February has this particular weight to it, doesn't it? The holidays are over, New Year's resolutions have fizzled, and we're stuck in that gray stretch where spring feels impossibly far away. I've noticed that February brings a wave of patients into my office complaining about the same cluster of symptoms: crushing fatigue, irritability that seems to come from nowhere, difficulty concentrating at work, and sleep that's either maddeningly elusive or so heavy they can barely drag themselves out of bed.
Here's what most people don't realize: these aren't character flaws or signs you're "not handling stress well." Your brain is responding to accumulated sleep debt and disrupted circadian rhythms in exactly the way it's designed to respond. The problem is that modern professional life doesn't care about your circadian rhythm, and winter makes everything exponentially worse.
The Architecture of Sleep (And Why It Matters More Than You Think)
Let me start with something that might surprise you. Sleep isn't just "rest." It's not your brain shutting down for eight hours. Sleep is an active, structured process with distinct stages that serve wildly different functions.
When we talk about sleep architecture, we're talking about the pattern of these stages throughout the night—and when that architecture gets disrupted, everything falls apart.
You've got two main categories: REM (rapid eye movement) sleep and non-REM sleep.
Non-REM has three stages. Stage 1 is that brief transition when you're drifting off. Stage 2 is where you spend most of your night—it's light sleep, but it's doing important work for memory consolidation. Stage 3 is deep sleep, sometimes called slow-wave sleep, and this is where the physical restoration happens. Your body repairs tissue, builds bone and muscle, and strengthens your immune system.
Then there's REM sleep, which is where dreams happen. But REM isn't just about having weird narratives play out in your head. This stage is essential for emotional regulation and processing.
During REM sleep, your brain is essentially running simulations, working through emotional experiences, and integrating memories with emotional content. A 2012 study by Rosales-Lagarde et al. demonstrated that REM sleep deprivation enhanced emotional reactivity to threatening visual stimuli (Rosales-Largard et al.). Think about what that means for your professional life. If you're not getting adequate REM sleep, you're literally walking into meetings less able to read the room and react appropriately.
The architecture matters because you cycle through these stages multiple times per night, with each cycle lasting about 90 to 120 minutes. Early in the night, you get more deep sleep. Later in the night—those hours between 4 and 7 AM that many high-achievers sacrifice—you get more REM sleep. Cut your sleep short, and you're predominantly cutting REM. Stay up late scrolling, and you're cutting deep sleep. Either way, you're not getting the full restoration your brain needs.
Circadian Rhythm: Your Body's Internal Clock (That You Keep Ignoring)
Your circadian rhythm is a roughly 24-hour cycle that regulates sleep-wake patterns, hormone release, body temperature, and other functions. It's controlled by a tiny region of your brain called the suprachiasmatic nucleus, which sits just above where your optic nerves cross. This matters because light—particularly blue wavelength light—is the primary signal that sets your circadian clock.
Here's where winter becomes a problem. We're getting less natural light, and what light we do get is weaker and arrives later in the morning. Meanwhile, we're spending evenings under bright artificial lights and staring at screens that blast blue light directly into our eyes. We're essentially giving our brains conflicting information about what time it is.
The consequences go far beyond feeling tired.
A disrupted circadian rhythm affects cortisol release (you need cortisol to wake up and feel alert), melatonin production (which helps you fall asleep), body temperature regulation, and even glucose metabolism.
Research by Baron and Reid published in 2014 found that circadian misalignment increases insulin resistance and inflammation markers, even after a very short time (Baron & Reid, 2014). For my patients who are already managing ADHD, anxiety, or depression, a disrupted circadian rhythm doesn't just make them tired—it destabilizes everything.
I had a patient last month, a managing director at a financial firm, who came in convinced he was experiencing early-onset dementia. He was 42. He couldn't remember names in meetings, was losing his train of thought mid-sentence, and described feeling like he was "moving through fog." His sleep? Four to five hours a night, usually falling asleep after midnight, alarm at 5:30 AM for the gym. Weekends he'd sleep until 10 AM trying to "catch up."
This is textbook circadian disruption. His body had no idea when it was supposed to be awake or asleep. The weekend sleeping pattern was making it worse, not better—it's called social jet lag, and it's like flying from New York to Denver and back every single week.
