When night turns to day
By Gord Howard
Anchor Magazine
Getting a good night’s sleep is paramount for good mental health, yet depression can actually wreak havoc on sleep habits
Karri Christansen knows all too well what 3 a.m. looks like. The Chicago, Illinois-area freelance journalist was diagnosed with depression 20 years ago and says she spent about one-quarter of those years lying awake at night because of it.
“It made me feel like I was losing my mind,” says Christansen. “I couldn’t focus. I was exhausted all the time. I would take naps during the day to make up for the sleep I wasn’t getting during the night, and that would perpetuate the insomnia.”
Christansen says she got about five hours of sleep each night―usually divided into two or three sessions―over the course of about five years. “It was classic depression insomnia. I was up between 2 a.m. and 5 a.m., wide awake. Thoughts were racing through my brain―nothing I could grasp or hold on to, just tidbits of things: work, family situations, song lyrics. [It was] just a cacophony of sounds going through my head.”
And the up-and-down nature of her freelance career―and income―whereby busy weeks are followed by slow ones, just gave her one more thing to think about during the night.
Join the club
Most people, at one time or another, will experience at least a brief period of insomnia, says Michael Thase, MD, of the University of Pennsylvania School of Medicine. For those who experience longer bouts, the effects are far-reaching, impacting a person’s mood, appetite, and even their vulnerability to illness.
“Sleep is one-third of our lives, [so] the clich? goes,” says Thase, a distinguished fellow of the American Psychiatric Association and active clinical investigator whose work centers on evaluation and treatment of mood disorders. “[And] for most people, sleep is a marker of well-being.”
Sleep rests our bodies and minds; it has been proven to promote growth hormone levels in children, while those who don’t get good sleep have low growth hormone secretion. Sleep also produces an increased level of protein molecules that restore the body and help it recover from things like stress, air pollution, and infection. A good night’s sleep allows the body to repair damaged tissue, including that caused by exposure to ultraviolet light.
Several studies also show that people who sleep better live longer. One, led by Sanjay R. Patel of the Harvard Medical School, involved 82,000 nurses and found a higher risk of early death for those who slept six or fewer hours per night.
For people with depression, however, a sound, recuperative sleep can be elusive. In fact, approximately 80 percent of depressed people deal with some form of sleep disorder, compared to roughly 15 percent of the general population, says Thase. In most cases the problem is insomnia, of which there are three kinds: onset insomnia (the inability to fall asleep); middle insomnia (waking frequently throughout the night); and terminal insomnia (waking early and being unable to fall back to sleep).
Prolonged insomnia can have serious psychological and physical implications, including an inability to concentrate during the day, mood changes, vulnerability to illness, and a loss of energy. At the American Diabetes Association’s 2001 annual meeting, it was reported that people who fail to get enough sleep actually become less sensitive to insulin, thereby putting them at an increased risk for high blood pressure and diabetes. Further, a 2004 study at the University of Bristol, England, found that people who sleep for five hours a night produce 15 percent more ghrelin and 15 percent less leptin than people who sleep eight hours. These changes in hormonal balance lead to an increase in hunger, which can cause weight gain.
Failing to get enough sleep can also compromise a person’s ability to do everyday things, such as operate a vehicle.
“One complete night of sleep deprivation is as impairing in simulated driving tests as a legally intoxicating blood-alcohol level,” said Mark Mahowald, a professor of neurology at the University of Minnesota Medical School, in a 2004 article on BioEdOnline.org.
Losing sleep over a lack of sleep
For Christansen, a remedy for her insomnia wasn’t easy to find. Because she had already been prescribed an antidepressant, she didn’t want to try an over-the-counter sleep aid to control the insomnia, but she was losing her ability to concentrate and the energy to enjoy the things she had always liked doing.
“I felt like the walking dead. I was just so out of it,” she recalls. “When you have insomnia, you go to sleep wondering, ‘Am I going to wake up at 2 o’clock in the morning?’ It’s almost a self-fulfilling prophecy, because you go to sleep anxious about not being able to sleep, [and] then you wake up and you think, ‘Oh crap, I’m up again!’”
After trying several medications, Christansen’s doctor finally found one that both controls her depression and helps her sleep at night. She’s not completely cured, however. The insomnia still comes back sometimes, usually during stressful times.
“Don’t be afraid to ask for help,” she advises. “Don’t be afraid to say to your doctor, ‘Look, I can’t sleep. I need something to help me sleep.’”
Exercise helps, too. She doesn’t belong to a gym, but because Christansen works from home, she is able to squeeze moments of activity into her day: push-ups while she’s doing the laundry, or using her step machine while she runs the dishwasher.
The five stages of sleep
To understand insomnia, it’s important to first understand sleep.
