How Psychiatrists Address Sleep Disorders

Another night spent staring at the ceiling. You watch the numbers on the clock tick by, your body exhausted but your mind wide awake. Or maybe you fall asleep easily, but you wake up feeling like you haven’t slept at all, dragging yourself through the day in a fog of fatigue. Sleep problems are more than just an annoyance; they are a serious medical issue that can have a devastating effect on your mental and physical health. When these problems are persistent, they are known as sleep disorders.

At Televero Health, we always conduct a thorough assessment of our patients’ sleep. That’s because sleep is inextricably linked to mental health. A psychiatrist is uniquely positioned to understand the complex, two-way relationship between sleep and psychiatric conditions and to develop a comprehensive plan to help you get the rest you need.

The Chicken-and-Egg Relationship

Sleep disorders and psychiatric conditions are frequent and challenging bedfellows. It’s often difficult to untangle which one is causing the other.

• Sleep problems as a symptom: Disturbed sleep is a core feature of almost every major psychiatric condition. The racing thoughts of anxiety can make it impossible to fall asleep. The chemical changes of depression can cause you to wake up in the early hours of the morning. The hyperarousal of PTSD can lead to nightmares that disrupt your rest.
• Sleep disorders as a cause: The relationship also works in the other direction. A primary sleep disorder can cause or dramatically worsen a mental health condition. If you have a condition like sleep apnea, where you are not getting enough oxygen at night, the resulting sleep deprivation can lead to severe depression, anxiety, and cognitive problems.

A psychiatrist’s first job is to be a detective, figuring out the nature of this relationship. Is the insomnia a symptom of your depression, or is an underlying sleep disorder making your depression worse?

The Psychiatrist’s Approach to Sleep

Because of this complexity, a psychiatrist will take a careful, multi-step approach to addressing your sleep problems.

1. A Thorough Evaluation

Your doctor will ask you detailed questions about your sleep. They’ll want to know: When do you go to bed? How long does it take you to fall asleep? Do you wake up during the night? How do you feel when you wake up? Are you tired during the day? Do you snore? This detailed history helps them to understand the specific nature of your sleep problem.

2. Treating the Underlying Psychiatric Condition

In many cases, the most effective way to treat a sleep problem is to treat the underlying anxiety or depression. As your mental health symptoms improve with therapy and medication, your sleep often improves right along with them. Some antidepressants, for example, can be very helpful for improving sleep quality in people with depression.

3. Recommending Behavioral Interventions (CBT-I)

As we’ve discussed, the first-line treatment for chronic insomnia is a specific type of therapy called Cognitive Behavioral Therapy for Insomnia (CBT-I). Your psychiatrist will almost always recommend this approach. They may provide the therapy themselves or refer you to a therapist who specializes in it. CBT-I is a highly effective, drug-free way to reset your body’s natural sleep patterns.

4. Considering a Sleep Study

If your psychiatrist suspects that you might have a primary sleep disorder, like sleep apnea or restless legs syndrome, they will refer you to a sleep specialist for a formal evaluation. This often involves an overnight sleep study (polysomnogram), where your breathing, brain waves, and body movements are monitored while you sleep. If a primary sleep disorder is diagnosed, treating it directly can lead to a dramatic improvement in your mental health.

5. Judicious Use of Sleep Medications

While behavioral approaches are preferred, there is a role for sleep medications. A psychiatrist might prescribe a medication for short-term use to help break a severe cycle of insomnia or to manage sleep while another medication starts to work. They will be very cautious, as many sleep aids can be habit-forming. They might use non-addictive options, like low-dose sedating antidepressants (e.g., trazodone), or other medications that work on different sleep-related brain chemicals. The goal is always to use the lowest dose for the shortest time needed.

Your psychiatrist understands that sleep is not a luxury; it is a fundamental pillar of health. By taking a comprehensive approach that addresses your mental health, your behaviors, and any underlying medical sleep issues, they can help you find your way back to the restorative rest your brain and body need to heal.

Key Takeaways

• Sleep disorders and psychiatric conditions are deeply intertwined; one can cause or worsen the other.
• A psychiatrist’s first step is a thorough evaluation to understand the nature of your sleep problem.
• Treating the underlying depression or anxiety is often the most effective way to improve sleep.
• The preferred non-drug treatment for insomnia is CBT-I. If a primary sleep disorder like sleep apnea is suspected, a referral for a sleep study is necessary.
• Sleep medications are used cautiously, typically for short-term relief, due to the potential for dependence.

Ready to take the first step? We can help. Get started with Televero Health today.