This article is part of PAR’s Mental Health Awareness Month series, in which we will be focusing on the multifaceted issue of mental health in the U.S.
“Waking up on the wrong side of the bed” is more than just a saying—we all have experienced the impact of a poor night’s sleep on our daily activities. Quality sleep is an essential component to good mental health, and there is a significant body of research showing the impact of sleep on anxiety, depression, suicide risk, PTSD, addiction, and much more.
In support of Mental Health Awareness Month, we sat down with Melissa Milanak, PhD, Clinical Assessment Advisor at PAR and sleep expert, to get some tips on how to get a more restful night’s sleep and debunk some of the common misperceptions of sleep.
Dr. Milanak, what do you think people need to know about the importance of sleep?
People have come to believe the myth that the body can get used to less sleep. We have such busy days that we cheat our sleep to try to fit more in but fail to realize that on too little sleep, we are less productive and less efficient. This means it can actually take us longer to do things than if we had gotten more sleep! Research finds that both short- and long-term sleep deprivation can have significant negative effects on your body and your brain, proving that your body doesn't adapt to lack of sleep.
We have to make sure that we're giving ourselves the opportunity to have quality restorative sleep without it being fragmented. It’s important for us to prioritize sleeping straight through the night and get the full amount of sleep that our bodies need.
From a short-term standpoint, if you don’t have a good night’s rest, you may have some difficulties concentrating, some decline in mood or memory, or even feel fatigued. But longer term, we can see a significant negative impact on work performance or cognitive functioning. Lack of sleep can even increase the risk for dementia.
Does everyone need the same amount of sleep?
The standard of 8 hours of sleep is not actually a one-size-fits-all number. Eight hours is only an average. We are all unique and our needs vary. Some individuals require a shorter amount of time to be fully rested, while others need more. Also, this changes throughout our lives based upon many factors such as age and physical activity.
As we sleep, we go through a process of cycles of sleep made up of stages of sleep. So much of this is dependent on how quickly we cycle through the different stages of sleep. Over the course of the night, the percentage of time spent in each stage of sleep changes, so we have to build up enough sleepiness to sleep all the way through the night to complete the process. We need to make sure we are getting to spend enough time in the stages of sleep that occur more frequently later in the process, in the early morning hours.
This is also why we need to reduce the number of times we wake up. Each time we wake up, the process has to start over, so we can end up cheating ourselves out of those later stages of sleep that are responsible for cognitive processing and emotional wellbeing.
Also, the older we get, typically the less sleep we need. If you think of it logically, sleep is designed for repair, rejuvenation, and growth. As we age, our cells are changing at a much slower pace. Think of how much sleep a newborn needs versus a baby or an adolescent.
How do you know what your ideal amount of sleep is?
When you have achieved your ideal amount of sleep, you will fall asleep within 10–15 minutes, sleep straight through the night (minus a possible bathroom break) and wake up feeling rested without daytime fatigue.
Can I catch up on sleep if I take a nap or sleep late on the weekends?
Catching up on sleep is something that people are constantly talking about trying to do. But research shows us that if you are not getting the adequate amount of sleep that your body needs, it can take at least four days for the body to make up for one hour less sleep.
If you're trying to make up that sleep debt and you take that nap and go to bed earlier, you may wake up the next day and not feel as tired, but it doesn't mean that your body made up for the lost sleep the night before.
Additionally, research has shown catching up on sleep doesn't immediately right the impact lack of sleep can have on our metabolism. We want to get ourselves right back on track to get to a place where we're getting the adequate amount that our bodies need. It's not as simple as just taking our weekends to try and “catch up” on sleep. It's going to be a much longer process to get back to what our bodies need.
When you go to bed at different times, it can confuse your brain and make it harder to fall asleep over time. Your brain doesn't know when to feel tired. Think of it just like if you eat dinner at the same time every night, your brain knows to get hungry at the same time.
What should I do if I can’t fall asleep?
If you are trying to get to sleep and are awake for more than 15 minutes, get out of bed and do something boring in low light until you are sleepy enough to return to bed.
The longer you spend in bed when you are not sleepy or are worrying, the more you will associate your bed with fear, worry, anxiety, and frustration. You want your body to associate your bed with sleep and not those feelings.
