Sleep and Mental Health: When Poor Sleep and a Low Mood Go Together

Finn: The institute says research has not proven that melatonin is an effective treatment for insomnia.

Claire: That may surprise some people. So what should they do if they're taking something?

Claire: Thanks for joining us. You're listening to Between Visits, sponsored by Hope Health Network, a network of medical practices serving South Carolina. We dig into the medical and mental health topics that matter most to patients and the public.

Claire: I'm Claire, and this is episode 4. I'm going to quickly play our disclaimers, and then we'll get started!

Recorded disclaimer: This show is for entertainment, education and general information only. It's not medical advice, and listening doesn't make you a patient. Our hosts and guests are not real people, medical doctors or healthcare providers. We do our best, but we can be wrong, and our content can have errors and omissions. Talk with a licensed medical provider in your state before you make any decisions about your health or medical care.

Claire: In an emergency, call 911. In a crisis, call or text 988.

Claire: Joining me today is Finn, from our digital entertainment team. Welcome, Finn!

Finn: Glad to be back, Claire. I've been looking forward to this one.

Claire: Me too. People keep asking about this, so it's good timing.

Finn: Then let's not keep them waiting.

Claire: Today we're talking about Sleep and Mental Health: When Poor Sleep and a Low Mood Go Together. Well, we're excited to get your thoughts on this important topic, Finn. Let's get started.

Claire: Today we're talking about sleep and mental health. A lot of people notice their sleep is off when the clocks change. But for some people, poor sleep lasts a lot longer, and it comes along with a low mood or constant worry.

Finn: That's right. Poor sleep and a low mood often go together. Each one can affect the other.

Claire: Before we get into that, let's start with a word we all use. Insomnia. Everybody has a rough night now and then. Is that insomnia?

Finn: A rough night now and then is normal. The National Heart, Lung, and Blood Institute says that with insomnia, you may have trouble falling asleep, staying asleep or getting good quality sleep.

Claire: So it's not only lying awake. You could sleep all night and still not get good sleep.

Finn: Yes, it can look different for different people. There are also two kinds. Short-term insomnia is often linked to stress or changes in your routine or surroundings. It can last for a few days or weeks.

Claire: And the other kind?

Finn: That's chronic insomnia. Chronic just means it keeps going. It happens 3 or more nights a week and lasts more than 3 months.

Claire: Three nights a week, for more than 3 months. That's a long time to feel worn out.

Finn: It is. And it can be treated, so it's worth telling your provider if that sounds like you.

Claire: Who gets it? Is it mostly older people?

Finn: You can develop insomnia at any age, the institute says. Your chances of having it go up as you get older.

Claire: Okay. So how does this connect to mood? Which one comes first, the poor sleep or the low mood?

Finn: It can run both ways. Sleep problems are part of how depression and anxiety show up. The National Institute of Mental Health lists trouble sleeping, waking too early or oversleeping among the signs of depression.

Claire: Oversleeping too? I would have thought depression only keeps you awake.

Finn: A lot of people think that. It can go either way. And people with generalized anxiety disorder, which is one kind of anxiety condition, may have trouble falling asleep or staying asleep, or they may feel very tired.

Claire: And the other direction? Can poor sleep affect how you feel?

Finn: Yes. The National Heart, Lung, and Blood Institute says sleep deficiency, which means not getting enough good sleep, has been linked to depression, suicide and risk-taking behavior.

Claire: That's serious. Let's pause on that for a moment. If someone's listening and that hits close to home, what do you want them to know?

Finn: If you or someone you know is struggling, or having thoughts of suicide, call or text 988, any time. That's the 988 Suicide and Crisis Lifeline. It's free and it's confidential. In a life-threatening emergency, call 911.

Claire: Thank you for saying that. What else can raise the risk of insomnia?

Finn: Stress and worry about work, relationships, money or the death of a loved one can raise your risk. The institute also says that worrying about whether you'll get enough sleep and watching the clock can raise it too.

Claire: So worrying about sleep can get in the way of sleep. And I think many of us have looked at that clock at 3 in the morning.

Finn: Many people have. It's one more reason to bring it up with someone.

Claire: How much sleep do we actually need? I hear different numbers all the time.

Finn: The Centers for Disease Control and Prevention breaks it down by age. Adults 18 to 60 need 7 or more hours. Adults 61 to 64 need 7 to 9 hours. And adults 65 and older need 7 to 8 hours.

Claire: So about 7 hours or more, depending on your age. What can a person do at home to help with that?

Finn: The Centers for Disease Control and Prevention suggests going to bed and getting up at the same time every day. It also suggests turning off electronic devices at least 30 minutes before bedtime.

Claire: So the phone goes down a half hour before bed. What else?

Finn: Avoid caffeine in the afternoon or evening. The National Heart, Lung, and Blood Institute also suggests avoiding caffeine, nicotine and alcohol close to bedtime.

