When I had my baby, almost as soon as she was safely out, the medical experts around me were urging me to sleep.
A nurse was assigned to feed her and the midwife team taped handwritten signs across my door: “Do not disturb this patient” and “This patient must sleep”.
I had a 95% chance of entering postpartum psychosis, and nobody wanted that.
While managing manic depression, I have probably met with 20 or so psychiatrists in and out of hospital, and they share a unified obsession – sleep.
So I did as I was told my first day as a mother, as I knew it was the single-most protective action I could take for myself and my baby.
While sleep has always been an intimate part of manic depression, new lines of inquiry are exploring whether sleep and the disruption of it are the defining characteristic of the disease itself and not just a symptom or side-effect of it.
Sleep and circadian rhythm abnormalities are found across the spectrum of bipolar disorders, and present in every phase of it – depression, mania and euthymia (remission).
That means that even when you’re well, you don’t get the quality sleep other people do.
But in addition to the classic sleep problems of bipolar, which are well-known and documented, an increasing body of evidence is unearthing the importance of sleep in the prevention and management of a host of other psychiatric disorders.
Sleep is also pivotal to the prevention of mental disorder in otherwise healthy individuals with no history of mental illness.
“The dominant view is that sleep [problems are] either a symptom of several mental health problems or it is a secondary consequence,” Daniel Freeman, a professor of clinical psychology at the University of Oxford told the Guardian.
“Really, sleep is one of the contributing causes.”
It’s very chicken and egg. Did you get sick because you weren’t sleeping, or did you not sleep because you were sick?
People with serious mental illnesses are often regarded as the outliers of society; there to show the general population what a malfunctioning brain looks like (and how best to avoid one).
But the psychiatric risks of too little sleep are population-wide.
Brain imaging scans have found the impact of sleep disruption on otherwise healthy individuals induces hypomanic mood problems similar to those found in bipolar patients, as well as emotional dysregulation, poor impulse control and severe irritability.
To experience what having a mental illness is like, try not sleeping for two to three nights. It’s a bit like that.
Poor quality sleep is also a significant and recognised risk factor in developing certain conditions, especially depression, anxiety, psychosis and even suicidal ideation.
So while sleep disturbance is a key symptom of the above illnesses, what scientists are discovering is that sleep problems can also precipitate mental illness, long before the illness may be recognised and diagnosed, let alone treated.
So is sleep the canary in the coalmine, a clue to the health of our minds?
“Having insomnia doubles your chances of developing depression and we now know that if you treat the insomnia it reduces depression,” said Freeman.
In my own case, research out of Italy has found that even a single night of disrupted sleep can lead to an episode in bipolar type one. If I have a very short or disturbed night, the early symptoms of a manic or psychotic episode generally appear in the following one to two days.
According to the sleep foundation, it can take between four to nine days to fully recover from a disrupted night and return to “baseline”.
That’s a long time for your brain to be at risk.
I have left weddings, family gatherings and sleepovers because of missing sleep, and checked myself into hotels alone with nothing on the agenda but to fall unconscious.
For a long time, I didn’t realise that my reaction to even minimal sleep deprivation is somewhat extreme – bugs crawling across my vision, chairs swaying under me – and a clear indication of greater psychiatric disturbance.
But we are all subject to the ravages of sleep loss. It’s a spectrum, but one all of us are bound too.
With a global sleep loss epidemic worsening since the pandemic, treating insomnia and sleep disturbances as a preventative measure in the general population should be an urgent public health priority. But too often sleep problems are given the magazine-treatment, and shallow tips and tricks (“try a warm bath scented with lavender”) abound.
For a long time I fought the sleep interventions that were imposed on me, especially in my 20s. It made me feel old and pathetic to go to bed when everybody else was out partying till dawn or, in news circles, covering some crisis. I wanted to keep up, I didn’t want a disease slowing me down.
In our culture, it’s very hard to slow down – frowned upon even.
But eventually, I had to get some sleep. The mayhem caused by me not sleeping is simply not worth it, for myself or, more crucially, those around me.
The offhand “I’m fine, I’m fine” as I wave my concerned husband away at a late-night party is simply not true. The next day, I’m almost never fine.
But it’s really hard to admit that. “I’m going to bed because of my bipolar” is a bit of a mood-killer.
The powerful and free treatment of sleep should be better recognised for its extraordinary therapeutic properties, not just in the management of psych patients, but for everyone. Sleep is probably the single best thing you could do for your mental health right now, yet as a society we continue to neglect it, treating it as a luxury rather than a necessity.
I find it staggering that a single night of good sleep can quieten psychotic symptoms, quell anxiety, extinguish hypomania and tamp down depression.
Your relationship with sleep (and not getting it) will no doubt look different to mine, but the power of using this drug-free, specialist-free intervention is something we all have in common.
Cancel plans. Shuffle your schedule around. Whatever it takes to get you to bed.
Eleanor de Jong is the former New Zealand correspondent for the Guardian. She now lives and works in the Kimberley town of Derby, Western Australia