Sleep and Psychiatric Disorders: Shared Mechanisms and Clinical Relevance
Key Clinical Summary
- Sleep disturbances are transdiagnostic across major psychiatric disorders and contribute to onset, severity, and relapse.
- Neurobiological mechanisms linking sleep and psychiatric illness include circadian dysregulation, neurotransmitter pathway disruption, and stress-immune interactions.
- Routine sleep assessment and targeted interventions like Cognitive Behavior Therapy for Insomnia (CBT-I) and chronotherapy should be integrated into psychiatric care to improve clinical outcomes.
A narrative review in PLOS Mental Health synthesizes evidence on the bidirectional relationship between sleep and psychiatric disorders and highlights shared neurobiological mechanisms that span major depression, bipolar disorder (BD), anxiety, posttraumatic stress disorder (PTSD), schizophrenia, attention-deficit/hyperactivity disorder (ADHD), and substance use disorders.
Main Findings
The review examines sleep as both a contributing factor and consequence of psychiatric pathology. Sleep disturbances, previously considered secondary symptoms, are now recognized as active contributors to the onset, course, and relapse of psychiatric conditions.
Evidence shows that chronic insomnia increases risk for depression 2- to 3-fold and forecasts symptoms across diagnostic categories. The review integrates data indicating that sleep loss predicts manic episodes in bipolar disorder and that actigraphic sleep disturbances in clinical high-risk youth correlate with psychotic symptom escalation.
Neurobiological overlap includes disruption in circadian rhythms, dysregulation of neurotransmitters (GABA, serotonin, dopamine, orexin), and hyperactivation of stress-immune pathways. These shared mechanisms link sleep regulation with emotional control, reward processing, and cognitive functioning.
The review emphasizes the transdiagnostic nature of sleep disturbances. Altered serotonin signaling affects both mood regulation and rapid eye movement (REM) sleep architecture, while dopamine pathways implicated in psychosis also influence wake–sleep balance.
Clinical Implications
For clinicians, the review underscores sleep assessment as essential in psychiatric evaluations. Traditional diagnostic protocols often underweight sleep symptoms, but structured sleep evaluation can uncover contributory factors to mood and anxiety presentations.
Interventions such as Cognitive Behavior Therapy for Insomnia (CBT-I) and chronobiological strategies like light therapy or Interpersonal and Social Rhythm Therapy (IPSRT) have demonstrated efficacy in improving psychiatric outcomes. Addressing circadian misalignment and sleep hygiene can lead to symptom reduction in depression and anxiety, lower relapse rates in bipolar disorder, and decreases in suicidal ideation.
Clinicians should consider sleep not only as a symptom domain but as a modifiable factor that influences treatment response, prognosis, and overall functioning. Integrating sleep-focused care alongside pharmacologic and psychotherapeutic treatment plans may yield better patient-centered outcomes across diagnostic categories.
Expert Commentary
“Sleep is critical for emotional regulation, memory, and cognitive performance. Sleep disturbances, including insomnia, hypersomnia, and circadian misalignment, are highly prevalent and clinically significant across various psychiatric disorders,” said Anna Hyndych, PhD, Sleep and Health Research Program, University of Arizona College of Medicine, Tucson, AZ, and co-authors. “Sleep is a tractable factor in mental health,” they emphasize, “offering a potent intervention leverage point.”
This review highlights the importance of adopting sleep-focused strategies as part of comprehensive psychiatric care.
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