If anxiety and depression are relieved, will sleep be good as well?

In most cases, sleep problems will indeed improve after anxiety and depression are relieved, but there are also a small number of people who still have trouble sleeping even after their mood stabilizes. We cannot give a 100% sure answer.

I have met many patients with insomnia due to emotional problems in clinical practice before. The one who impressed me most was a junior girl who was preparing for the postgraduate entrance examination. When she came here, her anxiety scale score was fast to moderate. She said that her mind was spinning uncontrollably as soon as she lay in bed. Sometimes she was thinking about the political knowledge points she had memorized today, and sometimes she was afraid that she would not pass the exam and have to fight World War II. In the most severe period, she only slept 2 hours a day for four days in a row. She would cry inexplicably while sitting in class during the day. After more than two months of adjustment with the school's psychological counselor, her anxiety score had dropped to the normal range during the follow-up visit. She said she could fall asleep in less than half an hour in bed and rarely woke up in the middle of the night. In fact, you can understand that there is a lot of overlap between the pathways that control emotions and the pathways that control sleep rhythms in our brains. During an anxiety and depression episode, the secretion of neurotransmitters such as serotonin and norepinephrine is completely disrupted. It is like two switches connected together. One tripped and the other could not work normally. When the emotional problem is sorted out and the pathways are opened, most of the sleep switches can slowly return to normal.

But there are really exceptions. Last year, a young man who works in Internet operations came for a follow-up consultation. After taking antidepressants for half a year, his emotional state has improved a lot. Before, he could not even leave the house. Now he can go hiking with friends on weekends. However, his sleep has not improved. He still has to stay up until one or two o'clock every day to fall asleep. He will wake up before seven o'clock the next day, and he will be groggy all day long. Later, I made a sleep diary for him for two weeks and found out that during the past half year of insomnia, he had already developed the habit of lying in bed and watching short videos until he was sleepy. Even if he was in a good mood, his biological clock had already changed into a "not sleepy until one o'clock" mode, which is equivalent to walking around every day. After walking on the road for more than half a year, even if the originally blocked road is cleared, you will subconsciously follow the old path you are accustomed to. The adjustment of sleep rhythm is half a beat slower than the adjustment of emotion. At this time, it is enough to adjust the sleep habits alone, and there is no need to wonder whether there is something wrong with your mood again.

There are also some people whose sleep problems are not directly related to anxiety and depression. For example, they have physiological problems such as sleep apnea and restless legs syndrome. Even if they are in a good mood, they will still wake up in the middle of sleep because they are out of breath, or their legs will be so sore that they can't fall asleep due to tossing and turning. In this case, the sleep problem itself must be dealt with in a targeted manner, and not just focus on the mood.

What I usually tell my patients the most is, don’t take “good mood = good sleep” as a golden rule. If you really can’t sleep well after your mood stabilizes, don’t worry about the recurrence of anxiety. First, check whether your sleeping habits are correct and whether there are any undiscovered physiological problems. You can always adjust them back slowly if you take your time.