Sleeping Boy, Nikifor Krylov, 1824
Treating the insomnia can treat the depression, and vice versa
STUDY: Thomas DC et al, Medical Clinics of North America 2026
STUDY TYPE: Review
FUNDING: Independent
Background
This review shows how sleep is disturbed in a variety of psychiatric disorders, and looks for ways to improve those disorders by treating sleep.
Depression
About 90% of patients with major depressive disorder report sleep trouble, mostly insomnia (80% to 85%), with hypersomnia and mixed patterns also common. Insomnia with short sleep duration raises depression risk through constant arousal and an overactive stress-hormone system. CBT-insomnia improves depression and sleep.
Bipolar disorder
Sleep problems affect up to 70% of patients, persist in half during periods of stable mood, and sleep deprivation itself can trigger mania.
Dr. Aiken’s note: Dark therapy deepens sleep and improves mania. Surprisingly, sleep medications are not well studied in bipolar, so we don’t know if they help mood.
PTSD
80% to 85% of patients have significant sleep disruption. Insomnia can predate the trauma and predict who develops PTSD afterward. Treating the sleep problem directly, with cognitive behavioral therapy for insomnia or imagery rehearsal therapy for nightmares, eases PTSD symptoms even without trauma-focused treatment.
Dr. Aiken’s note: Sleep apnea is also common in PTSD (40-80%), even in patients who are young and thin. Prazosin addresses sleep and daytime symptoms of PTSD.
Anxiety
Roughly two-thirds have sleep disruption. When anxiety and depression coexist, sleep problems are worse than with either alone.
Dr. Aiken’s note: eszopiclone treats generalized anxiety and insomnia, but the use is short-term, 4-6 weeks.
ADHD
70% children with ADHD have sleep disturbance, including restless leg syndrome and sleep apnea (43%). Treating sleep apnea improves improve ADHD in children.
Dr. Aiken’s Note: Atomoxetine may improve ADHD and sleep apnea. Stimulants treat symptoms of sleep deprivation, which means when people with ADHD are miss out on sleep their stimulants don’t work as well.
Psychotic disorders
Sleep disturbance often precedes psychosis and can signal impending relapse. CBT-insomnia improves not just sleep but hallucinatory distress.
Practice Implications
- Sleep enhances learning, neuronal growth, and helps us process anxiety.
- Sleep is the oldest psychiatric treatment around, and a good place to start for mental health.
—Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report
