Imagine you got a rough night of sleep. Perhaps you went to bed too late, needed to wake up early or still felt tired when you woke up from what should have been a full night’s sleep.
For the rest of the day, you feel groggy and unfocused. Things that are usually fun or exciting don’t give you the same level of pleasure. You don’t have energy to exercise, so you avoid it. You don’t feel motivated to see friends, so you cancel plans with them. You focus on your rough day as you try to fall asleep that night and start to have anxiety about the next day. Instead of getting the restful night of sleep you need, you have another night of poor sleep. You become caught in a vicious cycle of poor sleep and depressed mood.
Sleep and mental health problems often go hand in hand. Sleep problems are a core symptom of depression. In addition, there is strong evidence that sleep problems contribute to many mental health disorders, including schizophrenia and post-traumatic stress disorder, or PTSD.
Yet our mental health also affects how well we sleep. Issues such as distressing thoughts and trouble relaxing can make it difficult for people to fall asleep or stay asleep, exacerbating sleep problems.
These issues are particularly pronounced during pregnancy, when the circular effects of inadequate sleep and mental health challenges can have harmful effects for mothers and their offspring.
We are a developmental psychologist and a doctoral student in psychology who study sleep and mental health from pregnancy through adulthood. As researchers in this field, we see the impacts of sleep and mental health problems firsthand.
Sleep and mental health problems are so entangled that it is unsurprising that they can each make the other worse. But it does make treating them more challenging.
Biology of sleep and mental health
Researchers and medical professionals know that sleep is essential for the body and brain to function properly.
Sleep is important for establishing circadian rhythms, which optimize alertness during the day and rest at night. When sunlight fades in the evening, the brain produces more of the hormone melatonin, and your core body temperature drops to promote sleep. When the brain detects sunlight, it reduces melatonin production, and body temperature increases to promote wakefulness.
Although light and dark are the most important signals to the brain about when you should be awake and when you should be sleeping, other things such as stress, disruptions in daily routines and social interactions can also throw off your circadian rhythm.
Circadian rhythms affect other important biological processes, including the body’s production of the stress hormone cortisol. Cortisol follows a daily rhythm where it is highest soon after waking in the morning and lowest in the middle of the night. Disruptions in normal sleep can lead to difficulties in daily regulation of cortisol levels, which can have negative effects on mental health and the ability to effectively manage stress.
Sleep is central to the proper functioning of the immune system, which in turn has implications for mental and physical health. Sleep disturbances have been linked to poorer immune responses against viruses and other challenges to the immune system, making it harder to stay healthy and to recover after getting sick.
Sleep disturbances also lead to greater inflammation, which is when the immune system’s natural responses become overactive. Inflammation underlies mental and physical health problems, including depression, heart disease and cancer.
How poor sleep leads to behavior changes
Chronic disruptions to a person’s natural circadian rhythm – such as people who work night shifts or who switch between day and night shifts – lead to greater risk for both depression and anxiety.
Shift work is an extreme example of disrupting the natural pattern of sleeping at night. However, less severe types of sleep problems, such as not getting enough sleep or waking up feeling tired, are also bad for mental health.
Sleep disruptions make it more difficult to regulate emotions. Having too little or poor quality sleep make handling everyday stressors more difficult. This is because sufficient sleep is necessary for effective problem-solving, memory and focusing. The combination of impaired emotion regulation and stress management abilities are a recipe for greater mental health difficulties.
One key reason why poor sleep and mental health struggles can become so problematic and difficult to treat is that without adequate sleep, it’s challenging to muster energy for healthy activities such as exercise and maintaining social relationships.
What’s more, when decision-making is impaired by poor sleep and negative emotions, people are more likely to reach for alcohol, drugs and unhealthy foods to cope with stress. These unhealthy behaviors can, in turn, reinforce the cycle by interfering with sleep.
Sleep and mental health problems in pregnancy
These cycles between poor sleep and mental health challenges can be especially problematic during pregnancy.
Common pregnancy symptoms include nausea, heartburn, back and joint pain, cramps, a frequent urge to pee and contractions, all of which can make it more difficult to get restful sleep.
Sadly, around 76% of pregnant women report having sleep problems at some point in their pregnancy, compared with only 33% in the general population. Relatedly, about 1 in 5 pregnant women in the U.S. struggle with mental health problems such as anxiety and depression.
Our team’s new research, published in December 2025, further establishes these links between sleep and mental health. We found that during pregnancy, mental health problems contribute to sleep problems over time and that sleep problems in turn can exacerbate mental health problems.
This cycle can also have negative effects on the fetus and on the child after birth.
Prenatal sleep problems such as short sleep, sleep apnea and restless sleep can lead to preterm births and low birth weight in newborns.
A large study in Sweden in 2021 found that pregnant women who frequently worked the night shift or quickly shifted between night and day work in early pregnancy showed a three-to-four times greater risk for having a preterm birth. Preterm birth and low birthweight are associated with greater cardiovascular risk in both mothers and their offspring.
Prenatal maternal sleep problems can also lead to problems later in the child’s development. A review we also published in 2025 found that children of mothers who had sleep problems in pregnancy tend to have more sleep problems themselves. Our review also reported that children of mothers with prenatal sleep problems are more likely to develop obesity and have more behavioral problems in childhood.
Tassii/iStock via Getty Images Plus
Talking to your doctor about these concerns
In our opinion, it should be standard to screen for sleep problems at medical visits, given the potential implications of inadequate sleep for both mothers and their babies.
If you’re close to someone who is pregnant, consider asking how their sleep is and how they’re feeling. If they note ongoing sleep issues or emotional or behavior changes, you can ask if they have talked to their doctor.
They may feel overwhelmed and need support in talking to their doctor or help finding resources. The Sleep Foundation’s website has a list of sleeping tips for pregnant women as well as guidelines for when to speak with a doctor.
If you are the person experiencing these issues, you can report sleep problems to your doctor and ask for guidance for improving sleep.
If you’re experiencing difficulties with depression or anxiety, tell your doctor and ask for resources. There are mental health resources specific to pregnancy that can help. You can also find mental health professionals through Psychology Today’s find-a-therapist tool.
Healthy sleep is a necessity for improving your mental health during pregnancy and at all times of life.