Any tips for waking up in the middle of the night?
If you wake in the night, do not check the clock! This adds to your stress as you begin calculating how much more sleep you might get. If your alarm has not gone off, then it does not matter what time it is. All that matters is that it is not time to be awake yet.
If you truly cannot fall back to sleep, get out of bed. You can also do things to trigger sleep like redoing your wind-down routine to help your body and brain know it's time to sleep.
What is the most important thing people should focus on to improve their sleep?
One of the most important things we can do to improve our sleep is to have a consistent sleep and wake time seven days a week. If you go to sleep one night past your bedtime, it is very important to still wake up the next day at your regular wake up time. Although you will feel sleepier throughout the day, it is important to stay awake until your normal bedtime. Consistency with your sleep schedule is key.
If you have a night where you did not sleep well, do not go to bed earlier the next night trying to catch up on sleep. When you try to force yourself to spend more time in bed than your body needs, you will wake up more often and get less quality, sustained sleep.
And finally, make sure you reserve your bed for sleep—not reading, watching TV, or eating. Otherwise, your brain gets confused as to whether it should be asleep or awake when in bed.
This article is part of PAR’s Mental Health Awareness Month series, in which we will be focusing on the multifaceted issue of mental health in the U.S. Come back each week for more insight.
Our mental health often takes a backseat in the world of constant hustle, daily pressures, and to-do lists. But what if the key to a brighter mood and a more resilient mental state lies in the very act of movement? New research finds that physical activity, in any form, is directly linked to better mental health.
From the growth of new brain cells to exercise's benefits on sleep, this article takes a deep dive into this topic and reveals:
The Mind–Body Connection
As we dive into the relationship between exercise and mental health or the “mind–body” connection, understanding how exercise helps release chemicals that positively influence brain function is essential. Below, we highlight three key actions that take place during physical activity.
Neurotransmitter Release
During exercise, your body releases neurotransmitters, including:
This chemical release is not just good for your body; it also benefits your mental well-being. Why? These neurotransmitters elevate mood and reduce stress. One review revealed that the positive effects of physical exercise on dopamine levels could result in using exercise as an intervention for treating mental illness.
BDNF: "Miracle-Gro" for the Brain
Not only does exercise kickstart neurotransmitter release, but it also amplifies neuroplasticity, or the brain's ability to adapt and change. Exercise heightens neuroplasticity by boosting brain-derived neurotrophic factor (BDNF) release. BDNF supports neuron growth and development, or as Dr. John Ratey, Harvard neuropsychiatrist, states in his book SPARK: The Revolutionary New Science of Exercise and the Brain, "BDNF is Miracle-Gro for the brain."
What does this mean? The more brain cells you activate during exercise, the more BDNF you have—it's like brain fertilizer. This increase in neuroplasticity leads to improved cognitive function.
Oxygen Boost
Exercise also boosts the oxygen supply to the brain, promoting better cognitive function. When you engage in physical activities, your heart pumps faster, leading to blood vessel growth. This increase in oxygen supply has a profound effect on mental health.
Why? A well-oxygenated brain is a healthy brain. Boosting oxygen levels through exercise helps improve executive function, including flexible thinking and self-control. This action allows the brain to become more resilient against issues like depression and anxiety.
The Protective Benefits of Physical Activity
According to the John W. Brick Foundation and their review of more than 1,000 studies on the link between exercise and mental wellness, 89% found a significant positive association between physical activity and mental health.
So, what do these benefits look like, and how do they protect mental well-being? We break them down below.
Relieves Stress
Stress is a toxic, silent killer. Chronic stress in the body leads to high cortisol levels and other stress hormones that disrupt almost all the body's systems. This upheaval can lead to obesity, heart disease, and other health disorders. Unfortunately, it can also usher in mental health issues such as depression. Regular physical activity is effective because it reduces stress hormones such as cortisol and norepinephrine. This activity reboots the body's stress response, reducing the reactivity to psychological stressors—leading to better cognitive balance and calm.
The latest research also reveals that people with stress-related conditions such as depression experience the most cardiovascular benefits from exercise. The study also found that physical activity enhances prefrontal cortex function, which helps regulate stress responses in the brain.
