Why I Prioritise Client’s Sleep

Did you know that 35% of people are chronically under slept? This statistic, although sourced from the US, reflects a global issue with varying degrees of severity across different countries. For instance, Malaysia ranked 90th in the Sleep Quality Index study, with an average nightly sleep duration of under 6 hours and 45 minutes.

But why should those of us in mental health care be concerned about this? The truth is, sleep plays a pivotal role in our clients’ overall well-being. Surprisingly, more than a third of the individuals are grappling with poor sleep. In fact, it's safe to say that over 90% of my clients experience some form of sleep disturbance.

As clinicians, we often delve into our clients’ histories, traumas, and relationships, yet we frequently overlook the importance of addressing their sleep health. In this article, I aim to highlight why this oversight is a missed opportunity and why aiding our clients in achieving better sleep is one of the most crucial interventions we can offer as mental health professionals.

Research consistently underscores the significance of sleep in mental health. Despite not always being explicitly listed as a criterion in diagnostic manuals like the DSM, sleep disturbances are pervasive across various mental health disorders. Even when acknowledged, such as in Major Depressive Disorder, sleep issues are often regarded as outcomes rather than potential contributors to the condition. This view is incredibly limiting. 

Sleep influences every facet of our mental well-being. It directly impacts our cognition, with disrupted sleep linked to heightened negative thoughts—an alarming fact for those who recognize the significance of thoughts in shaping mood and behaviour. 

Further, sleep directly affects our mood. We've all experienced heightened irritability and sensitivity when sleep-deprived. However, the cumulative effect of sustained poor sleep on our emotional health is often underestimated. Poor sleep amplifies fear, anxiety, and negative moods by enhancing amygdala function while impairing our prefrontal cortex, responsible for emotional regulation and decision-making. This pairing of neurological changes makes us both more susceptible to negative moods while simultaneously lowering our defences and decision making capacity.

Additionally, the repercussions of sleep extend beyond mental health; they profoundly affect our physical well-being. Contrary to common belief, even a single night of poor sleep can significantly impact our health. Studies have shown that as little as a one-hour reduction in sleep duration, as seen during daylight savings time changes, correlates with a 24% surge in heart attack rates the following day. Additionally, reduced sleep has been linked to increased suicide risk and accidents, particularly car accidents. These are just some of the findings linking sleep disturbance with health outcomes. 

The implications of these findings underscore the critical importance of prioritising sleep in all mental health settings. As a clinical psychologist, my primary aim is to assist clients in improving their well-being. Nearly every client I've worked with has presented some form of sleep disruption, spanning from depression and anxiety to trauma and even schizophrenia.

The role of a clinical psychologist

Firstly, I prioritise investigating my clients' sleep patterns. Incorporating dedicated sleep related questions into diagnostic interviews is essential for understanding their sleep quality. This involves assessing various factors such as sleep duration, bedtime consistency, ease of falling asleep, nocturnal awakenings, and morning wakefulness. This is essential for diagnosing possible sleep disorders that clients may be suffering from, as well as understanding the habits that might be disrupting their sleep. 

My next step is to incorporate sleep interventions if appropriate. The impact of seemingly minor adjustments in sleep habits can be profound. Let me share a case example: one client, who had experienced depressive symptoms since childhood, reported sleeping around 6 hours per night with inconsistent sleep schedules due to work and social commitments. By implementing a simple intervention—setting a consistent wake-up time and getting morning sunlight for two weeks—the client experienced a remarkable increase in sleep duration (over 7 hours) and a significant decrease in depressive symptoms for the first time in her life.

I share this story not to suggest that sleep is the sole determinant of mental health but to underscore the transformative effects of addressing sleep health.

So, what can you do if you want to improve your sleep?

In a world that challenges our natural sleep rhythms, adopting simple strategies can significantly enhance sleep quality and duration:

• Maintain Regularity: Establish a consistent wake-up time every day, even on weekends, to synchronise your body clock. Many people deprive themselves of sleep during the week nad try to make up for it on the weekend. By sleeping in on the weekend we confuse our bodies and weaken our natural circadian rhythm. This leads to increased difficulty falling asleep, poorer sleep quality, and fatigue over time. 

• Leverage Light: Expose yourself to sunlight in the morning to regulate your body clock, and minimise exposure to artificial light, particularly blue light from screens, before bedtime. This is because our brain sets our body clock based on the light that comes through our eyes. Exposure to sunlight in the mornings helps our bodies understand that this is the time to be awake and alert. The inverse in the evenings helps our bodies know that it’s time to wind down for sleep. 

• Track Your Sleep: Utilise tools like smartwatches or apps to monitor your sleep patterns and identify potential disruptions. This can allow you to identify patterns of behaviour that impact your sleep. This could include foods, drinks, stress. It can also help to review the effectiveness of strategies you implement to try to improve your sleep over time. 

• Moderate Caffeine and Alcohol: Limit caffeine intake within 12 hours of bedtime, as it can disrupt sleep, and be mindful of alcohol consumption, which may initially induce sleep but disrupts sleep quality.

In conclusion, while these recommendations are universally beneficial, they may not fully address individual sleep issues. If you suspect that sleep disturbances are impacting your well-being, don't hesitate to seek professional guidance. We're here to help.

Chris Henshaw

Clinical Psychologist at Betterment