The Link Between Insomnia and Mental Illness

“I’ve always envied people who sleep easily. Their brains must be cleaner, the floorboards of the skull well swept, all the little monsters closed up in a steamer trunk at the foot of the bed.”  ~ David Benioff (co-creator of Game of Thrones)

Surely you have experienced a poor night’s sleep. You wake up feeling unrested, groggy, like you got hit by a train… And the fun lasts throughout the day with slow reflexes, foggy brain, inability to concentrate, impatience, stress, worry, anxiety and even headaches. It is absolutely no surprise that sleep quality has a direct impact on your physical and mental health. Today I am going to highlight the connection between insomnia and mental illness, in hopes that those experiencing it can get the help they deserve.

Insomnia is defined as the inability to get the necessary amount of sleep to function efficiently during the daytime. It is a sleep disorder that is characterized by difficulty falling asleep, waking up often throughout the night, having trouble going back to sleep, and waking up too early in the morning. In essence, insomnia results in feeling tired upon waking. Understandably, said fatigue can lead to difficulties functioning during the daytime and have unpleasant effects on work, social and family life. 

You likely already knew all of that about insomnia. But what you may be unaware of is that insomnia can be indicative of more serious issues, including medical issues like sleep apnea, or even mental illnesses like anxiety, depression, schizophrenia, bipolar disorder, and attention deficit hyperactivity disorder (ADHD). Sleep issues can even be a sign of an impending condition such as bipolar disorder. Many existing medical and mental health conditions can be worsened by sleep-related problems because lack of sleep slows recovery from mental illness. People with depression who continue to experience insomnia, for instance, are less likely to respond to treatment for depression. They are also at greater risk of relapse than those without sleeping problems.

Many people do not know there is an undeniable link between insomnia and mental health issues. More than fifty percent of insomnia cases are related to depression, anxiety or psychological stress, and many anxiety disorders are associated with difficulty sleeping. For instance, obsessive-compulsive disorder (OCD) is frequently associated with poor sleep. Panic attacks during sleep may suggest a panic disorder. Poor sleep resulting from nightmares may be associated with post-traumatic stress disorder (PTSD). The severity of sleep issues can determine the type of mental illness a person my experience. For example, early morning wakefulness, low energy, inability to concentrate, sadness and a change in appetite or weight can be indicative of depression. A sudden dramatic decrease in sleep accompanied by an increase in energy (or the lack of need for sleep) may be a sign of mania

Poor sleep patterns can not only be indicative of mental health issues, but it can also significantly worsen them. Insomnia makes it difficult to process and react to appropriately to negative emotions. Severe sleep problems can decrease the effectiveness of certain treatments. Treatment of sleep disorders has also been studied in relationship to schizophrenia, ADHD and other mental illnesses. All of the scientific data shows the connection between medical and mental illnesses: good sleep is necessary for recovery—or prevention—in both types of conditions.

There was a research trial done where fifty-one percent of individuals who overcame depression after psychological treatment (therapy) or medication were still experiencing insomnia. Insomnia tends to persist unless it is directly targeted for treatment. Insomnia can either be short-term or long-term; short-term insomnia is very common and has many causes such as stress, travel or other life events. It can generally be relieved by simple sleep hygiene interventions such as exercise, a hot bath, warm milk or changing your bedroom environment. Long-term insomnia lasts for more than three weeks. This is when you need to be examined by a physician with a potential referral to a sleep disorder specialist (a psychiatrist, neurologist or pulmonologist who have expertise in sleep disorders) for assistance. A balanced diet, regular exercise, meditation and relaxation, good sleeping habits, herbal remedies, medication and therapy are powerful actions that can help relieve insomnia. 

Living with insomnia is hard. The constant exhaustion and inability to sleep is an ailment which may require medical attention to overcome. Remember that insomnia often comes paired with a mental illness. Only as you work through both ailments will you find lasting relief. But it is doable, and I am here to help! Please do not hesitate to contact me today!

Melissa Cluff is a licensed marriage and family therapist based in Lewisville, Texas, personally seeing clients in the North Dallas area.


