May 11, 2020

The relationship between sleep, mental health, and measurement-based care

For many, a good night’s sleep feels more like a dream than a real possibility. But adequate sleep isn’t a luxury - it’s an essential component of physical and mental wellbeing. Over the past decade, the relationship between sleep and health has received increasing attention, as has the prevalence of sleep problems.

The U.S. Centers for Disease Control and Prevention has declared sleep disorders a public health epidemic, and the unique, widespread stress and anxieties of the COVID-19 global pandemic has exacerbated this issue. There is an abundance of research examining the sleep-health connection, and the fact that it comes from many different disciplines creates exciting possibilities for collaborative care initiatives, particularly in the context of bridging the mental and physical health divide.

A recent study, published in Sleep Health exemplifies the value and necessity of integrating physical health assessment into mental healthcare. This cross-sectional study examined “the associations of sleep problems with health-risk behaviors and psychological well-being” using a robust data set collected from the national Canadian Community Health Survey (CCHS). Specifically, researchers analyzed data from participants over the age of 18 in the CCHS’s sleep survey module.

This participant group, comprised of 42,600 adults from Nova Scotia, Quebec, Manitoba, Alberta, and Yukon, represented 10,614,600 Canadian adults. Researchers analyzed participant’s answers about sleep problems (e.g., extreme sleep duration and insomnia), health-risk behaviors (e.g., physical inactivity, daily smoking, highly sedentary behavior, and low fruit and vegetable consumption) and psychological well-being measured by changes in self-rated general health, mental health, sense of belonging, and being dissatisfied with life.

Researchers found that that sleep problems were very widespread in the general population. Moreover, a higher prevalence of all health-risk behaviors and worse psychological wellbeing among participants was identified among those who had reported sleep problems. Even after multivariate adjustments for confounding variables, both measures of sleep problems were independently associated with increased odds of health-risk behaviors and worse psychological wellbeing.

This study reaffirms much of what we already know about the prevalence and implications of sleep problems in the general population as well as sleep’s robust and complex relationship with a more comprehensive definition of health. The fact that it uses a representative sample of Canadian adults, approaching the subject of sleep problems from a public health perspective,  makes this study all the more valuable to clinicians and pertinent to mental healthcare providers. Given its widespread relevance, screening for sleep problems should become a standard component of mental and physical health evaluation.

Much has been said about the value of expanding our definition of wellness to include both physical and mental health, as well as the need to contextualize individual experiences of behavior. The merit of these approaches to clinical practice is more apparent than ever. In the months since the study’s conclusion, both the tone and details of conversations about public health and individual wellbeing have shifted dramatically. The emergence and rapid spread of COVID-19 has forced greater awareness and concern about public health - physical and mental. This pandemic is both a physical and mental health crisis, with unique pressures that impact such health behaviors for most, if not all, of us - including changes in sleep patterns.

While we are in the midst of exceptional, abnormal times, it can be easy to neglect sleep and other (seemingly) mundane health patterns that comprise overall mental and physical wellbeing. However, it is more important than ever that providers include metrics of these patterns in measurement-based care. Individual sleep patterns reflect and help to protect overall wellbeing. By encouraging healthier sleep, providers can help individuals and communities build and maintain both psychological and physical resilience in this time of need.  

Dai, H., Mei, Z., An, A., Lu, Y., & Wu, J. (2020). Associations of sleep problems with health-risk behaviors and psychological well-being among Canadian adults. Sleep Health.