A healthy person should take no longer than 30 minutes to fall asleep at night, explains Thase. Through the first four of the five stages of sleep, brain activity slows progressively; the heart rate slows, breathing becomes shallower, blood pressure drops, and muscles relax.
But in the fifth stage―the REM (rapid eye movement) stage―the brain comes to life. Memories, ideas, recent experiences all go through the mental mixer. It is during REM sleep that a person dreams.
“In REM sleep, brain activity looks just as it does when we’re awake, but our muscles are inhibited,” Donna Giles, PhD, a professor of psychology and neurology at New York’s University of Rochester Medical Center, said in a 2001 interview published on sciencedaily.com.
So why do people with depression have so much trouble sleeping? One theory is that depressed individuals move too quickly into REM sleep, missing out on the restorative quiet stages that lead up to it, causing them to spend a disproportionate amount of sleep time dealing with information.
It’s also possible, Thase says, that people with a more severe depression sleep lightly because their minds are in a too-high state of psychophysiological arousal to sleep deeply, but “these are speculation, not facts.”
He notes insomnia may not only be a symptom of depression, but a potential indicator of its onset as well. “If you don’t have depression but you have insomnia, the chances are greater that over the next six months to a year, you will develop depression.”
In fact, the National Sleep Foundation reports there is evidence to suggest that people with insomnia have a ten-fold risk of developing depression compared to people
who sleep well.
However, Thase rejects the suggestion that because the two conditions appear related, there might be a single genetic cause found someday that will allow both to be treated as one.
“There are likely to be some number of inherited factors that increase the likelihood of depression or insomnia, and there may well be inherited resilience factors that decrease that likelihood,” he says. “There are some people that, even under the most stressful circumstances, don’t become depressed, [while] others don’t require much life stress to become depressed.”
Find what works
Generally speaking, sleeping pills prolong sleep, but they aren’t effective at increasing the amount of deep sleep a person needs, Thase says. And often, the antidepressant that a person with depression is prescribed reduces REM sleep.
Finding the right antidepressant can be key, as can learning relaxation techniques and lifestyle changes to better prepare the body for sleep. “Sleeping pills alone don’t treat depression; just helping people sleep better doesn’t relieve the depression,” says Thase. “(But) it does help them to be more comfortable, (so) they have one less thing bothering them.”
Gord Howard is a freelance journalist who has worked in the Canadian newspaper industry for more than 20 years.
By Gord Howard
Anchor Magazine
Getting a good night’s sleep is paramount for good mental health, yet depression can actually wreak havoc on sleep habits
Karri Christansen knows all too well what 3 a.m. looks like. The Chicago, Illinois-area freelance journalist was diagnosed with depression 20 years ago and says she spent about one-quarter of those years lying awake at night because of it.
“It made me feel like I was losing my mind,” says Christansen. “I couldn’t focus. I was exhausted all the time. I would take naps during the day to make up for the sleep I wasn’t getting during the night, and that would perpetuate the insomnia.”
Christansen says she got about five hours of sleep each night―usually divided into two or three sessions―over the course of about five years. “It was classic depression insomnia. I was up between 2 a.m. and 5 a.m., wide awake. Thoughts were racing through my brain―nothing I could grasp or hold on to, just tidbits of things: work, family situations, song lyrics. [It was] just a cacophony of sounds going through my head.”
And the up-and-down nature of her freelance career―and income―whereby busy weeks are followed by slow ones, just gave her one more thing to think about during the night.
Join the club
Most people, at one time or another, will experience at least a brief period of insomnia, says Michael Thase, MD, of the University of Pennsylvania School of Medicine. For those who experience longer bouts, the effects are far-reaching, impacting a person’s mood, appetite, and even their vulnerability to illness.
“Sleep is one-third of our lives, [so] the clich? goes,” says Thase, a distinguished fellow of the American Psychiatric Association and active clinical investigator whose work centers on evaluation and treatment of mood disorders. “[And] for most people, sleep is a marker of well-being.”
Sleep rests our bodies and minds; it has been proven to promote growth hormone levels in children, while those who don’t get good sleep have low growth hormone secretion. Sleep also produces an increased level of protein molecules that restore the body and help it recover from things like stress, air pollution, and infection. A good night’s sleep allows the body to repair damaged tissue, including that caused by exposure to ultraviolet light.
Several studies also show that people who sleep better live longer. One, led by Sanjay R. Patel of the Harvard Medical School, involved 82,000 nurses and found a higher risk of early death for those who slept six or fewer hours per night.
For people with depression, however, a sound, recuperative sleep can be elusive. In fact, approximately 80 percent of depressed people deal with some form of sleep disorder, compared to roughly 15 percent of the general population, says Thase. In most cases the problem is insomnia, of which there are three kinds: onset insomnia (the inability to fall asleep); middle insomnia (waking frequently throughout the night); and terminal insomnia (waking early and being unable to fall back to sleep).
