Unexpected Emotional, Psychological and Psychiatric Effects of Sleep Deprivation
There has been a resurgence of interest in the effects of poor sleep habits on our psyches after the Wall Street Journal published an article entitled, The Unexpected Ways Sleep Deprivation Makes Life Tougher. As a sleep doctor, I applaud any effort to raise awareness of the mental health problems associated with sleep deprivation. The article focused on research by Dr. Mathew Walker and other sleep researchers linking sleep deprivation with impairment in our "emotional intelligence." To summarize the article's findings, sleep deprivation can cause:
- decreased ability to read people's facial expressions
- higher levels of stress, anxiety, and anger when working
The article did not specifically define sleep deprivation. When sleep specialists talk about sleep deprivation, we refer to acute (short-term) and chronic forms of it. For experimental research purposes, acute sleep deprivation protocols are often used, which may involve keeping subjects awake all night or restricting sleep to 4 hours or less for several nights in a row. Chronic sleep deprivation is more related to what people face in the real world; commonly this is defined as people with sleep patterns that lead to them getting less than 6 hours of sleep per night.
Sleep deprivation is associated with many mental health issues, most of which are largely unknown by the majority of people. Here are some of the most interesting ones:
In people with bipolar disorder (often referred to as "manic depression" by laypeople), sleep issues are one of the classic symptoms of mania. In fact, lack of sleep is part of the "DIG FAST" mnemonic that we learn in medical school to help us remember the diagnostic criteria for mania:
- Distractability (and easy frustration)
- Indiscretion (excessive orientation towards pleasure-seeking behaviors)
- Flight of ideas
- Activity increase
- Sleep deficit (decreased need for sleep)
- Talkativeness (pressured speech)
But behaviorally-induced insufficient sleep can also trigger a manic episode in those predisposed to it. This is why it's very important for bipolar patients to maintain steady sleep-wake schedules and get enough sleep.
Lack of sleep can lead people to "lose their filter". Acute sleep loss can cause disruption in the prefrontal cortex, which maintains "executive function" - the neurocognitive function that encompasses self-control, planning and decision-making. Resulting symptoms can be the "verbal diarrhea" known by neurologists and psychiatrists as "talking ragtime," irritability, and just plain rudeness. Poor decision-making and risk-taking behaviors can lead to disastrous consequences, so a good rule of thumb is to not make any major life decision when sleep-deprived.
Keep people awake long enough and they can eventually start hallucinating. This usually manifests as hearing things that aren't there, including voices. For students pulling all-nighters or residents on a 24- hour shift in the hospital, hearing whispers and realizing that there's no one there can be particularly alarming. The good news is that the hallucinations, which are synonymous with psychosis, go away once the sufferer has normalized her sleep habits and been allowed to catch up on her sleep debt, unlike the chronic hallucinations of mental illnesses such as schizophrenia. Visual hallucinations are less common with sleep deprivation.
Attention Deficit Hyperactivity Disorder (ADHD)
That inability to sit still and stay on task could be due to simply not getting enough sleep. There is a strong relationship between sleep disorders such as sleep apnea (which can be diagnosed using a home sleep apnea test) and restless legs syndrome and ADHD-like syndrome. These sleep disorders cause functional chronic partial sleep deprivation which negatively affects the functioning of the frontal lobes in the brain which modulate attention. The evidence is particularly strong in children where ADHD (both inattentive and hyperactive subtypes) has been consistently shown to be a common symptom of obstructive sleep apnea. Children tend to have a paradoxical reaction to disrupted sleep: Unlike adults who get sleepy, children bounce off the walls. After diagnosis and treatment, outcomes such as behavioral assessments by parents and teachers and school performance may improve dramatically.
Joseph Krainin, M.D., FAASM is the founder of Singular Sleep, the world's first online sleep center. He is a Fellow of the American Academy of Sleep Medicine and board-certified in both sleep medicine and neurology. He has been practicing medicine for over 10 years.