by Gina DeMent
Five County Mental Health Authority
Sleep problems are common.
They can be caused by stress, physical illnesses that cause pain or frequent urination, having noisy neighbors, a partner who snores, having young children, an uncomfortable bed, working shifts, or jet lag.
Some medicines, heavy or spicy food and drinks (e.g. alcohol and those containing caffeine, such as coffee and tea) can also make it harder to sleep or disrupt the normal pattern of sleep. In addition to all of these causes of sleep disturbance, depressive illnesses also commonly cause sleep problems.
Disturbed sleep can cause a great deal of distress for people, whether it is caused by depression or not. People with depression can have many types of sleep problems. Generally, these involve getting less sleep than usual and include:
* difficulty getting off to sleep – often because of lying in bed with thoughts going around in your head.
* frequently waking up during the night.
* waking early in the morning and not being able to get back to sleep.
Even if people with depression do get a reasonable number of hours of sleep, they often wake in the morning feeling ‘unrefreshed’ and feel tired through the day. Occasionally, people with depression sleep too much, finding it hard to get out of bed and spending much of the day there. Again, this does not tend to lead to these people feeling any less tired. Probably more than 80 per cent of people suffering from depression have problems with their sleep, usually not getting enough.
We are all aware that if we don’t get a good night’s sleep, we are less effective the next day. Important body processes occur during sleep that help to ‘recharge our batteries’. If we get less sleep than we need, we are more at risk of having accidents in the home, at work, or when driving.
In people with depression, not being able to sleep (especially when this involves spending hours lying in bed awake) can cause other problems as well. During this time, people tend to dwell on their problems.
If you are depressed, everything seems black and dismal. Such bleak thoughts going around and around your head can cause your mood to get even lower. A lower mood makes the thoughts even bleaker and a vicious circle can occur.
Severe sleep problems in depressed people are associated with an increased risk of suicide. On the other side of the coin, an improvement in sleep often indicates an improvement in mood.
How much sleep is enough? Everybody’s needs are different. The range of time people sleep normally is as wide as 3 to 10 hours. As a general rule of thumb, five to six hours of sleep is probably a minimum below which your performance at work, when driving, etc., will be affected. Most people need between seven and eight hours of sleep a night to feel refreshed. Generally, people require less sleep the older they get.
Sleep can be assessed by measuring the electrical activity that occurs in the brain. By doing this, sleep can be divided into a number of different stages: we tend to go through stages 1 to 4 when we fall asleep and the reverse when we wake up.
However, through the night we also make transitions between the different stages. Stages 1 and 2 are regarded as light sleep. Stages 3 and 4 are deep sleep.
During deep sleep various restorative processes go on throughout the body. If we do not get enough deep sleep we feel tired and ‘washed out’.
A fifth stage of sleep is called rapid eye movement (REM) sleep because although our eyes remain shut, they move around a lot during this stage. REM sleep is the time that we dream when we are asleep. Dreaming has important psychological effects, helping us to put ‘things in order’.
We normally undergo several cycles during the night moving through the various stages of sleep. We have most of our deep sleep in the first half of the night and REM sleep (when we dream) occurs later on. This explains why if you doze back to sleep in the morning, you will often wake and be aware of dreaming.
It is not uncommon to wake during the night. Normally, these awakenings are so brief that we are unaware of them.
The sleep pattern of somebody with depression is very different:
* It takes much longer to get off to sleep.
* The total sleep time is reduced.
* There is little or no deep sleep.
* REM sleep occurs earlier in the night.
* There are more frequent awakenings during the night, which may last long enough for the person to be aware of them.
* The person wakes up earlier in the morning.
What can be done about sleep problems? It can be extremely distressing not being able to sleep. Fortunately, there are a number of things that you can do to try and improve your sleep. These suggestions are not miracle cures and they do require some effort. This is good advice for anybody who has a sleep problem.
* Get into a routine with your sleep times. Get up at the same time each morning, even if you have not had a good night’s sleep. Don’t sleep during the day, and don’t go to bed early to try and get more sleep – you are likely just to lie in bed thinking over problems. Go to bed in the evening when you are tired.
* Take some physical exercise during the day. This helps to make your body more tired in the evening and makes it easier to get to sleep. Exercise is good for you physically, and there is also research that suggests that exercise can itself be antidepressant.
* Avoid exercise two hours before bedtime. This is because exercise ‘activates’ the body, which can make it difficult to get off to sleep.
* Avoid watching disturbing or violent films prior to bedtime.
* Avoid drinking caffeine (tea, coffee, cola) in the evening after 6:00 p.m. Caffeine is a stimulant and can prevent sleep.
* Avoid heavy meals two hours before bedtime. It can be extremely difficult to get off to sleep with a full stomach.
* Avoid alcohol in the evening. While alcohol is sedative, it is not a good idea to try to use it to sort out a sleep problem. This is because alcohol does not lead to normal restful sleep. In addition, alcohol causes you to pass increasing amounts of urine, which further disrupts sleep. Unfortunately, a significant number of people with depression develop an alcohol problem from using alcohol to help them sleep.
If you are kept awake, or wake up worrying during the night, try the following:
* At least two hours before bedtime, write down the problems that keep you awake. Also write down the next step you need to take towards resolving each problem.
* If you find yourself thinking over the problems in bed, tell yourself you have the matter in hand and that going over it now will not help.
* If a new worry occurs during the night, write it down or commit it to memory and deal with it the next day.
* If you still do not manage to get to sleep, or you wake during the night and can’t get back to sleep, get up. Do not lie in bed tossing and turning. Go and do something else like listening to relaxing music, having a warm bath or making yourself a milky drink. Go back to bed when you feel tired again.
Many people become preoccupied by sleep itself. In this case:
* Do not try to fall asleep.
* Tell yourself that sleep will come and that relaxing in bed is nearly as good.
* Try to keep your eyes open. As they naturally try to close, tell yourself to resist for just another few seconds. This should tempt sleep to take over.
There are medicines that can help but it is always better to try to sort out a sleep problem using the techniques above rather than relying on medicines. However, if, despite following all of these suggestions, a person still has problems with their sleep, a doctor may recommend some medicines. There are a number of different possibilities and many different medicines – far more than can be mentioned here.
If these lifestyle changes don’t help, contact your doctor. You may have a sleep disorder or just may need some temporary help getting yourself in good “sleep shape”. Sleep disorders and neurological conditions can be diagnosed at many local hospitals.
If you or someone you know has symptoms of depression, you may get want to seek further assistance from your physician or you may contact the Five County Mental Health Authority’s toll free Helpline number 1.877.619.3761. A professionally trained, experienced clinician will listen to you and carefully help determine what kind of assistance is best, based on your needs and preference.