“Bookending” Your Day With Morning and Evening Routines

We are all aware of using either morning or nightly routines to be productive and either jumpstart our morning or end the day on a positive note. But how many of us use both morning and nightly routines with the intent of reaching our goals? In September, I wrote in detail about nightly routines, and in November I wrote about morning routines. In this post I want to combine the elements from these posts to demonstrate the powerful concept of “bookending” your days with morning and nightly routines in order to reach your goals. It’s almost 2019–it is the perfect time to start being intentional with your routines!

Let’s start by talking about the bigger picture. Many of us have goals or resolutions that give us a trajectory in a given direction–towards what we want to accomplish or who we want to become. In my opinion, goals play a necessary role in our growth; without them we will almost certainly fall short of our potential. On that same vein, just because we have goals written out does not mean we are sure to reach them. We need to be actively aware of what we are striving towards; that requires dedication and focus in order to reach them.  How many of us are giving our goals the attention they deserve?

Bookends are a support used to keep a row of books upright; without them, the books lean one direction or another, or fall down completely. Consider this analogy: Your day is like the row of books on a shelf, and the bookends, or supports, are the morning and evening routines.  A successful person’s morning and evening routines are the “bookends” of a productive life. How so? Because what they include in their routines ensures the really important things get done each day. While we may be unable to control what goes on in the middle of a day, we usually can control how we begin and end the day. We can take advantage of this fact by incorporating our most important tasks, actions, goals and/or behaviors into our morning and evening routines.

For example, many businessmen refuse to check email first thing in the morning–for fear of getting prematurely sucked into work. Instead, their morning routine consists of waking up, getting dressed, and dedicating an hour or so to working on important tasks or working towards a higher goal before going into the office. This may include reading, meditating, exercising, meal preparation, etc. These people are ensuring they accomplish what they want to before the chaos and interruptions of the workday get in the way.

For me, if I fail to exercise first thing in the morning, it is very unlikely I will be able to find time to exercise later in the day. So, daily exercise is part of my morning routine. Similarly, being a better journal writer is another important goal for me. If I do not set aside a specific time for journaling, it simply will not happen. Thus, I have incorporated journal writing into my evening routine (which also serves as a great way for me to unwind before bed!).

Here’s how to do it:

  1. Make or review goals, life plan, bucket list or resolutions
  2. Incorporate elements from step one into morning and evening routines
  3. Adjust routines as life happens (this will become even more vital when you have kids, not the other way around!)

Sounds simple enough, right? Here is a real life example: At the end of 2017, my friend made a goal to participate in a race during 2018 (step one). That goal could have remained written down for her to occasionally glance at, and she may or may not have reached it. But she decided to use her daily routines to reach her bigger goal. Each morning she would review her goals as a reminder for what she was working towards. She broke down her goal to run a race into achievable increments which she then incorporated into her morning routine of exercise (step two). Then, each night, she would make plans for the following day’s exercise goals, and so on and so forth until she was able to run, bike, and swim the assigned distances for her race. She successfully “bookended” her days to reach a goal by incorporating it into her morning and evening routines. She said it was exhilarating to accomplish something so seemingly unreachable through consistent baby steps! This is possible with any goal–whether it be increasing your physical flexibility, mastering a language, learning a new hobby, or traveling to somewhere on your bucket list. No matter the goal, you can reach it as you use routines to bookend your progress.

How can we possibly expect to reach our goals or cross things off our bucket lists if we are not actively working towards them? The concept of bookending our days with morning and nightly routines ensures that we will be consistently focused on our goals on a daily basis.  None of us want to look back and see that we failed to reach our full potential or have missed out on valuable experiences. Make your dreams a reality in 2019 by bookending your days with effective morning and nightly routines. By being intentional with your routines, you will make more progress than ever. And, as always, should you feel you need the help of an experienced therapist to become the person you want to be, schedule a session today. My door is always open–especially for those looking to make 2019 a fabulous year!

Melissa Cluff is a licensed marriage and family therapist based in Lewisville, Texas, personally seeing clients in the North Dallas area


Sleep Like a Baby: Nightly Routines

Sleep Like a Baby - Cluff Counseling - North Texas Therapist

Sleep Like a Baby - Cluff Counseling - North Texas Therapist

“Think in the morning, act in the noon, read in the evening, and sleep at night.” -William Blake

Just like young children, adults thrive off of routines. Children learn that bedtime is near because they consistently have a bath, put on warm jammies, have a bottle, read a book, sing lullabies, rock in a dimly-lit room, etc. Adults can do the exact same thing–in principle–as they signal to the brain that bedtime is approaching. How? By consistently doing things that relax the body and mind around the same time each day.

