Living with a mental illness can affect how well you sleep, and poor sleep can have a negative impact on your mental health.
“People with mental health issues often have sleep problems. If you’re too anxious or depressed, you don’t sleep well. Moreover, poor sleep can cause or aggravate a mental health problem,” says Dr. Elliott Lee, a sleep specialist in The Royal’s Sleep Disorders Clinic. The statistics bear this up, with one in five people with depression having some form of sleep apnea, and one in five people with sleep apnea having some form of depression.
Studying this bidirectional relationship is helping to inform the treatment and care of a wide range of patients, including teenagers dealing with changes in their biological clock, women who have trouble getting pregnant and people with fragile cardiovascular health, says Dr. Rébecca Robillard, head scientist of the Clinical Sleep Research Platform.
“Because sleep is a multidimensional phenomenon, there are different types of sleep disturbances that emerge in the context of mental illness. By better understanding the nature of these distinct sleep problems, we hope to personalize and enhance treatments,” she says.
"My dream is to see that the research work we are doing is benefitting people who need help."
-Dr. Rébecca Robillard
To build understanding between sleep and mental illness, patients who are referred to the Sleep Disorders Clinic are offered the opportunity to take part in a new research project(s) and will receive extended assessments, which are tracked over time.
This fosters a partnership between the research and clinical teams. Information from these additional assessments will be fed back to the Clinic, to help inform ongoing treatment and care.
“Through the research being conducted by the team, we want to be able to identify people with sleep issues at the outset who are more vulnerable to developing mental health problems down the road — the loaded guns, if you will,” says Dr. Lee.
“When people encounter a traumatic issue or event in their life, this can be like pulling the trigger to precipitate a mental health problem such as a mood episode, an anxiety episode or a post-traumatic stress disorder. However, if we’ve unloaded the gun by optimizing their sleep, the hope is that a mental health problem will be mitigated.”
"If sleep is one area that we can fix for people, to improve their resilience to life events or to prevent mental illness from developing, that’s the dream that all of us share."
- Dr. Elliott Lee
The potential for research to inform clinical care is huge and offers considerable hope for the 150 to 200 new patients who are referred to the Clinic every month.
Through the multidisciplinary team working with her and through the use of state-of-the-art technology, Dr. Robillard is excited not only about the research possibilities, but also about the ability to assist with clinical processes.
“Having strong connections to the clinical side is vital to our ability, as researchers, to determine what lines of research are the most relevant and useful, and will have a positive impact on people’s lives,” says Dr. Robillard.
THE BIOLOGY OF SLEEP DISTURBANCES: A SAMPLE
Puberty: Many young people have problems with their internal biological rhythms — a by-product of puberty and excessive disruptions caused by mobile phones and technology — which gets worse with depression. Through the use of light therapy (using glasses that emit green light in the morning), Dr. Robillard is demonstrating that light has a positive impact on the biological clock and on mood. “Those with the most trouble falling asleep and the poorest sleep quality are showing the highest mood improvements,” says Dr. Robillard.
Heart: The Sleep Research Unit has identified abnormal patterns of heart rate during sleep in people with depression, which may serve as a novel biomarker of depression.
Fertility: Another research area involves the interplay between sleep and fertility. “We have some early data suggesting that women who have difficulty getting pregnant have breathing problems during sleep,” says Dr. Lee. “If we can treat their breathing problems, can we improve their chance of getting or staying pregnant?”