Sleep
- 3 days ago
- 10 min read
For infants, toddlers, children, teenagers and adults: Importance of sleep, strategies to encourage sleep, sleep problems, further resources
Contents:
A. Young People
a. Background Material – Young People
b. Suggestions for Practice – Young People
c. Further Resources – Young People
d. References
B. Adults
a. Background Material - Adults
b. Suggestions for Practice - Adults
c. Further Resources – Adults
d. References
Feedback welcome!
A. Young People
This topic is presented elsewhere on this site under the heading “Children – Sleep”. The link is https://www.thesocialworkgraduate.com/post/sleep-health
B. Adults
Background Material – Adults
Section A: Introduction to Sleep
Source: Royal Society for Public Health (2016, 2021).
Sleep forms part of a natural rhythm of life. It is a force to be harnessed rather than challenged. Opposing or disrupting sleep and this rhythm of life can be very harmful. It is essential for all manner of creatures.
Circadian rhythm
The circadian rhythm is a 24-hour biological clock that all humans possess. The circadian rhythm cycle can be responsible for a person feeling drowsy or alert at different times during the day. The circadian rhythm is controlled by a part of the brain called the hypothalamus, although external factors such as lightness and darkness can also affect it. A 'typical' circadian rhythm cycle is presented below. However, since the circadian rhythm varies between individuals and also changes with age, the diagram below should be interpreted as a loose guide.
NREM and REM sleep
Sleep can be broadly divided into four stages – three non-rapid eye movement stages (non-REM) and one rapid eye movement stage (REM). They range from light sleep in stage one through to when dreams occur in the final REM stage of sleep. Sleepers progress cyclically through stages 1, 2 and 3 of NREM (Non-Rapid Eye Movement) sleep before entering REM (Rapid Eye Movement) sleep. The first cycle of NREM sleep takes about 90 minutes, with the following cycles lasting between 90 and 100 minutes.
Stage 1 occurs when a person has just fallen asleep and it is a very light sleep. While in this stage a person can be awakened easily.
In stage 2 eye movements stop and brain activity becomes slower, with occasional bursts of quick brain waves. The hear rate slows and the body temperature drops.
Stage 3 is the deepest and most restorative phase of sleep. Neuronal activity is at its highest in this stage. Muscles relax and all eye movements stop.
REM stands for Rapid Eye Movement and follows stage 3. During REM sleep the brain is almost as active as it is when awake. Other characteristics of REM sleep include dreaming, frequent rapid eye movements, paralysis of nearly all muscles (to ensure dreams are not acted out), quick, irregular breathing, an increase in the brain’s oxygen consumption and blood pressure, and changes in core body temperature.
Recommended sleep times
A person’s sleep is made up of quantity and quality. It is important that a person establishes what a good night’s sleep feels like for them. If one is alert and awake between 10am and 11am, they have probably had a good night’s sleep. In 2015, American organisation National Sleep Foundation assembled experts from various fields to produce a consensus statement in which recommended sleep ranges were established. They recommended the following sleep times.
Sleep Deprivation
The purpose of sleep is not yet fully understood; but it likely involves saving energy, restoring the body and brain, and/or organising networks in the brain, for instance for learning and memory. A wealth of evidence supports the fundamental role sleep plays in protecting us from severe problems with our health and wellbeing: sleep-related accidents are a major cause of injury and death; poor sleep increases the risk of chronic illnesses including high blood pressure, diabetes, depression, cancer, heart attack and stroke. It is related to obesity in both children and adults and reduced quality of life and early death. In older people it may be related to accelerated cognitive decline.
Despite all of this evidence the number of people not getting enough sleep is now around four in ten, while one in five people sleep poorly most nights, representing the second most common health complaint after pain, potentially having a significant impact on the nation’s health. Given sleep’s pivotal role in the nation’s health and wellbeing, it needs to be a key priority for the public’s health. Some of the consequences of poor sleep are presented in the table below.
