Sleep, mood, and stress
Sleep and mood pull on each other. A hard week can wreck sleep, and a run of poor sleep can make the week feel harder. This article looks at how the two connect, and at when it’s time to get more help.
Both directions
Stress, anxiety, and low mood all disturb sleep. They raise the body’s alertness and fill the quiet of the night with thoughts. Poor sleep, in turn, makes emotions harder to manage. After short sleep, the brain’s alarm center reacts more strongly to upsetting things, and the parts that usually calm it have less of a hold. Small problems feel bigger, and patience runs out sooner.
Studies that follow people over time find the link runs both ways. Insomnia raises the chance of developing anxiety or depression later, and anxiety and depression raise the chance of developing insomnia.
Stress
Stress is one of the most common things people name when they describe how their insomnia began. A short stretch of bad sleep during a stressful time is normal. It’s the body staying alert while something needs attention, and for most people sleep settles once the stress eases.
When it doesn’t, the habits that grew up around those bad nights are often what keeps it going. “What insomnia is,” in Learn, explains how that happens.
Worry time and a wind-down routine, both in the app’s “Quiet a busy mind,” are built for evenings when stress follows you to bed.
Depression
Sleep problems are one of the most common parts of depression. Some people sleep much less, often waking very early and not getting back to sleep. Others sleep much more and still wake up tired.
Insomnia often comes before depression, too. In studies following people over years, those with ongoing insomnia were about twice as likely to develop depression as people who slept well. That’s a pattern across large groups, not a prediction about you, and it’s one reason insomnia is worth working on.
Insomnia that comes with depression doesn’t always lift when mood improves, so it often needs attention of its own. CBT-I can be used alongside treatment for depression. In a large trial of online CBT-I with university students, depression and anxiety eased along with insomnia.
Anxiety
Anxiety and insomnia share a lot, from a body on alert to a habit of scanning for what could go wrong. For many people, anxiety about sleep itself is part of insomnia, even if they aren’t anxious in other ways. For ways to work with it, see “Racing thoughts at night” and “Calming the body.”
Pain
Pain and sleep affect each other as well. Pain makes it harder to fall asleep and stay asleep. Poor sleep also lowers the body’s tolerance for pain. In studies that track both, a bad night predicts more pain the next day more reliably than a painful day predicts a bad night.
People with chronic pain can still use CBT-I, and a clinician can help adapt it, especially the parts about getting out of bed at night.
Mood running high
For some people, especially those with bipolar disorder, needing much less sleep than usual while feeling fine or full of energy can be an early sign of a mood episode. Losing sleep can also help set one off. If you notice your mood running unusually high, your thoughts racing, or that you need far less sleep than usual, stop the sleep window and talk with a health care provider.
When to get more help
Talk with a doctor, therapist, or other health care provider if any of these sound familiar.
- Low mood, or losing interest in things you usually enjoy, lasts more than a couple of weeks.
- Worry fills your days as well as your nights, or comes with panic attacks.
- You wake very early with low mood most mornings.
- You’re relying on alcohol, cannabis, or other drugs to sleep or to get through the day.
- Your mood is getting in the way of work, relationships, or looking after yourself.
Depression and anxiety are treatable, and treatment can run alongside work on sleep. Many therapists who treat mood and anxiety also know CBT-I.
If you’re having thoughts of suicide, or of harming yourself or someone else, get help now. In an emergency, call 911. If you are in crisis in the United States, call or text 988. Mental health resources lists more options.
References
- Alvaro, P. K., Roberts, R. M., & Harris, J. K. (2013). A systematic review assessing bidirectionality between sleep disturbances, anxiety, and depression. Sleep, 36(7), 1059–1068. doi.org/10.5665/sleep.2810
- Baglioni, C., Battagliese, G., Feige, B., Spiegelhalder, K., Nissen, C., Voderholzer, U., Lombardo, C., & Riemann, D. (2011). Insomnia as a predictor of depression: A meta-analytic evaluation of longitudinal epidemiological studies. Journal of Affective Disorders, 135(1–3), 10–19. doi.org/10.1016/j.jad.2011.01.011
- Hertenstein, E., Feige, B., Gmeiner, T., Kienzler, C., Spiegelhalder, K., Johann, A., Jansson-Fröjmark, M., Palagini, L., Rücker, G., Riemann, D., & Baglioni, C. (2019). Insomnia as a predictor of mental disorders: A systematic review and meta-analysis. Sleep Medicine Reviews, 43, 96–105. doi.org/10.1016/j.smrv.2018.10.006
- Freeman, D., Sheaves, B., Goodwin, G. M., Yu, L.-M., Nickless, A., Harrison, P. J., Emsley, R., Luik, A. I., Foster, R. G., Wadekar, V., Hinds, C., Gumley, A., Jones, R., Lightman, S., Jones, S., Bentall, R., Kinderman, P., Rowse, G., Brugha, T., . . . Espie, C. A. (2017). The effects of improving sleep on mental health (OASIS): A randomised controlled trial with mediation analysis. The Lancet Psychiatry, 4(10), 749–758. doi.org/10.1016/S2215-0366(17)30328-0
- Goldstein, A. N., & Walker, M. P. (2014). The role of sleep in emotional brain function. Annual Review of Clinical Psychology, 10, 679–708. doi.org/10.1146/annurev-clinpsy-032813-153716
- Finan, P. H., Goodin, B. R., & Smith, M. T. (2013). The association of sleep and pain: An update and a path forward. The Journal of Pain, 14(12), 1539–1552. doi.org/10.1016/j.jpain.2013.08.007
Helpful links
- NIMH: Depression
- NIMH: Anxiety disorders
- NIMH: Bipolar disorder
- 988 Suicide and Crisis Lifeline
- Mental health resources, from Everyday Insight
Everyday Insight’s tools are for education and personal reflection. They are not therapy or medical care, and they are not for emergencies. In an emergency, call 911. If you are in crisis in the United States, call or text 988.