Enhances Mood
Exercise is also a powerful mood enhancer. It activates the release of neurotransmitters like endorphins and endocannabinoids, also known as “feel-good” chemicals. These little mood boosters can ease depression and anxiety symptoms, potentially preventing these conditions from recurring.
Improves Sleep
Regular exercise can significantly improve sleep quality. But first, why is good sleep crucial to positive mental health? Studies show that sleep deficits can change activity in some parts of the brain. When this happens, it can lead to a person having trouble solving problems, controlling emotions and behavior, and managing change.
Sleep deficiency is also linked to depression, suicide, and risk-taking behavior. Research reveals that physical activity can counteract these issues because it contributes to better sleep efficiency, longer sleep duration, and quicker sleep onset. One study explains why:
Now that we know how exercise can protect mental health, it's time to spotlight its role as preventive medicine.
Exercise as Preventive Medicine
Engaging in regular physical activity lowers the risks of mental health conditions, including depression and anxiety. Here is some notable research supporting these benefits:
Another way physical activity can lower the risk of mental health issues is by reducing inflammation. Immediately after exercising, the muscles release myokines, hormones produced by muscle tissue, which clean up inflammation. Through consistent exercise, the body becomes less and less inflamed. This is important because inflammation impacts mood by altering the production of serotonin (the “feel-good” hormone). When this malfunction happens, it can be challenging to shut off the stress response.
Creating an Effective Exercise Routine for Better Mental Health
Understanding exercise's protective factors on mental health is only half the battle. The real challenge lies in building a routine that boosts physical fitness and promotes better mental health.
Here are four easy guidelines to get started:
It's clear that exercise isn't just a powerhouse for physical health; it also protects against potential mental health problems. Whether a seasoned athlete or someone just starting out, remember that each step and stretch contributes to a stronger body and a more resilient mind.
So, get out there and get moving!
Before the pandemic, reports indicated a concerning increase in mental health issues among American youth, including rising feelings of sadness, hopelessness, and suicidal ideation. There was already an approximate 40% surge in these factors before the COVID-19 pandemic introduced additional stressors such as social isolation, disruptions in daily routines, and economic strain due to caregiver job losses. These stressors led to a significant increase in mental health emergencies, with a 24% increase in emergency department visits for mental health issues among children aged 5–11 and a 31% increase among those aged 12–17. Suspected suicide attempts among girls aged 12–17 also rose by 51% in 2021 compared to 2019.
The issue of chronic absenteeism, where students miss 10% or more of instructional days per year, has only added to the existing problems. Before the pandemic, in the academic year 2021–2022, more than 66% of students attended schools where 20% or more of the student population was chronically absent. In 2023, 26% of students continued to be chronically absent. Mental health concerns are one of the reasons many cite for this increase in chronic absenteeism.
State Efforts
Several states have responded to students’ mental health challenges by enacting laws allowing for mental health days. Minnesota took the lead in 2009 by passing a bill that recognized excused absences for mental health conditions requiring treatment. This effort has since expanded to states like Oregon, where legislation allows students to take mental health days without fear of penalties.
The specifics of these policies vary among the 12 states that have implemented laws allowing mental health days, but some states have similar laws. Washington, Maine, and Virginia permit students to cite mental or behavioral health issues as valid excuses for school absences.
California's Senate Bills 14 and 224 allow for mental or behavioral health days and incorporate mental health content into the health education curriculum. In Illinois, schools are mandated to grant students up to 5 mental health days annually and treat them as excused absences. Colorado passed a bill requiring school districts to establish policies for excused absences related to behavioral health concerns.
Oregon allows students to take up to 5 days off within a three-month period, including mental health days. Connecticut allows for 2 mental health wellness days yearly, provided they are not consecutive. Arizona treats mental health days similarly to sick days, with policies varying across school districts. Nevada introduced Senate Bill 249, enabling students age 7–18 years to miss school for mental health reasons with a note from a mental or behavioral health professional. Utah acknowledges mental or behavioral health as a valid reason for an excused absence for all students. Meanwhile, Kentucky signed House Bill 44, permitting students to take days off from school for mental health reasons as excused absences.
