Opinion: Good sleep health to support good mental health

The theme this year for Mental Health Awareness Week is “Top Up Together” which promotes bringing the Five Ways to Wellbeing (take notice, give, be active, connect, keep learning) into our lives by connecting with others. One ‘superpower’ that strongly underpins all of these things is our sleep.

Do you remember a recent time when you didn’t get enough sleep for a night or two? It’s likely that in the following days you were a bit more emotional, maybe a little more anxious, or you were more withdrawn than usual. When we miss out on sleep, it can be harder to communicate and connect with others, we may not feel as motivated to be physically active and it can be harder to learn new things.

Sleep is vital in helping us control and process our emotions, and sleep and mental health are tightly interconnected. Studies that follow people over time find that changes to sleep often occur before the onset of poorer mental health, and that poorer mental health can in turn lead to more disrupted sleep.

Our research group has been exploring relationships between sleep and mental health for Māori and non-Māori in Aotearoa at different times of life. Using large datasets, our work has shown that sleep is associated with mental health outcomes in preschoolers, school age children, adolescents and women who are pregnant or have young children.

For example, we have found that school age children who sleep less than is recommended for their age are more likely to have emotional or psychological concerns that limit what they can do, and are more likely to have a diagnosis of anxiety than children who get enough sleep. We have also shown that adolescents who usually go to bed after midnight or get up before 6am on school days are more likely to report attempted suicide than adolescents who go to bed before midnight or get up between 6am and 8am.

In another study, we compared women who have stable good mental health from late pregnancy until their child is a preschooler with women who experience ongoing depression and found that depressed women were more likely to report poorer sleep quality and difficulties falling asleep and staying asleep across this timeframe.

Like other aspects of health, we see stark and persistent inequities (unfair, unjust and avoidable differences) in sleep health between Māori and non-Māori, even as early as 3-4 years of age. Key drivers of sleep inequities include socioeconomic deprivation, lack of adequate housing and racism, all of which Māori are unequally and unfairly exposed to due to ongoing impacts of colonisation.

Some of our work also suggests that this unfair patterning of sleep may be one of the drivers of inequities in mental health, highlighting how important it is that everyone in Aotearoa has access to resources, living conditions and opportunities that support healthy sleep.

Our work is now shifting to how we might use sleep to help improve mental health, with a focus on two key groups who face some of the greatest sleep and mental health challenges: adolescents and birthing parents. Lately, we’ve been talking with teens to hear what they have to say about the importance of sleep to them and how they would like to be supported to get good sleep and in turn also better mental health.

This work is ongoing, but the grand plan is to continue to work alongside young people and birthing parents, their whānau, and those in the health care system that support them, to figure out how to use sleep as one way of supporting people to be mentally healthy. In a society where mental health care is excellent but hard to access unless a person is very unwell, we believe that sleep is an under-utilised but powerful pathway for helping people to stay mentally well.

So, what are some things that you can do to care for your sleep? Value it as something that helps you to live your best life. Prioritise it by making space for sleep in your life. Sleep is not a one-size-fits-all scenario, so personalise it to figure out what works best for you, such as experimenting with different bedtimes and waketimes.

It is perfectly normal to struggle with sleep occasionally which can feel really stressful, but trust that your brain and body know how to sleep. However, lying in bed worrying about not sleeping can become very unhelpful so if you cannot sleep then get up and go into another room and do something quiet until sleepiness returns. Finally, protect your sleep by with tips such as these:

• Sleep thrives on a pattern. Having a bedtime routine and consistent bedtimes and rise times can be really helpful.
• A racing mind is the biggest enemy of sleep, so don’t over analyse things. Put the day to bed well before your bedtime.
• Make your bedroom a safe place for sleep. Keep work out of your sleeping space, so you have positive associations with sleeping well.
• If your sleep problems persist and make it hard to function during the day, then talk to your GP. You might also find these websites and resources helpful: Australian Sleep Health Foundation and https://www.justathought.co.nz/insomnia.

Acknowledgements: The research discussed here is conducted with large teams of people and is based on the generous contribution of knowledge from many participants. We are grateful to all those that contribute to this work. The 5 principles of sleep are based on work by Professor Colin Espie.

Professor Leigh Signal and Dr Dee Muller are part of the Sleep/Wake Research Centre, School of Health Sciences.