Physical Risk of … | Mental Risk of … | Behavioural Risk of … | Performance Risk of … |
Cancer | Depression | Sleepiness | Impaired attention and concentration |
Cardiovascular disease and stroke | Psychiatric relapse | Road traffic accidents | Decreased memory |
Disorders of the Hypothalamic-Pituitary-Adrenal (HPA). | Mood fluctuation | Falls and fractures | Reduced multi-tasking |
Metabolic abnormalities | Delirium | Repeat prescribing | Impaired decision making |
Weight gain and obesity | Impulsivity | Alcohol and drug dependence | Reduced creativity |
Reduced immunity | Anger and frustration | Increased sedative and stimulant use | Reduced communication |
Bodily sensations of pain | Higher risk of suicide | Less likely to attend appointments | Reduced socialisation |
Thermoregulatory problems | Anxiety and hyperarousal | Longer stay in hospital | Less likely to be employed |
Vulnerable seizure threshold | Chronic fatigue | Earlier admission to long-term care | More likely to be on benefits |
Adequate sleep is essential in treating many of the unhealthy behaviours, chronic conditions and lifestyle diseases that exist in society.
Short sleepers are more likely to be obese; and young children who do not get enough sleep are at greater risk of becoming obese as older children and adults. Poor sleep alters appetite regulating hormones, leptin and ghrelin, which in turn can influence our food choices.
One in five crashes on major roads is related to sleep. Road traffic collisions follow a 24-hour pattern, peaking between 2-7am in the morning and 2-4 pm in the afternoon; times when our circadian arousal signal is low.
Almost 4 in 5 long term poor sleepers suffer from low mood and are seven times more likely to feel helpless. This can be a vicious cycle with stress, anxiety, depression and poor mental health contributing to difficulties sleeping. Persistent insomnia increases the risk of developing severe depression and suicidal behaviour. Sleep problems may be implicated in the aetiology and maintenance of psychiatric disorder rather than being a mere symptom.
Vigilant attention, complex attention and working memory are the cognitive processes most sensitive to sleep loss. Sleep deprivation prior to learning impairs the ability to build new memories - this is true at all ages but may be a particular vulnerability in older people. Sleep also plays a crucial role in consolidating our memory, which is markedly affected by inadequate sleep.
People whose Lifestyle Affects Their Sleeping Patterns
New parents The effects of lack of sleep, such as clumsiness, forgetfulness, disorientation and others are of particular concern when coupled with the responsibilities of being a new parent. Tasks such as co-sleeping, carrying the child, bathing, remembering medications and maintaining a safe environment all become precarious when under the influence of lack of sleep.
Commuters Longer commutes mean that many workers have less free time outside of work to dedicate to health promoting activities, including physical activity, cooking healthy meals and also, sleeping; a phenomenon known as ‘time crunch’ or ‘time scarcity’.
Shift workers There is mounting evidence that the disruption of our body clock over the longer term increases the risk of breast, colorectal, endometrial and prostate cancers, and such data have led WHO to treat night shift work as a probable carcinogen. In addition, increased weight gain, type 2 diabetes and cardiovascular disease have been associated with shift work. ‘Shift work sleep disorder’ is characterised by insomnia, sleep that feels un-refreshing, difficulty concentrating, lack of energy, irritability and potentially depression.
Young people Adolescents have biological changes and environmental and societal demands that impact on sleep. Teenagers are staying up later to interact with peers and engaging in behaviours that contribute to poor sleep hygiene and insufficient sleep. Excessive screen time and screen time in the evening contribute to the problem as not only are young people being prompted to stay up later, they are also being exposed to light in the late evening which shifts the biological clock.
Party animals By staying up past normal sleeping hours when partying, people run the risk of creating a sleep deficit that they often do not compensate for later in the week, leaving themselves susceptible to the negative effects of sleep deprivation.
Section B - Sleep and Mental Health
A study of 273,695 US adults (Blackwelder et al., 2021) participants who averaged 6 hours or less of sleep per night were about 2.5 times more likely to have frequent mental distress than those who slept more than 6 hours. Participants who were divorced/separated/widowed had twice the odds of frequent mental distress compared with study participants who were married. As education levels decreased, the odds of frequent mental distress increased.