Why Is Sleep Beneficial for Mood Stabilization?
The relationship between sleep and mood is bidirectional and powerful. Poor sleep makes mood disorders worse. Mood disorders disrupt sleep. It's a vicious cycle that I see play out constantly in my practice.
Here's the neurobiological reality: sleep deprivation affects the prefrontal cortex—the part of your brain responsible for executive function, emotional regulation, and rational decision-making. A fascinating 2007 study using fMRI imaging by Yoo and colleagues showed that sleep-deprived participants had significantly greater amygdala reactivity to negative emotional stimuli compared to well-rested participants (Yoo et al., 2007). The amygdala is your brain's emotional alarm system. When you're sleep-deprived, that alarm is hypersensitive and your prefrontal cortex—which normally helps regulate emotional responses—is essentially offline.
What does this look like in real life? You snap at your assistant over something minor. An email that would normally be mildly annoying sends you into a spiral of rumination. You can't shake off a difficult conversation. You feel emotionally raw, like everything is just too much.
For individuals with ADHD, sleep deprivation is particularly brutal. ADHD already involves dysregulation of attention and emotional control. Sleep deprivation exacerbates every single ADHD symptom. Inattention gets worse. Impulsivity increases. Emotional regulation—already a challenge—becomes nearly impossible.
I've seen patients whose ADHD medication works beautifully when they're sleeping well become convinced the medication has "stopped working" when they're chronically sleep-deprived. The medication didn't change. The neurological foundation it's working with did.
Primary vs. Secondary Insomnia: What's Actually Keeping You Awake?
When someone comes to me reporting insomnia, the first thing I assess is whether this is the primary problem or a symptom of something else. This distinction between primary and secondary insomnia is important because it completely changes how we approach treatment.
Primary insomnia means difficulty sleeping isn't caused by another medical or psychiatric condition. It might be learned—people who've gone through periods of stress sometimes develop conditioned arousal around bedtime. The bedroom becomes associated with anxiety and wakefulness rather than sleep. Or it might be related to hyperarousal, where the nervous system is stuck in a higher gear and can't downshift for sleep.
Secondary insomnia is insomnia that's happening because of something else: depression, anxiety, chronic pain, medication side effects, sleep apnea, restless leg syndrome. The list goes on. Treating secondary insomnia means addressing the underlying cause.
Give someone sleeping pills for insomnia caused by something like untreated sleep apnea, and you've just made them a sedated person who still isn't breathing properly at night.
This is where a thorough evaluation becomes essential. In our practice's concierge psychiatric services, we have the time to actually dig into these questions.
What does your evening routine look like? When did the sleep problems start? What else was happening in your life at that time? Are you waking up gasping? Is your partner complaining about your snoring? Do you have creeping sensations in your legs when you're trying to fall asleep?
I can't tell you how many patients I've seen who've been taking Ambien or trazodone for months or years without anyone asking these questions. They're medicating the symptom while the underlying problem continues unchecked.
The Problem With Medicating Sleep (And When It Makes Sense)
Here's my unpopular opinion: sleep medications have their place, but that place is temporary and specific. If you're taking something to sleep every single night for months, we're doing it wrong.
Most sleep medications don't actually produce normal sleep architecture. Benzodiazepines and Z-drugs (like Ambien, Lunesta) suppress deep sleep and REM sleep while increasing lighter stage 2 sleep. You might be unconscious for eight hours, but you're not getting the restorative sleep your brain needs.
A meta-analysis by Glass and colleagues found that these medications provided only marginal improvements in sleep latency (how long it takes to fall asleep) and total sleep time, while carrying significant risks including next-day cognitive impairment and dependency (Glass et al., 2005).
So when do sleep medications make sense? Short-term crisis management. You're going through a divorce and literally haven't slept more than three hours a night for a week—okay, let's get you some sleep so you can function while we work on the real issues. You're traveling internationally and need to adjust to a new time zone quickly. You're recovering from a traumatic event and hyperarousal is preventing sleep. These are situations where a few weeks of medication can break a crisis cycle.
But if you're still taking that medication three months later, we need to have a conversation. Either there's an underlying condition we haven't addressed (secondary insomnia), or we need to work on behavioral interventions that actually fix the problem rather than masking it.
