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Depression and insomnia are closely intertwined

Those seeking to beat depression might want to start with sleep patterns

Special to The TribuneJune 17, 2014 

LOS ANGELES TIMES ILLUSTRATION

We all have times when we feel blue. And there are nights when we just can’t sleep. But it seems that depression and insomnia are closely intertwined, exacerbating each other’s symptoms and complicating treatment.

Insomnia has long been viewed as a symptom of depression. At least 80 percent of depressed patients have trouble falling or staying asleep. An additional 15 percent report they sleep too much. Doctors believed that treating the depression would alleviate sleep problems at the same time.

New research indicates that curing insomnia may make depression treatments more effective. A study conducted by Colleen Carney at Ryerson University in Toronto found that 87 percent of subjects who resolved sleep issues using biweekly talk therapy also saw their depression improve after eight weeks of treatment. That’s twice the success rate of the subjects who didn’t better their sleep.

In 2008, Rachel Manber of Stanford found that 60 percent of patients receiving seven sessions of talk therapy plus an antidepressant fully recovered from their depression, compared to 33 percent who received the same medication and sleep hygiene counseling alone.

The kind of therapy used in these experiments is called cognitive behavioral therapy for insomnia, or CBT-I. The therapist instructs clients to establish and adhere to a regular sleep schedule, to get out of bed during periods of wakefulness, to avoid eating or use of electronics in bed and to eliminate daytime napping.

Insomnia may even predict the onset of depression. Sleep researcher Michael Perlis, Ph.D., has shown that sleep disturbances precede episodes of depression by about five weeks. And sleep disorders intensify over the course of a new depressive episode or relapse.

According to Perlis, associate professor of psychiatry and neuroscience at the University of Rochester, disordered sleep sets off a chain of disruptive symptoms that leads to fatigue, irritability, confusion and loss of memory, disinterest in social activities and lack of pleasure.

The subsequent sleep loss makes people more susceptible to depression and increases the likelihood of further episodes.

The good news is that both disorders are treatable regardless of which causes the other. The first step is to get a proper diagnosis in order to embark on the appropriate path.

ELIMINATING INSOMNIA

The National Sleep Foundation offers the following suggestions for overcoming insomnia:
  • Keep a sleep diary. Include all pertinent data, such as the time you go to bed, number of times you wake up during the night, medications taken, amount of caffeine consumed during the day, number of naps and time spent exercising. You’ll quickly notice which actions support good sleep behavior and which ones cause disruptions.
  • Eat light meals early in the evening. Heavy meals can cause discomfort. Spicy food may lead to heartburn.
  • Steer clear of alcohol. Although alcohol is a sedative and may initially help you fall asleep, it disrupts sleep later in the night.
  • Learn to relax. One simple technique is to lie quietly on your bed and systematically tense and relax various muscle groups in your body. You may also practice deep breathing, guided imagery or meditation.
  • Evaluate your room. Make sure you have a clean, comfortable, quiet and dark sleep space. Use a sound machine or fan to block unwanted noise. Install blinds to close out streetlights and morning light.
  • Wind down. Your body needs time to shift into sleep mode. Devote the hour before bedtime to calming activities, such as reading or taking a warm bath. You’ll be mentally and physically calmer. Your actions will signal your brain that it’s time to go to bed.

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