Ria (2026) supports these findings, as described immediately below.
The Connection Between Sleep and Mental Health
Enough sleep, especially during the rapid eye movement (REM) phase, facilitates the way the brain processes emotional information through thought and memory processing. As such, insufficient sleep can make it hard to solve problems, make decisions, cope with change, and control your behavior/emotions. Research shows that inadequate sleep is associated with significantly increased odds of frequent mental distress. In fact, sleep and mental health are related in such a way that one may be a cause or consequence of the other.
Poor sleep patterns can also harm the consolidation of positive emotions, leading to mood and emotional reactivity, which are tied to mental health issues such as depression, anxiety, schizophrenia, bipolar disorder, and suicidal ideation. Even ‘healthy’ people are prone to exhibit increased anxiety and/or distress following poor sleep. Late sleep behavior has been linked with a higher risk of anxiety, depression, and other mental conditions. Sleeping earlier, meanwhile, was deemed better for mental health (Ria, 2026).
Sleep & Depression
While sleeping problems have long been seen as a symptom of depression, a report has shown a bidirectional relationship, with insomniacs having a 10-fold risk of developing depression compared to those who sleep well. Furthermore, poor sleep quality has been associated with a worsening of symptoms. In most cases, addressing sleep problems may help alleviate depressive symptoms as doing so will help build emotional resilience (Ria, 2026).
Sleep & Anxiety
Anxiety is often linked with sleep issues. The constant state of worry and fear can lead to hyperarousal, a state where the mind is always racing, and as such can lead to insomnia. Furthermore, lack of sleep can be another source of worry, which could lead to anticipatory anxiety, making it even harder to sleep. PTSD also has a strong connection to poor sleep, as people with PTSD suffer from nightmares, are on high alert, and often replay traumatizing events in their mind (Ria, 2026).
Suggestions for Practice
During their short course on Understanding Sleep (RSPH, 2021) and an earlier 2016 publication RSPH suggest a number of strategies that people can implement if having trouble sleeping.
Try and implement 'screen-free' time in the hour or two leading up to bed time. If you do use screens in this time, ensure whether what you are viewing is relaxing and does not raise your heart rate.
Consider using a nicotine-free e-cigarette in the evenings if you smoke..
Exercise regularly. Be careful not to participate in intense exercise close to your bed time.
Keep a regular sleep schedule - try and wake up and go to bed at more or less the same time each day.
Establish what a good night's sleep feels like.
Have a relaxing bed time routine e.g. having a bath or reading.
Keep a cool bedroom environment.
Replace caffeinated evening drinks with un-caffeinated ones such as herbal teas.
Keep a notepad next to the bed and write down any thoughts or worries that enter the mind while trying to sleep.
Employers should consider implementing flexible working hours and managing the risks of shift work.
Avoid
Consuming alcohol, nicotine or caffeine in the hours before bed time.
Eating too close to bed time because digesting food raises the body’s core temperature which impacts the ability to produce melatonin.
Napping for more than 20-30 minutes at a time.
Having lie-ins that last longer than one or two hours on the weekend.
Lying in bed for hours if not sleeping. If trying to sleep for half an hour or more then get up, move to another room and read or do something relaxing until tired enough to try sleeping again.
Ria (2026) includes many of the above when providing strategies to improve sleep and mental health.
Establish a Consistent Sleep Routine To get enough sleep every night, you need to establish a sleep routine, which could include a shower, brushing teeth, and wearing comfortable pyjamas before bedtime. Reading a book or listening to soft music could be part of a nightly routine as well. Setting a ‘lights off’ time and avoiding afternoon naps will also help. Additionally, make sure to avoid caffeine, nicotine, a large meal, or strenuous exercise near bedtime.
