The worst thing in the world is to try to sleep and not to. – F. Scott Fitzgerald
When first diagnosed with depression, my sleep became fragmented in a way I had never experienced before.
Before this time, I, like most frenzied lawyers, had periods of restless sleep tinged by stress and anxiety. But my sleep would return to normal after a lengthy trial or round of contentious depositions.
But this was different.
Lots of Depression, Little Sleep
I was always tired, but couldn’t sleep through the night. I went to bed early, exhausted from trying to make it through another day with depression. Trouble sleeping is a symptom of major depression. Kay Redfield Jamison, M.D., a psychiatrist, writes:
The body is bone-weary; there is no will; nothing is that is not an effort, and nothing at all seems worth it. Sleep is fragmented, elusive, or all-consuming. Like an unstable, gas, an irritable exhaustion seeps into every crevice of thought and action.”
Often waking at 3 to 4 a.m., I was unable to go back to sleep. I’d get up, watch T.V., or read old magazines while my family slept upstairs. Other times, I would shower, shave, put on my suit and tie, and drive to an all-night coffee shop. I was the only customer that early in the morning. Sitting there with my coffee, I stared out into the night. I wondered when I would start feeling better; when things would get back to normal. When the sun came up, I drove to work with no one the wiser about the anguish I was going through. At least for the time being.
Walking into the law office, I felt irritable. Sitting down at my desk, I found it hard to concentrate. Sometimes, I would close my door. People thought I needed the quiet to whittle down some critical project. The truth? My head was laying in my arms on the desk, trying to sleep.
Our Internal Clock Gone Haywire
The circadian rhythms in our bodies dictate our sleep patterns. There is a body clock located in the hypothalamus of our brains which controls how we sleep and feel. The center creates daily signals or rhythms that govern when our hormones and neurotransmitters are released – two critical elements in depression.
Due to problems with our circadian rhythms during depression, our sleep cycle does not function properly, and we feel sleepiness in the daytime and will be awake at night.
While there are several possible antecedents to depression, as genetic and environmental factors can lead to a depressive episode, the neurophysiological causes of depression pertain to a deficiency of chemicals in the brain that regulate mood: serotonin, dopamine, and norepinephrine.
However, these neurotransmitters do far more than just regulate mood. They have also been found to be integral to sleep efficiency. Disruptions in these brain chemicals can lead to disturbances in sleep, particularly REM sleep, and can also lead to more restlessness during typical times when one should be in bed. This can create a vicious cycle wherein the more severe one’s depression becomes; the more severe one’s insomnia becomes. The inverse can also true: The more severe one’s insomnia becomes; the more severe one’s depression becomes.
A growing body of research has found that sleep disturbances and depression have an extremely high rate of concurrence, and many researchers are convinced that the two are biconditional—meaning that one can give rise to the other, and vice-versa. One recent research study concluded, “The link between the two is so fundamental that some researchers have suggested that a diagnosis of depression in the absence of sleep complaints should be made with caution.” It found that 83 percent of depressed patients experienced some form of insomnia, which was more than double the amount (36 percent) of those without depression.
Finally, there are a number of prompts or small behaviors that you can employ to let your body and mind know that it’s time to sleep. These prompts can be important because sleep disturbance is just not about biology, but also psychology. Depressives ruminate, and they do it at the worst of times: when trying to fall asleep. There are several things you can do to get ready for sleep. Just don’t leave it to chance that you might sleep well. Be pro-active and recognize the critical importance of a good night’s sleep in helping you to recover from depression.
My own experience is that the type of antidepressant you are on may be helping or hurting your ability to sleep. You may need to change antidepressants (or the dosage). Alternatively, you may need to supplement your antidepressant with another medication that will help you to sleep. I know many who are doing, this and it helps them to sleep well.
- Sleep Study
Research has also shown that sleep apnea leads to depression. Sleep apnea is a sleep disorder characterized by abnormal pauses in breathing or instances of abnormally low breathing, during sleep. A sleep study is a test that measures how much and how well you sleep.
Sleeping pills may help you fall asleep, but they are not long-term solutions for anyone struggling with depression. If you are suffering from depression, you need to address that disorder to address your insomnia.
Another potential treatment during the dark winter months involves a combination of medication, light treatment, and melatonin, a hormone that helps regulate the circadian process.
- Natural Sleep Aids
Although the evidence is mixed, the following supplements have the most research backing them up as insomnia treatments.
Valerian. Valerian is a sedating herb that has been used since the second century A.D. to treat insomnia and anxiety. It is believed to work by increasing brain levels of the calming chemical GABA. Although the use of valerian for insomnia hasn’t been extensively studied, the research shows promise, and it is generally considered to be safe and non-habit forming. It works best when taken daily for two or more weeks.
Melatonin. Melatonin is a naturally occurring hormone that increases at night. It is triggered by darkness and its levels remain elevated throughout the night until suppressed by the light of morning. Although melatonin does not appear to be particularly effective for treating most sleep disorders, it can help sleep problems caused by jet lag and shift work. Simple exposure to light at the right time, however, might be just as effective. If you take melatonin, be aware that it can interfere with certain blood pressure and diabetes medications. It’s best to stick with low doses—1 to 3 milligrams for most people—to minimize side effects and next-day drowsiness.
Chamomile. Many people drink chamomile tea for its gentle sedative properties, although it may cause allergic reactions in those with plant or pollen allergies. To get the full sleep-promoting benefit, bring water to a boil, then add 2-3 tea bags (or the equivalent of loose-leaf tea), cover with a lid, and brew for 10 minutes.
Tryptophan. Tryptophan is a basic amino acid used in the formation of the chemical messenger serotonin, a substance in the brain that helps tell your body to sleep. L-tryptophan is a common byproduct of tryptophan, which the body can change into serotonin. Some studies have shown that L-tryptophan can help people fall asleep faster. Results, however, have been inconsistent.
Kava. Kava has been shown to improve sleep in people with stress-related insomnia. However, kava can cause liver damage, so it isn’t recommended unless taken under close medical supervision
A restful sleep is one of the most important things that need to be addressed to recover from depression and manage it in the long haul.
Address it sooner than later.
By Daniel T. Lukasik, Esq.
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Why We Sleep: Unlocking the Power of Sleep and Dreams, Matthew Walker, Ph.D.
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