Stanford Medicine researchers are examining the complex relationship between sleep and mental health, highlighting how each can affect the other. According to Andrea Goldstein-Piekarski, PhD, assistant professor of psychiatry and behavioral sciences at Stanford Medicine, “It’s becoming increasingly clear that sleep and mood have a bidirectional relationship.”
Data from the Centers for Disease Control and Prevention indicate that more than one-third of U.S. adults and nearly 80% of teens do not get enough sleep. Chronic sleep disorders like insomnia or sleep apnea affect about a quarter of adults. The National Institute of Mental Health reports that over 20% of U.S. adults have a mental health condition.
Research has shown that people with insomnia are significantly more likely to experience depression or anxiety compared to the general population. Sleep apnea also increases these risks. Short-term studies show that lack of sleep can reduce emotional control, while psychiatric conditions such as depression and anxiety may cause sleep disturbances.
Goldstein-Piekarski’s research uses functional MRI to study how changes in sleep affect brain regions involved in emotion processing. Her team is also applying cognitive behavioral therapy (CBT) for insomnia patients to improve their sleep habits and monitor changes in brain activity and mood.
She led a study during the early stages of the COVID-19 pandemic using CBT virtually, which found that better sleep led to lower levels of depression among participants. Other studies support these findings: interventions improving poor sleep often result in reduced symptoms of depression and anxiety, with greater improvements in sleep linked to greater improvements in mental health.
Jamie Zeitzer, PhD, professor at Stanford Medicine, led a large-scale study involving nearly 75,000 people in the U.K., finding that going to bed earlier and waking up earlier is associated with better mental health outcomes—even for those who naturally prefer late hours. Zeitzer explained this might be related to activities undertaken late at night when social oversight is low: “There is a theory called ‘mind after midnight,’ which is this idea that after midnight, your brain makes choices it wouldn’t make at noon,” he said.
The relationship between disrupted sleep and mental health conditions can be difficult to untangle because both issues can reinforce each other over time. Norah Simpson, PhD, clinical professor at Stanford Medicine, notes clinicians look for whether insomnia persists independently even as other symptoms improve: “Does it look like the insomnia has taken on enough of a life of its own that it would be helpful to treat independently? Does it look like it’s sticking around even when other things are getting better?” she asked.
Shift workers—about 16% of employed Americans—face particular challenges due to irregular schedules affecting circadian rhythms; shift work has been linked with higher rates of depression and anxiety.
Teenagers face their own challenges as biological changes delay melatonin production by about two hours compared with children or adults. Despite needing just as much or more rest than adults, many teens struggle due to early school start times combined with extracurricular demands—a situation correlated with rising rates of chronic sleep deprivation among adolescents since before the pandemic.
Zeitzer commented on teen weekend sleeping patterns: “The question becomes, if your kid is sleeping until 2 in the afternoon on the weekend, is that OK? Frankly, they need that sleep. That is not an ideal sleep pattern. But not getting enough sleep overall is worse.”
To help improve both mood and rest quality, Stanford Medicine experts recommend maintaining consistent bedtimes—even on weekends—avoiding caffeine after early afternoon or alcohol before bed; creating comfortable bedroom environments; reducing screen time before bedtime; not panicking if unable to fall asleep immediately; seeking professional help if problems persist; and considering cognitive behavioral therapy for chronic insomnia.
Goldstein-Piekarski described part of this approach: “We work on decoupling the connection between the bed and arousing feelings. When someone has insomnia, they are so aroused and anxious, it prevents them from being able to fall asleep,” she said. “By decoupling those experiences, to re-pair sleep with the bed, you can more easily fall asleep.”
This story was originally published by Stanford Medicine.
