Med thumb skittles

Depictions of obsessive compulsive disorder (OCD) in entertainment are familiar: Someone methodically soaps up and rinses off their hands four times, or has to open and close a door seven times before leaving a room. They're particular about their forks and chairs, and establish precise routines from which they can’t bear to deviate.

These rituals reflect compulsions, the behavioral component of the disorder marked by an unyielding and irrational need to perform certain actions, typically in repetition. The obsessions that comprise the mental part of the disorder are less ripe for on-screen dramatization, but no less debilitating. In fact, it’s often hard to tell whether the mental or behavioral aspect, or both, account for problems associated with OCD. Case in point: disturbed sleeping.

Sleeping issues are actually not considered a core feature of OCD. Still, sufferers frequently complain that they can’t sleep, which has prompted an uptick in research on the connection between insomnia and OCD. Resulting studies have consistently shown OCD sufferers as having higher-than-normal rates of insomnia, among other sleep issues, such as delayed sleep phase disorder.

Research differs as to which aspect of OCD primarily hampers the process of falling and staying asleep. The disorder is complex to begin with, and people with OCD frequently have a secondary diagnosis of depression — a condition that, as Van Winkle’s has reported, already has a fraught relationship with rest.

One study, published in the Journal of Psychiatric Research in 2014, implicated obsessions as the likely culprit behind disturbed sleep. Based on patients’ self-reported assessments, researchers found a link between insomnia symptoms and obsessive thoughts, but not compulsive behavior.

Then again, in a 2011 study on pediatric OCD, researchers found a strong correlation between insufficient sleep and severe compulsive behavior. While kids with OCD sometimes only exhibit compulsions (without the obsessions), the study reflected children with both the mental and behavioral symptoms.

Some researchers say it’s prohibitively difficult at this point to parse co-existing depression and OCD in attempts to flesh out the roots of sleeping issues. Others, however, essentially say they’ve eliminated depression from the equation and still found a strong OCD-insomnia connection.

Clashing findings aside, one conclusion remains consistent across the research: We need more of it.