Depression and Sleeping Habits
Feeling sad every now and then is a fundamental part of the human experience, especially during difficult or trying times. In contrast, persistent feelings of sadness, anxiety, hopelessness and disinterest in things that were once enjoyed are symptoms of depression, an illness that affects at least 20 million Americans. Depression is not something that a person can ignore or simply will away. Rather, it is a serious disorder that affects the way a person eats, sleeps, feels and thinks. The cause of depression is not known, but it can be effectively controlled with treatment.
The relationship between sleep and depressive illness is complex – depression may cause sleep problems and sleep problems may cause or contribute to depressive disorders. For some people, symptoms of depression occur before the onset of sleep problems. For others, sleep problems appear first. Sleep problems and depression may also share risk factors and biological features and the two conditions may respond to some of the same treatment strategies. Sleep problems are also associated with more severe depressive illness.
Insomnia is very common among depressed patients. Evidence suggests that people with insomnia have a ten-fold risk of developing depression compared with those who sleep well. Depressed individuals may suffer from a range of insomnia symptoms, including difficulty falling asleep (sleep onset insomnia), difficulty staying asleep (sleep maintenance insomnia), unrefreshing sleep, and daytime sleepiness. However, research suggests that the risk of developing depression is highest among people with both sleep onset and sleep maintenance insomnia.
A 2007 study found that when healthy participants were deprived of sleep, they had greater brain activity after viewing upsetting images than their well-rested counterparts, which is similar to the reaction that depressed patients have, noted one of the study authors.
"If you don't sleep, you don't have time to replenish [brain cells], the brain stops functioning well, and one of the many factors that could lead to is depression," says Matthew Edlund, MD, director of the Center for Circadian Medicine, in Sarasota, Fla., and author of The Power of Rest.
Even partial sleep deprivation has a significant effect on mood. University of Pennsylvania researchers found that subjects who were limited to only 4.5 hours of sleep a night for one week reported feeling more stressed, angry, sad, and mentally exhausted. When the subjects resumed normal sleep, they reported a dramatic improvement in mood.
Insomnia and Psychological Problems
"There's a big relationship between psychiatric and psychological problems and sleep. So people who are depressed or have anxiety often have trouble with sleep as part of those disorders," says Dr. Lawrence Epstein, Medical Director of Sleep Health Centers and an instructor at Harvard Medical School.
Difficulty sleeping is sometimes the first symptom of depression. Studies have found that 15 to 20 percent of people diagnosed with insomnia will develop major depression. While sleep research is still exploring the relationship between depression and sleep, studies have shown that depressed people may have abnormal sleep patterns.
Sleep problems may, in turn, contribute to psychological problems. For example, chronic insomnia may increase an individual's risk of developing a mood disorder, such as depression or anxiety. In one major study of 10,000 adults, people with insomnia were five times more likely to develop depression. Lack of sleep can be an even greater risk factor for anxiety. In the same study, people with insomnia were 20 times more likely to develop panic disorder (a type of anxiety disorder). Another study showed that insomnia is a reliable predictor of depression and many other psychiatric disorders, including all types of anxiety disorders.
Why Is Sleep So Important?
Normal sleep is a restorative state. However, when sleep is disrupted or inadequate, it can lead to increased tension, vigilance, and irritability.
Physical or emotional trauma and metabolic or other medical problems can trigger sleep disturbances. Poor sleep can lead to fatigue. With fatigue, you exercise less and that leads to a decline in your fitness level. Eventually, you find yourself in a vicious cycle of inactivity and disturbed sleep, which causes both physical and mood-related symptoms.
Addressing Sleep Problems Makes a Difference
If you sleep poorly and feel depressed, anxious, or less emotionally responsive, there are many treatments that can help. First, look at your sleep habits and see if there are steps that you can take on your own to improve the quantity and quality of your sleep. If problems persist, you may wish to see a medical provider and ask about an evaluation for sleep problems and mental health concerns. After an evaluation and diagnosis, your provider can advise you on the best course of treatment. Options may include behavioral or other forms of therapy and/or medications.
What the Sleep Doctors Say
Sleep doctors recommend a variety of measures to help adults and children achieve adequate sleep. In general, all of these approaches are intended to help with relaxation as the desired sleep time approaches, to maintain a comfortable sleep environment, and to encourage a healthful balance of nutrition and exercise. Their recommendations include:
1. Stick to a sleep schedule of the same bedtime and wake up time, even on the weekends. This helps to regulate your body's clock and could help you fall asleep and stay asleep for the night.
2. Get as much natural sunlight as possible during the day time.
3. Practice a relaxing bedtime ritual. A relaxing, routine activity right before bedtime conducted away from bright lights helps separate your sleep time from activities that can cause excitement, stress or anxiety which can make it more difficult to fall asleep, get sound and deep sleep or remain asleep.
4. If you have trouble sleeping, avoid naps, especially in the afternoon. Power napping may help you get through the day, but if you find that you can't fall asleep at bedtime, eliminating even short catnaps may help. Go to sleep when you are really tired, not earlier than that to get engage in the lengthy unrelated routines, like watching TV or reading.
5. Avoid bright screens within 1-2 hours of your bedtime. The blue light emitted by your phone, tablet, computer, or TV is especially disruptive. You can minimize the impact by using devices with smaller screens, turning the brightness down, or using light-altering software such as f.lux. Say no to late-night television. Not only does the light from a TV suppress melatonin, but many programs are stimulating rather than relaxing. Try listening to music or audio books instead.
6. Exercise daily. Vigorous exercise is best, but even light exercise is better than no activity. Exercise at any time of day, but not at the expense of your sleep or immediately before the sleep time.
7. Evaluate your room. Design your sleep environment to establish the conditions you need for sleep. Your bedroom should be cool – between 60 and 67 degrees. Your bedroom should also be free from any noise that can disturb your sleep. Finally, your bedroom should be free from any light. Check your room for noises or other distractions. This includes a bed partner's sleep disruptions such as snoring. Consider using blackout curtains, eye shades, ear plugs, "white noise" machines, humidifiers, fans and other devices.
8. Sleep on a comfortable mattress and pillows. Make sure your mattress is comfortable and supportive. The one you have been using for years may have exceeded its life expectancy – about 9 or 10 years for the best quality mattresses. Have comfortable pillows and make the room attractive and inviting for sleep but also free of allergens that might affect you and objects that might cause you to slip or fall if you have to get up,
9. Try to avoid or minimize consumption of the caffeine, alcohol, nicotine, and other chemicals that may interfere with your healthy sleep pattern.
10. Eating and Drink enough—but not too much or too soon before bedtime. Also, drinking lots of fluids before bed may result in frequent bathroom trips throughout the night.
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