Claire: Okay, but let me push back. I think people hear that and say, I already tried all that, and I'm still awake. Then what?

Finn: That's fair. Habits help, but they aren't always enough. The National Institute of Mental Health says a healthy lifestyle, including enough sleep and less caffeine, can help with anxiety. But that alone can't replace treatment.

Claire: So good habits help, but they're not the whole answer. What's the next step?

Finn: There's a type of counseling made just for sleep. It's called cognitive behavioral therapy for insomnia. You may hear people call it C B T I.

Claire: And in regular words, what is it?

Finn: The National Heart, Lung, and Blood Institute describes it as a 6 to 8 week treatment plan. It helps you learn how to fall asleep faster and stay asleep longer.

Claire: What happens during those weeks?

Finn: It can include learning about sleep, ways to relax and a regular schedule for sleeping and waking. It can also include therapy that lowers your worry about not being able to sleep.

Claire: So it goes after that clock watching we just talked about.

Finn: That's a nice way to put it. A provider can talk with you about whether it's a good fit.

Claire: What about medicine? Plenty of people have something in the cabinet for sleep.

Finn: Medicines are another option, and they need care. The National Heart, Lung, and Blood Institute talks about a group of medicines called benzodiazepines. It says they can be habit-forming and should be taken for only a few weeks. They can also interact dangerously with other medicines.

Claire: So those are meant for the short term. What about melatonin? A lot of people take that.

Finn: The institute says research has not proven that melatonin is an effective treatment for insomnia.

Claire: That may surprise some people. So what should they do if they're taking something?

Finn: Tell your provider about every medicine and supplement you take for sleep. And please ask before you start or stop a sleep medicine.

Claire: Okay. Now, what if the sleep problem and the low mood are happening at the same time? Do I need to get help for each one separately?

Finn: When depression or anxiety is part of the picture, treating it can be part of treating your sleep. For generalized anxiety disorder, the National Institute of Mental Health says treatment typically involves talk therapy, medicine or both. Your provider can help you decide what fits.

Claire: I've heard there's a way to get mental health care right through my primary care. How does that work?

Finn: It's called Behavioral Health Integration, or B H I. It's a Medicare service that brings mental health care into your primary care. Medicare covers two kinds, psychiatric Collaborative Care and general B H I. Hope offers general B H I.

Claire: And what does that look like for a regular person?

Finn: The Centers for Medicare and Medicaid Services describes three parts. Your care team regularly checks and follows how you're doing. They change the care plan if you aren't improving enough. And you have an ongoing relationship with one chosen member of your care team.

Claire: Who is that one person?

Finn: At Hope, that's a care coordinator who works closely with your provider. That way your sleep, your mood and your physical health are all part of the same plan.

Claire: So it's all part of one plan. Let's talk about cost. What can people expect?

Finn: Medicare Part B may pay for these services if you have a behavioral health condition, such as depression or anxiety, and you are eligible. After the Part B deductible, you generally pay 20 percent of the Medicare-approved amount.

Claire: And if someone has a Medicare Advantage plan, or some other kind of insurance?

Finn: Medicare Advantage plans must cover everything Original Medicare covers, but costs and rules vary. So check with your plan. With any other coverage, your plan can tell you about your own costs.

Claire: Do I have to stay in it once I start?

Finn: No. Before it begins, you'll be asked for your consent, and you can stop at any time.

Claire: If someone's not sure how to bring this up, what could they say?

Finn: Here's a simple one. I have not been sleeping well, and my mood has been low. Could we look at both as part of my care plan?

Claire: I like that. It's short, and you could write it down and take it with you.

Finn: You could. It also helps to bring a list of anything you take for sleep.

Claire: Okay, before we wrap up. If people only remember a few things from today, what should they be?

Finn: First, poor sleep 3 or more nights a week for more than 3 months is chronic insomnia. It can be treated, so tell your provider.

Claire: Okay. What else?

Finn: Second, sleep and mood affect each other. If both have slipped, bring them up together.

Claire: And one more?

Finn: If you or someone you know is struggling, or having thoughts of suicide, call or text 988, any time.

Claire: That's really helpful. Thank you for walking us through this.

Finn: Thanks for having me, Claire. I hope it helps someone.

Claire: This episode is sponsored by Hope Health Network. Its member practices all have providers experienced in managing sleep and mental health, or can refer you to a network provider who is. Hope Health Network medical practices provide evidence-based medical care and include Hope Integrative Medicine, Hope Medical Associates, Hope Behavioral Medicine and Hope Addiction Medicine. To learn more, go to Hope Health Network dot com. That website, along with appointment links for all four practices, is in the description of this episode.

Claire: One last reminder. In an emergency, call 911. In a crisis, call or text 988.

Claire: This podcast is a production of Hope Health Network Media.

Claire: You've been listening to episode 4 of Between Visits, Sleep and Mental Health: When Poor Sleep and a Low Mood Go Together. Thanks for hanging out with us. See you next time!