Sleep Medicine and Psychiatry: The Bidirectional Risk

Ruth Benca, MD, shared an overview of her presentation at the American Psychiatric Association meeting on sleep medicine for psychiatrists, centered on the bidirectional relationship between sleep disorders and psychiatric illness.

Benca framed sleep disturbance as both a consequence and a predictor of psychiatric illness, positing that complaints of insomnia, excessive sleepiness, or fatigue are not merely symptoms to manage but independent risk factors for the onset and recurrence of major psychiatric disorders.¹ She described the relationship as bidirectional: "sleep problems of various types are predictive of new onset of psychiatric illness, and when patients are having acute episodes of psychiatric illness, that usually makes their sleep worse."²

Benca identified 3 primary sleep disorders warranting systematic evaluation in psychiatric patients. Delayed sleep phase disorder—characterized by an inability to fall asleep until the early morning hours and consequent difficulty waking—was described as disproportionately prevalent across mood disorders, schizophrenia, and posttraumatic stress disorder. Obstructive sleep apnea, she highlighted, is both underdiagnosed and clinically significant, with prevalence estimates of 25 to 50% in patients with mood disorders, and symptom overlap that can obscure the diagnosis or appear as treatment-resistant depression. Circadian rhythm disruption was identified as a third contributor to excessive daytime sleepiness.

Benca emphasized a critical and commonly neglected distinction between sleepiness and fatigue, noting that patients who report being "tired" may be describing either genuine hypersomnolence or a sense of exhaustion without actual sleep propensity—a distinction with direct implications for differential diagnosis and treatment planning. She attributed the most common clinical failure in this domain to an inadequate sleep history, advocating for a structured 24-hour assessment of sleep-wake patterns, onset and maintenance difficulties, daytime functioning, and potential contributing factors.

Dr Benca is chair of psychiatry at Wake Forest University School of Medicine and a specialist in sleep medicine.

References

1. Khurshid KA. Comorbid insomnia and psychiatric disorders: an update. Innov Clin Neurosci. 2018;15(3-4):28-32.

2. Benca R. The overlap in sleep problems and psychiatric disorders. Psychiatric Times. June 19, 2025. https://www.psychiatrictimes.com/view/the-overlap-in-sleep-problems-and-psychiatric-disorders