I have a terrible time getting up in the morning. I feel cold and grumpy. Is this part of mental illness?
(Column: Ask the Therapist)
Sleep: Normal Or Mental Illness?
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Maybe not. Each of us has an internal clock with daily rhythms. Some of us are morning people. Morning people have body temperatures that rise in the morning and they wake up cheerful. These are the folks who jump out of bed, ready to talk, to exercise, to go to work. Of course, these are the same people who fade early in the evening, feeling cold and tired and ready to go to bed about 10pm. Then, there are those of us who would just as soon stay in bed in the morning -- we feel cold and grumpy and hope no one tries to talk to us. We have trouble getting up for school, and resent the 9-5 schedule of the rest of the world. Of course, we are night owls; we feel warm and sharp as the evening unfolds.

If you were allowed to sleep whenever you wanted to, you would discover your ideal time for sleeping and waking. However, most of us get re-trained to an "early" clock by the realities of school, work, parents' schedules, and the schedules of our children. It is possible to learn to sleep and wake in response to a schedule that doesn't fit your internal clock. But, it will probably always be a struggle.

So, when is a sleep pattern part of mental illness? When might this sleep pattern actually contribute to illness? First, let's consider the notion of a "normal" amount of sleep. Most adults need about 8-9 hours of sleep to feel refreshed. And, we need undisturbed sleep. Sleeping "too much" or "too little" is one of the classic signs of depression. Further more, change in your pattern of sleep may be a sign of something wrong.

Most of us will sleep more if we have been working or exercising or worrying more than usual. But if your sleep pattern changes from its usual 7 hours to, for example, a need for 12 hours plus a nap -- and this pattern continues over a few weeks, it is worth asking what is the matter. People having manic episodes usually tell us of drastically reduced need for sleep. Again, when something new and exciting is going on in our lives, less sleep may be a "normal" response. But if the reduced sleep continues, you need to examine what is going on.

Second, more or less sleep is not the only concern. If you don't sleep soundly, your brain doesn't rest either. If you are having trouble breathing due to asthma or a cold or some other physical condition, you will not feel rested. The disturbed sleep will also interfere with your sense of well-being. We know from studies of humans in sleep experiments, that you can induce psychosis simply by keeping a person awake for a few days. We know that humans need sleep. We need the dreaming and non-dreaming periods. Medications can interfere with the dream cycle.

On the other hand, some people report that they have nightmares when they discontinue their anti-psychotic medications, even for a single dose. So, somehow, the antipsychotics work even when we are sleeping. We seem to need to dream. One of the bad effects of sleeping medications is that they can suppress dream sleep. When we go off the medication, the dreams rebound, and we dream more dreams, more vividly to make up for the missed dreaming.

So, if you are grouchy and cold in the morning or the evening, it may just be a part of normal daily rhythms -- and you may just have to learn to "manage" your clock if the rest of the world is not aligned with you. But if your sleep pattern changes and remains changed, or your sleep is disturbed beyond a few nights, or your dreams are disturbing to you over a period of time, ask for some help in figuring out what is going on.
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