Create a Sleep-Friendly Environment Making your bedroom sleep-friendly will assist sleep:
Keep the room dark and cool
Turn off devices that could affect sleep
Keep pets outside the room
Use a white noise machine
Manage Stress If feeling stressed, try any of these methods:
Deep breathing exercises: Inhale through the nose and exhale through the mouth. Count your breaths.
Progressive muscle relaxation (PMR): Focus on one part of the body — tense and relax these muscles until feeling fully relaxed.
Yoga: The deep breathing exercises, stretches, and slow movements associated with this exercise can help calm the mind and relieve stress.
Cognitive-Behavioral Therapy Cognitive-behavioral therapy (CBT) can help people determine the thoughts and behaviors that affect their sleep and replace them with habits that promote sleep. CBT can also help with depression, as it can help people break feelings of self-doubt and guilt. Likewise, CBT can help with anxiety disorders by altering one’s maladaptive emotional responses.
Seek Professional Help If sleeping problems have persisted for more than three months, then consider seeing a physician or nurse practitioner specializing in sleep. Likewise, a psychiatrist, psychologist, or psychiatric-mental health nurse can help deal with your mental health condition such as depression or anxiety.
Sleep and dementia (Dementia Australia, 2026)
Sleep disturbance is one of the most common causes of burnout for partners/carers of a person with dementia.
Treatment
Start with a medical consult (GP or neurological specialist)
Medication side effects
Restless leg syndrome
Sleep apnoea
REM sleep behaviour disorder
Hypersomnia
Pain
Mood disorders like depression
Acute illness (especially when there is a sudden change in sleep patterns)
Other things to do
Daily physical activity and access to fresh air and sunlight
Build a routine for cognitive and social stimulation
Many complimentary programs are available for people living with dementia
Dance
Music
Art
Improvised comedy
Massage and aromatherapy may reduce stimulation and support relaxation in the evenings
Adapt the physical environment
Ask an OT about optimizing “sleep hygiene,” the pre-sleep routine and set up of the sleeping space. This may include
Reducing blue light exposure and other stimuli in the room
Adding a white noise machine, positioning device, or a light box for daytime use
Supplementary Material - Adults
Further resources (from Beyond Blue, n.d.)
General information
Sleep Health Foundation – Facts sheets by Australia’s leading advocacy organisation for sleep health in the community. https://www.sleephealthfoundation.org.au/all-sleep-factsheets-a-z
Centre for Clinical Interventions – sleep information and self-help workbooks https://www.cci.health.wa.gov.au/Resources/Looking-After-Yourself/Sleep
Wellmob – Sleep resources for Aboriginal and Torres Strait Islander peoples. https://wellmob.org.au/e-health-topics/body/sleep/
Sleep programs for adults
This Way Up: Managing Insomnia – a free, 4-lesson online CBT-Insomnia program https://thiswayup.org.au/what-we-treat/insomnia
Let’s Yarn About Sleep – Culturally responsive programs for First Nations Peoples and health professionals to better understand sleep health and how to provide high quality care. https://letsyarnaboutsleep.org/
C. References
Beyond Blue. (n.d.). Sleep and mental health. https://www.beyondblue.org.au/mental-health/wellbeing/sleep
Blackwelder A, Hoskins M, Huber L. (2021). Effect of Inadequate Sleep on Frequent Mental Distress. Preventing Chronic Disease, 18, 200573. http://dx.doi.org/10.5888/pcd18.200573
Dementia Australia. (2026). Sleep and dementia. https://www.dementia.org.au/living-dementia/mood-and-behaviour-changes/sleep-and-dementia
Ria, R. (2026). The link between sleep and mental health: Why bad sleep fuels anxiety and depression. Nurse Practitioner Programs. https://npprograms.org/link-between-sleep-mental-health/
RSPH: Royal Society for Public Health. (2016). Waking up to the health benefits of sleep. https://www.ndcn.ox.ac.uk/files/news/sleep-report-rsph.pdf
RSPH: Royal Society for Public Health. (2021). Understanding sleep. https://www.rsph.org.uk/qualifications-training/online-courses/understanding-sleep/