Prolonged insomnia can have serious psychological and physical implications, including an inability to concentrate during the day, mood changes, vulnerability to illness, and a loss of energy. At the American Diabetes Association’s 2001 annual meeting, it was reported that people who fail to get enough sleep actually become less sensitive to insulin, thereby putting them at an increased risk for high blood pressure and diabetes. Further, a 2004 study at the University of Bristol, England, found that people who sleep for five hours a night produce 15 percent more ghrelin and 15 percent less leptin than people who sleep eight hours. These changes in hormonal balance lead to an increase in hunger, which can cause weight gain.
Failing to get enough sleep can also compromise a person’s ability to do everyday things, such as operate a vehicle.
“One complete night of sleep deprivation is as impairing in simulated driving tests as a legally intoxicating blood-alcohol level,” said Mark Mahowald, a professor of neurology at the University of Minnesota Medical School, in a 2004 article on BioEdOnline.org.
Losing sleep over a lack of sleep
For Christansen, a remedy for her insomnia wasn’t easy to find. Because she had already been prescribed an antidepressant, she didn’t want to try an over-the-counter sleep aid to control the insomnia, but she was losing her ability to concentrate and the energy to enjoy the things she had always liked doing.
“I felt like the walking dead. I was just so out of it,” she recalls. “When you have insomnia, you go to sleep wondering, ‘Am I going to wake up at 2 o’clock in the morning?’ It’s almost a self-fulfilling prophecy, because you go to sleep anxious about not being able to sleep, [and] then you wake up and you think, ‘Oh crap, I’m up again!’”
After trying several medications, Christansen’s doctor finally found one that both controls her depression and helps her sleep at night. She’s not completely cured, however. The insomnia still comes back sometimes, usually during stressful times.
“Don’t be afraid to ask for help,” she advises. “Don’t be afraid to say to your doctor, ‘Look, I can’t sleep. I need something to help me sleep.’”
Exercise helps, too. She doesn’t belong to a gym, but because Christansen works from home, she is able to squeeze moments of activity into her day: push-ups while she’s doing the laundry, or using her step machine while she runs the dishwasher.
The five stages of sleep
To understand insomnia, it’s important to first understand sleep.
A healthy person should take no longer than 30 minutes to fall asleep at night, explains Thase. Through the first four of the five stages of sleep, brain activity slows progressively; the heart rate slows, breathing becomes shallower, blood pressure drops, and muscles relax.
But in the fifth stage―the REM (rapid eye movement) stage―the brain comes to life. Memories, ideas, recent experiences all go through the mental mixer. It is during REM sleep that a person dreams.
“In REM sleep, brain activity looks just as it does when we’re awake, but our muscles are inhibited,” Donna Giles, PhD, a professor of psychology and neurology at New York’s University of Rochester Medical Center, said in a 2001 interview published on sciencedaily.com.
So why do people with depression have so much trouble sleeping? One theory is that depressed individuals move too quickly into REM sleep, missing out on the restorative quiet stages that lead up to it, causing them to spend a disproportionate amount of sleep time dealing with information.
It’s also possible, Thase says, that people with a more severe depression sleep lightly because their minds are in a too-high state of psychophysiological arousal to sleep deeply, but “these are speculation, not facts.”
He notes insomnia may not only be a symptom of depression, but a potential indicator of its onset as well. “If you don’t have depression but you have insomnia, the chances are greater that over the next six months to a year, you will develop depression.”
In fact, the National Sleep Foundation reports there is evidence to suggest that people with insomnia have a ten-fold risk of developing depression compared to people
who sleep well.
However, Thase rejects the suggestion that because the two conditions appear related, there might be a single genetic cause found someday that will allow both to be treated as one.
“There are likely to be some number of inherited factors that increase the likelihood of depression or insomnia, and there may well be inherited resilience factors that decrease that likelihood,” he says. “There are some people that, even under the most stressful circumstances, don’t become depressed, [while] others don’t require much life stress to become depressed.”
Find what works
Generally speaking, sleeping pills prolong sleep, but they aren’t effective at increasing the amount of deep sleep a person needs, Thase says. And often, the antidepressant that a person with depression is prescribed reduces REM sleep.
Finding the right antidepressant can be key, as can learning relaxation techniques and lifestyle changes to better prepare the body for sleep. “Sleeping pills alone don’t treat depression; just helping people sleep better doesn’t relieve the depression,” says Thase. “(But) it does help them to be more comfortable, (so) they have one less thing bothering them.”
Gord Howard is a freelance journalist who has worked in the Canadian newspaper industry for more than 20 years.
