hobbies, challenges and meaningful causes. Together they constitute a simple “do-it-yourself” approach to enhancing mental health. By encouraging people to follow these principles, as well as collaborating with community groups that offer activities and opportunities for social participation, the method – currently implemented in Australia and Denmark – seeks to bring about long-term benefits to mental health in populations

Act: Keep alert and engaged by keeping mentally, socially, spiritually and physically active. Research has credited a lifestyle with plenty of activities outside work as fostering positive emotions and protecting our brains from decline. An active mind and body, particularly in the company of others, can be naturally rewarding and a healthy alternative to worrying, over-thinking or engaging in substance use.

Belong: Develop a strong sense of belonging by keeping up friendships, joining groups, and participating in community activities. Research has shown that our relationships with one another are fundamental to mental health in terms of providing a sense of identity, acting as a source of support, and being an important coping resource for dealing with pain, stress and difficult life events.

Commit: Do things that provide meaning and purpose in life like taking up challenges, supporting a good cause and helping others. A sense of meaning and purpose is vital to our well-being and has been shown to help extend our lives and maintain a healthy brain. Committing to a hobby, a challenge, a good cause or helping others can all boost feelings of self-worth and protect against feelings of hopelessness and worthlessness. Participating socially and contributing to the community can preserve brain function, promote thoughts of “making a difference” and reduce feelings which aren’t helpful for well-being, such as self-centredness.

To show that these principles promote and protect mental health, we recently completed a series of observational studies on a nationally representative sample of adults in Ireland. People were interviewed at the start of the survey and then re-interviewed two years later. We categorised the activities of participants into indicators of acting, belonging and committing.

Engaging in various social and recreational activities, such as sport, going to films, eating out or travelling for pleasure were indicators of Act. Staying in touch with friends, family and community groups served as an indicator of Belong and the frequency of engaging in social and recreational activities was an indicator of Commit.

The results of these studies together demonstrate that higher levels of all three measures enhance quality of life, life satisfaction, and self-rated mental health, protect people against developing depression, anxiety and brain function decline, and lower the risk of people becoming dependent on alcohol. Our research has also shown that the approach is helping patients with mental illnesses and is now being used as a tool for recovery by mental health professionals.

The campaign

The Act-Belong-Commit campaign aims to harness resources already present in communities – because the behaviours that promote mental health and well-being are everyday activities that most people are already doing or are readily available. Hence the campaign’s focus is on raising awareness of this fact and validating the belief that these behaviours are good for mental health. In both Australia and Denmark the campaign connects academics who can advise on the ABC method with a diverse range of community groups, including theatres, women’s health groups and sport teams.

These partners are provided with training and resources such as self-help guides while advertising and event sponsorship help spread the campaign’s message. Particular targets include schools, workplaces and people recovering from mental illness.

In Australia, an annual survey asks people if they have heard of the campaign and, if so, how their beliefs and actions around mental health have changed. Twice a year, surveys ask partners how the campaign has affected their activities. Similar approaches are being used in Denmark. In this way, the campaign stays in touch with communities to constantly improve its methods.

By encouraging people to follow and prioritise this ABC approach, the campaign’s simple messages could resonate in communities worldwide and sustain the mental health and well-being of people well into the future.

Explore Further:

If you’d like to explore our range of medication-free products to support relaxation, help manage levels of stress and low mood and support mental health, then you’ll find them here or to return to our home page and view our full product range, it’s here

Source Material and Acknowledgements:

The authors of this article are Ziggi Ivan Santini, Postdoctoral associate, University of Southern Denmark; Rob Donovan, Adjunct professor, University of Western Australia and Vibeke Jenny Koushede, Senior researcher, University of Southern Denmark. ​The article was first published on 14th August, 2018 in the online academic discussion journal, The Conversation and is reproduced here under CC licence provisions. The original article, which includes all active links to references mentioned in the article, can be found here.