Sleep, anxiety, and depression

Insomnia is often overlooked and underdiagnosed in the United States, resulting in the difficulty of differentiating sleep disorders from depression, anxiety, or other mental disorders. Sleep quality is not only reflected in sleep duration, but also in the time it takes people to fall asleep, the frequency of awakenings, being awake during the sleep period, and time spent asleep while in bed. Good sleep is a multidimensional construct encompassing sleep quality in addition to sleep quantity. The coexistence of sleep disorders and depression is often seen in clinical settings, especially in patients experiencing psychiatric disorders, and that underlines the close association between sleep and mental health. In fact, depressive symptoms are approximately 33% more common among people with short sleep duration (<7h) compared to adults with sufficient sleep. Another contributing factor in the association of sleep and depression is anxiety, as symptoms of depression and sleep insufficiency are often manifest in patients experiencing anxiety, or vice versa. Depression is frequently comorbid with sleep and anxiety disorders, and treatments related to each of them may be applicable for facilitating improvement in the other two. Existing diagnostic tools and guidelines should guide efforts toward implementing evidence-based practice and development of patient-centered interventions for individuals with symptoms of any of these three disorders. A thorough examination, including demographic characteristics, sleep history, medical and psychiatric conditions, lifestyles, past experiences of self-help, and pharmaceutical interventions should contribute to efforts to identify any underlying causes of either anxiety, depression, or sleep disorders.