Poor sleep is common across virtually every psychological disorder, yet clinicians have long treated it as a side effect rather than a condition worth addressing directly. A new editorial in the British Journal of Clinical Psychology argues that sleep disturbance is a viable, lower-stigma route into mental health treatment.
The research, led by Aliza Werner-Seidler of the Black Dog Institute at the University of New South Wales, Sydney, makes the case that sleep treatment offers a low-stigma, widely accessible route into mental health care.
Sleep disturbance has historically been viewed as a symptom of mental illness rather than a cause. Its place as a diagnostic criterion for depression, generalised anxiety disorder and post-traumatic stress disorder reinforced the view that treating the underlying condition was the logical first step.
The picture has since shifted. Insomnia is now recognised as a key factor in the onset of depression, and poor sleep significantly raises the risk of depressive relapse. The relationship runs in both directions.
The case for targeting sleep rests on more than efficacy. People are more willing to seek help for poor sleep than for psychological difficulties, making it a lower-stigma entry point to care. Sleep is also routinely addressed in primary care, so a wider range of practitioners can identify and treat it.
Consumer wearables and sleep-tracking applications have heightened public awareness, creating opportunities for population-level approaches in schools and workplaces.
Up to about half of children, adolescents and adults worldwide experience poor sleep or inadequate sleep duration. Werner-Seidler and Orchard assembled a special issue of nine studies using randomised trials, cohort studies, pilot investigations, implementation research and qualitative enquiry.
Two papers examined sleep in the context of psychosis, an area the authors describe as relatively understudied. In one, focus groups with young people at very high risk of developing the condition were co-facilitated by peer researchers. Participants described clear links between sleep disruption and psychological distress.
Many reported that improving their sleep brought wider benefits. “Fixing the sleep helped everything else,” one participant said.
A second study examined excessive sleep in people already diagnosed with psychotic disorders. Oversleeping is common in this group, often as a side effect of antipsychotic medication, with interviews reporting significant impacts on daily functioning.
Three further papers examined sleep across depression, social anxiety and suicidality. In a student sample, the link between insomnia and depression was partly explained by two tendencies common in many disorders: interpreting ambiguous situations negatively, and repeatedly dwelling on distressing thoughts.
A daily diary approach tracked sleep and social anxiety across multiple consecutive days, capturing the short-term fluctuations that a snapshot assessment would miss.
Researchers found that poor sleep quality and difficulty falling asleep each predicted higher anxiety the following day, while the reverse was weaker. The pattern pointed to sleep as the more influential direction in the relationship.
A third study followed adults with suicidal ideation for 12 months. Sleep disturbance at the outset predicted greater distress, more severe depression and reduced functioning at every subsequent time point.
Four papers in the special issue tested whether targeting sleep directly could improve outcomes for people living with mental health difficulties. One randomised controlled trial delivered a sleep programme for preschool-aged children via videoconferencing, removing access barriers. Children showed greater reductions in sleep problems, nighttime fears and anxiety than those receiving standard care, with gains held at three-month follow-up.
A second study trained practitioners in youth mental health services to deliver a structured sleep intervention to young people already in their care. Both sleep and mental health outcomes improved, with medium to large effect sizes reported.
One pilot study tested whether sleeping immediately after exposure therapy would strengthen anxiety treatment through sleep’s role in consolidating new learning. The sleep group showed no better anxiety outcomes than those who stayed awake, though both improved.
Whether sleep can enhance other therapies this way remains an open question.
The final paper examined whether prior medical racism affected how Black women engaged with an online sleep programme. Just over a third of participants reported such experiences, but it did not significantly alter engagement or outcomes.
The editorial identifies two gaps the field still needs to address. Healthcare practitioners receive little training in sleep medicine, limiting their capacity to respond when patients present with sleep difficulties. Getting treatments into routine clinical practice also takes considerable time.
One analysis puts the average lag between treatment development and routine clinical adoption at around 17 years.
Werner-Seidler and Orchard argue that reducing the burden of psychological disorders requires broadening treatment targets beyond the disorders themselves. Sleep, they contend, is one of the most tractable: more accessible than specialist care, lower in stigma, and increasingly supported by evidence.
For someone whose depression or anxiety has not fully responded to medication or talking therapy, this collection raises a practical question: has sleep been directly assessed and treated as a target in its own right?
The editorial, “The importance of targeting sleep in the prevention and treatment of psychological disorders,” was authored by Aliza Werner-Seidler and Faith Orchard.