For varied reasons, many of my clients struggle getting quality sleep. I have found the common thread to be that we work, do chores, or are on a screen right up until the very last minute of our day. We get in bed and expect our bodies to know that, like a switch, it is time to turn off! Then we get frustrated when we toss and turn for hours.

The key is to take the necessary time winding down to let our brain and body know it is time to sleep–essentially preparing ourselves to rest. Taking 30-60 minutes to decelerate at the end of a hectic day by doing things which calm our minds is one of the most helpful sleep habits to practice! The benefits to having a nightly routine are many; I would like to name just a few: First, we will calm our overactive minds. Second, as we decompress, we are preparing our brains to avoid rumination (contemplating or stewing over things when we should be sleeping instead). And third, by regularly repeating our nightly patterns, we will condition our bodies and minds to realize that it is bedtime, so it will begin to happen more naturally with time.

Everyone is different. There is no single set nightly ritual that will work perfectly for everyone. But here are some helpful guidelines as we begin creating a routine:

  • Switch off the electronic devices. These stimulate the brain, interfere with our internal body clock, can be addictive, and can induce stress (like by checking emails right before bed). Some sources even recommend leaving your phone in another room or switching it airplane mode in order to avoid EMF (electromagnetic field) emission. I would suggest turning off electronic devices at least an hour before bedtime.
  • Relaxation exercises: meditation, breathing & mindfulness. I have written before about the power of meditation as a form of self-care. Meditating before bed is particularly effective as it calms the mind and helps prepare us to slow down and sleep.
  • Wins/gratitude. Think through the day and write down the wins, the things that went well, or the things to be grateful for. It is powerful!
  • Read. I would dare to say that many of us have a goal or New Years Resolution to read more books–I know I do! Sneaking it into the nightly routine is a great way to reach your goals while simultaneously reducing stress and boosting brain power.
  • Listen to music. (Refer to number one.) Listening to calming, peaceful music can have a soothing effect which will prepare us for bed.
  • Write down worries and reminders for the next day. Prepare a to-do list for the next day. Get organized. Think through things that must be done, prepared for, or accomplished. Write it down. Then put it on the backburner and relax. Another idea: To avoid lying awake worrying about things that may need to be done or people to get in contact with, keep a notepad near the bed. Write those ideas and impressions down so the mind can let them go and sleep.
  • Have a relaxing drink or light snack. While it is important to avoid large meals before bed, having a cup of herbal tea or warm milk can be a soothing, welcome pre-bed ritual.
  • Bring your temperature down. The ideal bedroom temperature for sleeping is between 65-72 degrees. The body associates a lowering temperature with a signal for sleeping, so avoid hot showers and cool down in order to wind down.
  • Spend time with family, friends or partner. For many, this time right before bed may be their only alone time with a spouse. Spend a moment talking and connecting with him or her as part of your nightly routine.
  • Don’t lie awake for hours. This is key: It takes most people between 20-30 minutes to fall asleep. We have to remember that if we are still awake after half an hour, it could be that we are not quite ready to sleep yet. Get up, repeat aspects of the nightly ritual, and try again after some time passes.

Here is an example of a nightly routine:
9:30 PM: Review day’s work, review goals (long term and short term), plan tomorrow’s schedule
10:00 PM: Get ready for bed; take vitamins.
10:15 PM: Write in journal
10:30 PM: Read a book
11:00 PM: Lights out.

The most important advice I can give is to be consistent. Whatever we decide to do for the nightly ritual, do it, and do it every night. Be consistent! If we start the wind-down ritual each night at 9:00 p.m., our bodies will quickly learn what is coming next, and the process will begin to happen more organically.

I fully understand that demanding work schedules or taking care of kids can make it difficult to take any time to relax at night. I can assure you that a nightly routine will not only help you fall asleep quicker, but it will help you sleep better. Additionally, if anyone regularly faces sleep problems, taking even just a few minutes on a nightly routine can work wonders! If you have questions or need additional assistance, please feel free to contact me. My door is always open!

Melissa Cluff is a licensed marriage and family therapist based in Lewisville, Texas, personally seeing clients in the North Dallas area.


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Sleep…It Does a Body Good!