These varied approaches reflect states' diverse strategies to support students' mental health needs. However, despite the progress made by some states, many still lack specific laws regarding mental health days.
Impact of Mental Health on Learning
Mental health can significantly influence academic performance, and stress and emotions are critical factors in the learning process. When properly managed, stress can improve memory and learning. However, when stress levels become excessive, they can disrupt concentration and memory retention, ultimately hindering academic achievement. Similarly, emotions like happiness or anxiety can affect learning. Although positive emotions can help, negative emotions can make focusing more difficult.
The following are some of the critical ways that mental health issues affect students:
Benefits of Mental Health Days
Advocates say that encouraging students to take mental health days can effectively address absenteeism and promote their mental health and overall well-being. And by making these excused absences, this can help parse which students are having mental health concerns from those who are actually truant. According to advocacy group Attendance Works, this can help create a more productive relationship between the school and the family by understanding the root cause of the absence, leading to better outcomes.
The following is a summary of other benefits:
In conclusion, although some states have recognized the importance of mental health days for students, there are still many disparities in legislation and implementation. No matter where you live, advocating for comprehensive mental health policies at the state level is critical to promoting a nationwide culture of prioritizing mental wellbeing in schools.
This is part of PAR’s Mental Health Awareness Month series, in which we will be focusing on the multifaceted issue of mental health in the U.S. Come back each week for more insight.
The last few years have seen a global pandemic, international conflicts, civil unrest, increased inflation, and many natural disasters. The American Psychological Association (APA) Stress in America survey takes a closer look at what Americans have been experiencing and provides insight into recent trends. This data provides better understanding of how Americans are handling a multitude of stressors and helps to show us what is going on in the minds of Americans of different ages.
Collective trauma and post-pandemic effects
The survey starts with the idea of collective trauma, understanding that everyone has been deeply affected by difficult events collectively. Even though COVID-19 may not be a national emergency anymore, it has left mental and emotional effects on most Americans.
Arthur C. Evans Jr., PhD, Chief Executive Officer of the APA, points out that although many people seem to be moving on from the pandemic, we are still dealing with the lasting effects of these challenging times. The collective trauma of the pandemic continues to have an impact on individuals in significant ways.
Long-term stress and health implications
The survey looks at how long-term stress has affected the bodies and minds of Americans. In addition to the impact of stress on mental health, ongoing stress has also led to various physical health problems. These physical health problems include inflammation, weakened immune systems, digestive issues, heart disease, weight gain, and even stroke.
Dealing with long-term stress requires different approaches and comprehensive strategies to stay healthy.
Increase in chronic illnesses and mental health diagnoses
One of the striking findings of this survey is the significant increase in chronic illnesses and mental health issues, especially among adults age 35 to 44 years.
The numbers show that chronic illnesses increased from 48% in 2019 to 58% in 2023 in this age group. At the same time, mental health diagnoses rose from 31% to 45%.
Moreover, although many people rated their physical health as good (81%), two-thirds still cite chronic illnesses like high blood pressure (28%), high cholesterol (24%), or arthritis (17%). Similarly, while 81% said their mental health is good, over a third have been diagnosed with mental health conditions, mainly anxiety (24%) or depression (23%).
Challenges in stress management
Although people know stress is a problem, many find it hard to handle. They may think their problems aren't big enough to be concerned about or they may not have time or resources to devote to combatting this concern.
According to survey data, about three out of every five adults don't talk about their stress because they don't want to bother anyone else—meaning most people who are struggling with stress are not sharing this concern.
Stress levels and sources
The survey gives a clear view of how stressed people are and what's causing this stress. The most common causes of stress were found to be worries about the country's future, violence, crime, money problems, and health issues.
Age-based and lifestyle stress variations
Different age cohorts experience stress differently. Adults age 35 to 44 and 45 to 64 are more likely to be stressed about financial and economic issues, whereas those age 65 years and older cite being concerned about health-related problems. Parents, single-adult households, and retirees experience stressors related to family responsibilities, finances, and personal safety, showcasing the diverse stress landscape across life stages.
