Poor sleep can cause or worsen mental illness. Which treatments work and what's just hype?

When Steve Ronningen was about 40 years old, he began experiencing some troubling new symptoms. When he tried to rest, he said it felt like “energy, electricity, [was] running through my limbs.” He couldn’t sit still, and he couldn’t sleep. He would pace his home at night – sometimes even jumping up and down — to relieve the sensation. But any relief was fleeting.

Ronningen was diagnosed with restless leg syndrome, a neurological condition marked by an irresistible urge to move the legs. Sleeping more than a few hours each night felt futile. He and his wife Mary started sleeping in separate beds, so she could get some rest. They avoided travel because long plane rides or drives could be torture. And the overwhelming fatigue eventually forced him to retire early from his role as a Lutheran pastor.

Sitting next to Mary on a couch in their living room in Rochester, Ronningen, now 78, holds the diaries he’s kept over the years documenting the weariness he’d experienced during decades of sleeplessness. He reads aloud an entry he wrote in 2010.

“I slept five minutes…10 minutes…one hour. I'm so tired, I collapsed and cried, and Mary held me.”

Treatments and misinformation abound

The typical American is underslept, and a lack of sleep can have severe physical and mental health consequences, including anxiety, high blood pressure, and depression, among other issues. But people seeking help in getting a good night’s sleep can easily be overwhelmed by the barrage of treatments available.

Dr. Bhanu Kolla, Ronningen’s doctor and a consultant at Mayo Clinic’s renowned Center for Sleep Medicine in Rochester, said sleep disorders are so common that sleep remedies, whether they work or not, have sprung into big business.

“It is an extremely lucrative industry,” Kolla said. “And I think a lot of private equity money and other money is sort of targeting sleep, which a lot of people rightly see as a ticket to good health.”

For people like Steve Ronningen looking for answers and any relief, it’s easy to get lured in by the social media influencers touting miracle cures.

There are supplements, sleep tracking apps, cannabis gummies, melatonin, special mouth guards, and weighted blankets, just to name a few. Ronningen even tried rubbing his body with olive oil at night on the advice of an ayurvedic doctor. There’s no shortage of advice online, and it can be hard to parse what works and what’s just trendy before seeing a doctor.

Kolla said some treatment options like CPAP machines are tried and tested. The mask-and-tube breathing machine is considered the gold standard for people with sleep apnea, a common sleep disorder in which breathing repeatedly stops and starts during sleep.

He said other options like cannabis gummies and melatonin, are fairly innocuous, but there are caveats. Kolla warned that there is little evidence that gummies help with sleep, and warned that people who use it can build up a tolerance to the drug and then suffer from impaired sleep once they stop taking it. Melatonin – though generally safe – is not FDA regulated, so Kolla recommends some discernment before purchasing the supplement.

Then there are treatment options that don’t amount to more than hype. Take “mouth tape,” a wellness trend where people tape their mouth shut to promote nasal breathing to supposedly improve sleep quality. And Kolla warned that the “social media phenomenon” could actually be dangerous.

“In certain subsets of the population where they have lung conditions, sleep apnea, significant nasal congestion – it might actually be detrimental,” Kolla explained.

Incoming innovations

For Steve Ronningen’s restless leg syndrome, Kolla put him on a medication regimen which helped initially. But then his body adjusted to the medications and they were no longer effective. The couple tried everything else they could think of, including cannabis, melatonin, and nearly a dozen other things, including the aforementioned olive oil rub, but to no avail.

“Nothing was changing, nothing was helping, nothing was getting better,” Mary Ronningen said. “He would do anything to make it better. And it felt like we were running out of things to do.”

Fortunately, for patients like Ronningen, the industry is evolving rapidly and treatments (backed by science over influencers) are improving. Andrew Stiehm, an Allina Health pulmonary and sleep medicine physician, said advancements on the medical side are accelerating alongside the ballooning commercial market.

“This is a field of medicine, really, by and large, in its infancy,” Stiehm said.

Take the problem of sleep apnea, for example. One of the first treatments was a tracheostomy, where doctors put a hole in a person’s neck so they can breathe through their neck at night instead of their mouth. Then CPAP came along. Then scientists developed a hypoglossal nerve stimulator that moves your tongue while you sleep and a mouthguard that moves your jaw. Now, the industry is testing out a pill to treat sleep apnea that would help maintain muscle tone in the neck to make breathing easier at night.

Stiehm now sees the industry shifting to put a bigger emphasis on therapeutic innovations, as products such as Apple watches and other devices that can monitor your sleep become more popular.

“I think you're going to see our field of medicine move away from testing, which has really been the biggest part of our profession in the 90s, and move more towards treatment.”

Finding answers

For many patients, it can take years of experimentation to find out what works. That’s what Steve was doing – from the get go. And it finally paid off.

A neurologist suggested he try opioids. The drugs act on receptors in the brain to relieve pain and they’re increasingly used to treat restless leg syndrome to help patients like Ronningen who have not responded to other therapies.

In 2024, Kolla prescribed that Ronningen start using a low-dose daily patch that dissolves in the mouth and lasts throughout the night.

“Boy, that has just been such a game changer,” Ronningen told MPR News. “I feel like I'm sleeping seven, eight hours a night.”

Sitting on his couch, the sun shining through his living room window, Ronningen looked at ease. He said his life feels different now.

“[I feel] chipper, like the whole day is in front of me and that I can do things,” he said.

“I think you feel joy,” Ronningen’s wife Mary added.

“Joy, yeah, that’s a good word,” Steve Ronningen agreed, smiling, adding that the improvement in his mental health now that he gets a good night’s sleep is like night and day.

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