Sleep problems and depression are often tangled up like sheets on an unmade bed.
Not getting enough sleep raises the risk for the mood disorder, and depression can deeply disrupt ZZZ’s. The whole disorienting frustration can be cyclical, causing a person’s mood to worsen, while making a good night’s rest seem out of reach.
Confusing the issue, decades of studies have found that many people who are depressed realize short-term symptom relief from acute sleep deprivation, like going 36 hours straight without any shuteye.
A meta-analysis published in the Journal of Clinical Psychiatry in September reviewed 66 independent studies evaluating this kind of total sleep deprivation as well as partial sleep deprivation, like getting just three to four hours of sleep followed by 20 to 21 hours of wakefulness. About half the participants in the studies evaluated who were sleep deprived saw a rapid reduction in depressive symptoms. (The studies didn’t report on individual symptoms of depression, but these can range from feelings of sadness or hopelessness and no longer finding pleasure in things a person previously enjoyed to irritability, agitation and trouble thinking or concentrating.) But what didn’t emerge were clear indicators of who would be likely to benefit from this unique approach or the best way to use short-term sleep deprivation as an antidepressant. And the results were short-lived.
[See: Coping With Depression at Work.]
While short-term sleep deprivation produces rapid improvements in about half of people studied, “as soon as they go back to sleep, most of the time the depression returns,” says Philip Gehrman, a psychologist and associate professor of psychiatry at the University of Pennsylvania’s Perelman School of Medicine, and senior author of the meta-analysis. “So it produces very rapid effects, but not very sustained effects.”
Given the significant limitations of the approach, acute sleep deprivation is not typically incorporated into depression treatment. “It’s not considered part of routine clinical care,” Gerhman says. Experts certainly don’t recommend trying the approach at home either, as it could be potentially dangerous — like if a person got behind the wheel — and at the very least quite disruptive. “Someone shouldn’t be driving, for example, after they’ve been awake all night, and this is why this isn’t really a self-help tool,” adds Elaine Boland, a research psychologist at the Corporal Michael J. Crescenz VA Medical Center in Philadelphia, and lead author of the meta-analysis.
Meanwhile being sleep-deprived for a longer period, like struggling to get adequate sleep for a month or more, can markedly increase one’s risk of becoming depressed. According to the American Psychological Association, research suggests that people with insomnia are 10 times as likely to suffer from clinical depression. Research also shows incorporating therapy that addresses sleep issues in people with depression — like cognitive behavioral therapy for insomnia — as part of overall depression treatment improves outcomes.
Too much or too little sleep can be associated with depression; so it’s not about simply lying in bed longer. “I would be concerned with somebody that is sleeping 12 hours a day, just as I would be concerned with somebody who is sleeping five hours a day,” says Ryan Bogdan, an assistant professor of psychological and brain sciences at Washington University in St. Louis. In today’s 24/7, fast-paced world, experts say the problem is more often that people aren’t getting the recommended seven to nine hours of sleep — rather than getting too much shuteye.
[See: 10 Reasons You May Be Feeling Fatigued.]
Bogdan and other mental health and sleep experts urge people to get back to the basics: allowing ample time to get recommended sleep, and not being discouraged from doing so by sleep difficulties and disruptions. “You try to go to bed at the same time, get up at the same time and have an absolute ritual before you go to bed,” says Dr. Matthew Edlund, a sleep medicine specialist, researcher and the author of the “The Power of Rest” based in Sarasota, Florida. “This is particularly powerful when you’re depressed — because a lot of people who are depressed can’t sleep.” His encouragement for those individuals: “It’s alright, you’re going to have some bad nights, you’re not going to be able to sleep so well. But get your body tuned, get your body clocks reset. That should help your mood and help your sleep both.”
The bedtime ritual may be different for everyone. But it should, at the very least, involve a period of unplugged time that gets the mind and body ready for rest.
“So about 60 minutes before you go to bed, you go on an electronic diet — you don’t look at the computer, you don’t look at your cellphone, you don’t get too much bright light,” Edlund suggests. “You do the standard things that people do before you go to bed — you floss your teeth, you put out your clothes for the next day. But you do something that will actually slow the world down,” he adds. “Some people, when depressed, are really agitated. Some people when depressed are absolutely flat and passive.” But, he recommends doing things, such as reading or listening to audio books or music, which can calm down the body.
Depression is often characterized by tiredness and sleep disturbances, where people awaken frequently and have difficulty getting back to sleep. “So having a stable, consistent pattern of sleep is really important,” Bogdan says.
Standard rules of sleep hygiene, such as having a distraction-free, cool, dark place to lay your head down for the night, of course, apply for anyone trying to improve sleep. For those with depression, the point is to make sure it’s part of a comprehensive approach to treating the disorder. That could include incorporating a better night’s rest with getting up and going for a walk outside in the morning (since exercise and light can boost mood); tapping into a deeper sense of purpose (which, research shows, is also associated with sleeping better at night); returning to those things that bring pleasure; and connecting with friends, along with mainstay treatments, therapy and medication.
[See: 8 Ways to Fall Asleep Fast.]
The point, experts say, is not to limit yourself to a one-dimensional approach to treat a dynamic disorder. Then — having taken various steps to boost mood — when the day is done, perhaps you’ll be able sleep better, too.
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Turning the Sleep Dial Up and Down on Depression originally appeared on usnews.com