According to the survey, the following are the top stressors based on age group:
Age 18–25 years
Age 26–39 years
Age 40–55 years
Age 56 and older
Gender disparities in stress
This year's data reveals that women report higher stress levels than men. On a scale of 1 to 10, women report an average of 5.3 compared to 4.8 for men. Nearly a third of women ranked their current stress level as an 8 out of 10, compared to 21% of men. Furthermore, 68% of women stated they needed more emotional support in the past year to deal with stress about money problems, family responsibilities, relationships, and discrimination.
Discrimination and personal safety are significant stressors
Discrimination is a growing concern for adults. Nearly two in five of the individuals surveyed cite personal safety as a major cause of stress. More than a quarter mention discrimination as a significant stressor.
LGBTQIA+ adults face even higher levels of discrimination-related stress, with more than half saying they do not feel comfortable sharing their experiences out of fear and 43% saying they do not feel acceptance in their community.
Adults with a disability cite discrimination as a significant factor (34%) in their stress and 40% of these individuals feel a lack of acceptance in their community.
Furthermore, Black and Latino/a/e adults surveyed were more likely than Asian and White adults to mention discrimination as a significant stressor (43% and 40% vs. 31% and 19%) and were more likely to report experiencing everyday acts of discrimination.
Importance of social support and coping mechanisms
The survey shows how important it is to have support from friends, family, and communities when dealing with stress. People who feel supported by others tend to have less stress. About 75% of the participants said social support helps them feel better and improves their mental health. Yet stress gets in the way of individuals bettering their communities—about 46% of adults say their day-to-day stress distracts them from acting to create change where they live.
The survey also found that doing things like exercising, practicing mindfulness, or enjoying hobbies can help manage stress. About 80% of people said using these coping strategies has proven to be helpful to their wellbeing.
Conclusion
The APA Stress in America survey offers important insights into stress across the US. Understanding these trends can help policymakers, healthcare providers, and communities in creating strategies and support systems for improving stress management, boosting mental health, and building resilience amidst ongoing challenges.
Learn more about APA's Stress in America results.
Mental Health Awareness Month takes place each May to promote awareness about the critical role mental health plays in overall health and well-being.
Throughout this month, PAR will be sharing information on the state of mental health as well as resources you can share to support individuals and communities who may be in need of mental health information and support.
Mental Health Awareness Month seeks to raise awareness about the importance of mental health and reduce the stigma surrounding mental health disorders. Please join us in playing a crucial role in promoting awareness and taking action to improve the mental health of our communities.
History of Mental Health Awareness Month
Mental Health Awareness Month began in the United States in 1949 as Mental Health Week, but expanded to a month-long observance in 1980.
The goal of Mental Health Awareness Month is to raise awareness about mental health and wellness, reduce the stigma surrounding mental health conditions, and promote greater access to mental health services and resources.
Why is Mental Health Awareness Month important?
According to the Centers for Disease Control and Prevention, more than 1 in 5 adults in the U. S. are living with a mental illness. And despite how common mental health concerns may be, discrimination and stigma are still cited as being significant barriers to treatment and recovery, meaning many people fail to receive the support and care they need.
Why is it important to talk about mental health?
Mental Health Awareness Month provides an opportunity to fight stigma and break down misunderstandings about mental health by raising awareness. It also helps people know about resources available in their communities. By speaking openly about mental health, we can encourage people to seek support, normalize the conversation around mental health, and help provide access to much-needed services.
What can mental health professionals do to get involved?
Mental health professionals play an important role in promoting mental health awareness. Here are a few things you can do during Mental Health Awareness Month:
1) Use your platform and expertise to educate others about mental health and wellness. Share information about Mental Health Awareness Month on social media and within your professional networks.
2) Connect with local organizations and community groups to promote mental health awareness. Offer to speak at events or host workshops on mental health and wellness. Collaborate with other mental health professionals and organizations to create events and initiatives that promote mental health awareness and reduce stigma.
3) Promote advocacy efforts that resonate with you. Contact your elected officials to express your support for mental health legislation and advocate for increased funding for mental health services and research.
Throughout the month, PAR will be providing education and resources that will help clinicians as well as those you serve. Come back each week to continue the conversation!