Cluff Counseling - Sleep for Health

Cluff Counseling - Sleep for HealthIs your mind racing when you lay down at night to go to sleep? Does your growing to-do list keep you awake for hours on end–even when you are exhausted and know you need a solid night’s rest? These 6 simple ideas can help you sleep better.

There is a Parks and Recreation episode where the main character, Leslie, is trying to come up with great ideas after the smashing success of a community festival. She has a deadline by which she needs to produce several applause-worthy ideas, and she is at a total loss. She recruits her team to get out in nature to brainstorm, but they come up dry and wind up at a motel where she plans to stay awake all night at the drawing board in order to make her deadline. She is frazzled, irritable, snappy, and certainly nowhere near having any quality–let alone showstopper–ideas. What happens? One of her team members forces her into her room, locks her inside, and demands that she sleep. After sleeping 8+ hours, Leslie runs into the office (late) with a LIST of awesome ideas that everyone is excited about.

You may wonder what Parks and Recreation has to do with this week’s blog post topic of self-care. Well, this episode demonstrates an important point many of us overlook in our daily lives. We often think we have to stay up late, push through it, work extra hard, and force ourselves to produce quality work. In fact, in a 2013 Gallup report, it was reported that 41% of Americans are not getting the recommended 7-8 hours of sleep each night! We are overscheduled, overworked and overburdened. By the time we hit the sheets, we may have so much on our mind that we either do not sleep well or do not sleep long enough. And quality sleep really does a body so much good!

Proper sleep affects all aspects of our life–our overall mood, our ability to make decisions, our productivity…even our weight is influenced by how much we sleep.  Last year, a study was published showing that sleeping less than six hours per night for just one week resulted in changes in 700 genes in the human body. Although researchers do not understand the full ramifications of these changes, it is clear that there is an impact on our immune system, stress response, and an increase in inflammation.

What needs to be done? We need sleep. We need more of it, and we need it to be quality sleep. Whether you fall into bed exhausted each night or you end up laying in bed for awhile with your mind racing, the following six pointers will help you improve your sleep:

    1. Create an environment meant only for sleeping: In college, I was counseled that it was unwise to study in bed because the bed is where I sleep and my body can get confused if I do other activities, such as studying or reading, in it. My advice for better sleep is to use specific places for certain activities: study at a desk, peruse instagram on a couch, and sleep in your bed. Give your body the signal that it is time to wind down by keeping work, tv and other digital devices out of the bedroom.
    2. Turn the thermostat down a few degrees. Several sleep studies have shown that people sleep better when their bedroom is on the colder side.
    3. Write. If your mind is often racing at bedtime, give yourself a few minutes before bed to to write down anything that is lingering in your mind. Once you jot your thoughts down, you will signal to your brain that is it okay to let those thoughts go.
    4. Shhhhh. Eliminate any unnecessary peripheral noises from your room. (If your partner snores, try earplugs or noise-canceling headphones.)
    5. Create a routine. Babies need a routine with things like a bath, massage, bottle, story time, and lullaby to signal that it is bedtime. Well, adults need routines, too! Create a “winding down” routine for yourself and try to go to sleep / wake up at the same time each day. Our bodies respond well to predictability; try it!
    6. Breathe. Dr. Weil recommends a simple breathing exercise that can invite sleep in 60 seconds. It is called the 4-7-8 Breathing Technique. Basically, you do the following:
  • Be in a comfortable position (where you are not restricting your ability for deep breathing)
  • Place the tip of your tongue on the roof of your mouth behind your front teeth
  • Exhale completely
  • Inhale through your nose to a count of four
  • Hold your breath for a count of seven
  • Exhale through your mouth to a count of eight
  • Repeat three times

Of all the things we can do for our bodies, there is nothing it needs more than quality sleep. Getting proper rest does so much good for our overall health! We owe our bodies time to reenergize so we can live, be, and do our best each day. If you find you need additional help or guidance, feel free to contact me to  schedule your first session today. Getting proper rest is not a passive activity, so let’s take action and let sleep do our bodies good!

Dr. Weil, “Three Breathing Exercises and Techniques”
Gallup Report: “In U.S., 40% Get Less Than Recommended Amount of Sleep”
Power of Positivity: “This Relaxation Exercise Can Help You Fall Asleep In 60 Seconds”
Simplemost: “Science Says Sleeping In A Cold Room Is Better For Your Health”

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