Ray M. Merrill, MPH, PhD

Credit: Brigham Young University

New research shows patients with mental health disorders and patients who are taking psychotropic drugs are at an increased risk of sleep disorders, including sleep apnea and insomnia.¹

A team, led by Ray M. Merrill, Department of Public Health, College of Life Sciences, Brigham Young University, examined the moderating influence of comorbid mental disorders and whether selected psychotropic drugs were associated with sleep disorders after adjusting for mental disorders.

Sleep and Mental Health

Recent studies have focused on the correlation between mental disorders and sleep issues.

For example, 1 study showed that 50% of patients with schizophrenia also exhibited insomnia. Other research has found that slow sleep waves and altered sleep spindles are linked to clinical symptoms and cognitive impairments in patients with schizophrenia.

Similar patterns have been found for other mental disorders, including ADHD, which is associated with circadian rhythm sleep disorders and depression, a known risk factor for insomnia.

“Mental disorders associated with sleep disorders include stress, anxiety, depression, attention-deficit hyperactivity disorder (ADHD), bipolar disorder, and others, with the causal association often two ways,” the authors wrote. “Sleep disturbances, especially insomnia, are common in people with schizophrenia or bipolar disorder.”

The Data

In the retrospective cohort study, the investigators identified medical claim data from the Deseret Mutual Benefit Administrators (DMBA) for mental disorders, psychotropic drug use, and demographic data for individuals aged 18-64 years between 2016-2020.

Correlations

The results show 11.7% filed 1 or more claims for a sleep disorder, including insomnia (2.2%) and sleep apnea (9.7%). The rates for selected mental disorders ranged from 0.09% for schizophrenia to 8.4% for anxiety, while the rate of insomnia is greater in patients with bipolar disorder or schizophrenia than it was for other mental disorders.

On the other hand, the rate of sleep apnea is greater in patients with bipolar disorder and depression.

The investigators also found a significantly positive association between mental disorders and insomnia and sleep apnea.

This was more pronounced for insomnia, particularly if the patient had other comorbid mental disorders.

The results also show psychotropic drugs, other than CNS stimulants, non-barbiturate sedatives and psychostimulants, explain the majority of the positive association between anxiety, depression, and bipolar disorder in patients with insomnia.

Non-barbiturate sedatives and psychostimulants were the psychotropic drugs with the largest effect on sleep disorders such as insomnia, while psychostimulants and anticonvulsants had the largest effect for sleep apnea.

“Mental disorders positively correlate with insomnia and sleep apnea,” the authors wrote. “The positive association is greater when multiple mental illness exists.

“Bipolar disorder and schizophrenia are most strongly associated with insomnia, and bipolar disorder and depression are most strongly associated with sleep disorders,” they added. “Psychotropic drugs other than CNS stimulants, primarily sedatives (non-barbiturate) and psychostimulants for treating anxiety, depression, or bipolar disorder are associated with higher levels of insomnia and sleep apnea.”

References:

Merrill, R.M., Ashton, M.K. & Angell, E. Sleep disorders related to index and comorbid mental disorders and psychotropic drugs. Ann Gen Psychiatry 22, 23 (2023). https://doi.org/10.1186/s12991-023-00452-3