This is where cognitive behavioral therapy for insomnia (CBT-I) comes in—it's been shown to be more effective than medication for chronic insomnia, and the benefits last long after treatment ends (Trauer et al., 2015).
And here's the thing: if insomnia persists despite addressing psychiatric factors and implementing behavioral interventions, you might need a sleep specialist. We're talking about polysomnography (a sleep study) to rule out sleep apnea, periodic limb movement disorder, or other sleep disorders that require specific treatment.
I'm a psychiatric nurse practitioner, and I know my lane. Prolonged, complex sleep disorders aren't my specialty (and this is true for most general psychiatrists), and pretending otherwise doesn't serve my patients.
Practical Steps (That Actually Work)
Everything I've explained is useless if it doesn't translate into something you can actually implement. So let's talk about what works.
First, light exposure. Get outside in the morning, preferably within an hour of waking up. Even on a cloudy February day, outdoor light is exponentially brighter than indoor lighting. This helps set your circadian rhythm. In the evening, dim the lights. If you're going to use screens, use blue light filters (though honestly, the best thing is to stop using screens an hour before bed).
Second, consistency. This is the part that makes high-achievers groan. Your circadian rhythm needs consistency to function properly. Going to bed at midnight on weeknights and 2 AM on weekends, then sleeping until noon, is sabotaging yourself. Pick a wake time and stick to it—yes, even on weekends. The bedtime will naturally adjust as your body learns when it's supposed to sleep.
Third, the bedroom is for sleep and sex only. Not work. Not scrolling through anxiety-inducing news. Not watching television. Your brain needs to associate the bedroom with sleep. If you're lying awake for more than 20 minutes, get up and do something boring in dim light until you feel sleepy, then try again.
Fourth, watch the substances. Alcohol might make you feel sleepy, but it fragments sleep and suppresses REM. Caffeine has a half-life of five to six hours, which means that afternoon coffee is still affecting your brain at bedtime. For some people, any caffeine after noon disrupts sleep.
Fifth, temperature matters. Your body temperature naturally drops as you fall asleep. A bedroom that's too warm interferes with this process. Most people sleep better in a cool room (around 65-68°F) with adequate blankets.
The Attention Connection
I mentioned earlier that sleep deprivation worsens ADHD symptoms. Let me expand on that because it's relevant even for people who don't have ADHD.
Attention and sleep are intimately connected. The same brain networks involved in maintaining wakefulness and alertness are involved in sustaining attention. When you're sleep-deprived, your ability to maintain focus deteriorates. You might be able to muster attention for short bursts—high-stakes meetings, emergencies—but sustained focus becomes nearly impossible.
Research by Lim and Dinges demonstrated that chronic partial sleep restriction (getting six hours instead of eight, night after night) produces cognitive impairment equivalent to staying awake for 24 hours straight (Lim & Dinges, 2010). But here's the insidious part: the subjective sense of impairment doesn't match the objective performance. In other words, you think you're functioning fine, but you're actually making more errors, missing details, and performing worse than you realize.
For my patients managing ADHD, we spend a lot of time discussing sleep hygiene because it's foundational. ADHD medications can help with attention and executive function during the day, but they can't compensate for chronic sleep deprivation. In fact, poor sleep can make it seem like medication isn't working when the real problem is the neurological foundation is compromised.
If you're wondering whether attention difficulties are ADHD or sleep-related (or both), this is where a thorough evaluation becomes valuable. Our practice offers adult ADHD evaluations that look at the complete picture—sleep patterns, stress, other psychiatric symptoms, medical history, developmental history—because getting the diagnosis right matters for treatment.
Why February Is When This All Comes to a Head
Back to February and why this topic matters particularly now. By February, we've accumulated months of shorter days, less sunlight, and disrupted rhythms. The initial adjustment to winter is over, and we're deep in the consequences. Sleep debt is real, and it accumulates. Missing an hour of sleep doesn't just mean you're tired the next day—that deficit carries forward and compounds.
Seasonal mood changes are closely tied to circadian disruption. Seasonal affective disorder (SAD) isn't just "winter blues"—it's a recognized pattern of depression that occurs at specific times of year, most commonly fall and winter. The mechanism involves disrupted circadian rhythms, changes in melatonin and serotonin, and reduced light exposure. Treating SAD often involves bright light therapy, which essentially means compensating for the lack of natural light by using a light box that provides 10,000 lux for 20-30 minutes each morning.
Even people who don't meet criteria for SAD often experience subclinical mood dips in winter. Energy drops. Motivation wanes. Everything feels harder. And when sleep is already compromised, these effects magnify.
When to Seek Help
Here's my advice as a psychiatric nurse practitioner who sees high-functioning professionals struggle with these issues constantly: if you've tried the behavioral interventions, you're consistent with sleep hygiene, and you're still not sleeping well—or if you're sleeping but still exhausted—it's time for professional evaluation.
This could mean addressing underlying anxiety or depression that's interfering with sleep. It could mean evaluating for ADHD if attention and sleep issues are both present. It could mean getting a sleep study to rule out sleep apnea or other sleep disorders. It could mean adjusting medications that might be interfering with sleep architecture.
In our concierge psychiatric practice, we have the luxury of time that traditional psychiatry often doesn't allow. We can spend an hour or more on an initial evaluation, really understanding the full picture of what's happening. We can coordinate with sleep specialists, primary care physicians, and therapists. We can see patients more frequently during acute phases rather than the standard "see you in three months" approach.
I'm not saying this to be promotional—I'm saying it because fragmented, rushed care is one of the reasons sleep problems and mood issues go unaddressed for so long. You can't address complex issues in a 15-minute medication check.
Final Thoughts
Why is sleep beneficial? Because your brain literally cannot function properly without it. Emotional regulation, attention, memory consolidation, physical health, immune function—all of it depends on adequate, high-quality sleep. And "adequate" doesn't mean "the minimum I can get away with." It means the amount your individual brain needs to function optimally, which for most adults is seven to nine hours of actual sleep (not just time in bed).
February is hard. Winter is hard. Professional demands don't care about circadian rhythms or sleep architecture. But ignoring these biological realities doesn't make them go away—it just means you're operating at a fraction of your capacity while feeling progressively worse.
The good news is that sleep is modifiable. Unlike some factors affecting mental health, you have significant control over your sleep habits. It requires prioritization, which I know feels impossible when you're already stretched thin. But the return on investment is substantial. Better mood, better attention, better stress resilience, better physical health. Everything gets easier when you're sleeping well.
If you take nothing else from this, take this: sleep is not optional. It's not something you can hack or outsmart or power through. Your brain needs it, and when you deprive your brain of sleep, everything else suffers. February is an excellent time to make sleep a priority, because the foundation you build now will carry you through the rest of winter and into spring.
The opinions and advice expressed in this and other content are purely for informational, entertainment, and educational purposes. The information provided is not a substitute for professional advice, diagnosis, or treatment. If you or someone you know is experiencing any of the physical or mental health symptoms referred to in this or any other of our content, please consult with a trained medical professional or a licensed mental health provider.
References
Baron, K. G., & Reid, K. J. (2014). Circadian misalignment and health. International Review of Psychiatry, 26(2), 139-154.
Glass, J., Lanctôt, K. L., Herrmann, N., Sproule, B. A., & Busto, U. E. (2005). Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits. BMJ, 331(7526), 1169.
Lim, J., & Dinges, D. F. (2010). A meta-analysis of the impact of short-term sleep deprivation on cognitive variables. Psychological Bulletin, 136(3), 375-389.
Rosales-Lagarde et al. (2012). Enhanced Emotional Reactivity After Selective REM Sleep Deprivation in Humans: An fMRI Study. Frontiers in Behavioral Neuroscience
Trauer, J. M., Qian, M. Y., Doyle, J. S., Rajaratnam, S. M., & Cunnington, D. (2015). Cognitive behavioral therapy for chronic insomnia: a systematic review and meta-analysis. Annals of Internal Medicine, 163(3), 191-204.
Yoo, S. S., Gujar, N., Hu, P., Jolesz, F. A., & Walker, M. P. (2007). The human emotional brain without sleep—a prefrontal amygdala disconnect. Current Biology, 17(20), R877-R878.