The Rem Theory Of Sleep And Why Its Not Quite Right
Sleep consists of a number of stages, one of which is termed REM sleep. The REM stage of sleep is linked to dreaming and during this stage our brain activity levels are similar to what they are when weâre awake.
There are also non-REM sleep stages, with the the most important of these being NREM slow-wave sleep. Thatâs the type of sleep we need to feel refreshed in the morning.
During sleep, we alternate between REM and NREM stages and itâs been found that people living with depression spend a greater amount of their sleep time in the REM stages.567
This has led to the suggestion that increased REM sleep leads to depression. This is something you may have read online or in earlier scientific literature relating to sleep science and depression but it isnât strictly true.
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Insomnia May Not Only Accompany Depressionit May Cause It
In a role switch worthy of Clark Kent, insomnia, long recognized as a symptom of depression, now appears to transmute itself into the mood disorder. Recent evidence indicates that persistent sleeplessness can actually instigate depressionsuggesting that taking sleep routines seriously can be a powerful intervention against major mood disorders.
For 40 percent of adults in the United States, each month will bring at least one night of staring at the ceiling, tangling with the blanket, and counting sheep into the thousands as the alarm clock prepares its vengeful cry. Fortunately for most, a bout with sleeplessnesscaused, say, by anxiety about a big project or presentationwill pass in a day or two. But for others, a few days of insomnia stretch into a week or more, causing further stress, exhaustion during the day, and even depression.
Almost any sleep disorder can mess with mood. But insomnianightly sleeplessness for three weeks or morehas the strongest link to major depression. According to one study, people with persistent insomnia are 40 times more likely to develop depression within a year than are those who sleep well.
In a 2006 study, epidemiologist Eric Johnson of Research Triangle Institute International in North Carolina, found that about half of adolescents who had ever had insomnia developed a psychiatric disorder. Among those with both insomnia and depression, the insomnia preceded the depression 69 percent of the time.
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Mistimed Rem Sleep Is Linked To Depression
A more helpful way to understand the sleep disturbances that people with depression experience is to think of their sleep cycle as being somewhat âshiftedâ.
As a result of this âshiftâ REM sleep appears to be experienced earlier in the night and consequently, the sleeper gets less restorative slow-wave sleep during their time in bed.
The disruption to the timing of REM sleep appears to lead to mood disturbances like depression because it reduces their opportunity to get that restorative slow-wave sleep.
Now that weâve explained a little about how sleep and depression are linked, letâs consider what options there are for someone living with depression to improve their sleep.
Get Help For Both Depression And Sleep
If you have insomnia and depression, dont assume that medical treatment for one will automatically cure the other. Treatments for depression, such as selective serotonin reuptake inhibitors and other medications, may improve your mood and outlook, but they may not be enough to improve your sleep.
Theres some evidence that lingering sleep problems in people undergoing depression treatment increase the risk of a slide back into depression. The good news: Theres also some early evidence that CBT-I , along with depression treatment, improves sleep in people with depression and may increase the chances of a remission of depression.
Poor Quality Sleep Reduces Resilience
In a recent Johns Hopkins study, healthy women and men whose sleep wasinterrupted throughout the night had a 31 percent reduction in positivemoods the next day. Sleep interruptions interfere with deep, restorativeslow-wave sleep, explains lead researcher Patrick Finan, Ph.D. Ongoing insomnia could increase a persons risk of depression, he says, byweakening their emotional resiliencethe buffer of positive emotions thathelps people deal with stress and challenges of life.
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Getting Back On Track
If oversleeping is a symptom of depression, its most important to see a healthcare provider for treatment of that depression. And even if someone is being treated for depression, the sleep difficulties can be residual. Sleep can remain a struggle because its developed a life of its own and become very habitual, she says.
Dr. Drerup does have a few suggestions on how you can avoid falling into bad sleep habits that could exacerbate the sleep situation. These techniques can make a huge difference for people when they implement behavioral changes like this because the mood symptoms arent impairing them.
If people can get out of bed and get a more consistent start to their day, it can make their day better, Dr. Drerup says. They feel like they can be more productive and get more accomplished. And it can help improve their mood and allow them to make other changes over time that helps increase more pleasurable activities and engaging with people instead of the oversleeping and avoidance of interactions.
Hands off the snooze button
This may not be a popular idea given how much its a ritual for so many of us. But Dr. Drerup points out that repeatedly hitting the snooze button doesnt really help you. When you hit the snooze button and you doze for those short seven or eight minute increments, youre getting brief, fragmented sleep periods. You may think youre gradually becoming more alert but really youre developing sleep inertia and your body wants to stay asleep.
What Depression And Insomnia Treatments Are Available
Treatment choices for depression depend on how serious the illness is. Major depressive disorder is treated with psychotherapy , medications, or a combination of the two.
The most effective treatment for depression is often a combination of psychotherapy and medication. Drugs tend to work more quickly to decrease symptoms while psychotherapy helps people learn coping strategies to prevent the onset of future depressive symptoms.
Medications used to treat depression include antidepressants such as:
- Selective serotonin reuptake inhibitors , like Zoloft, Prozac, Celexa, Lexapro, and Paxil these medications can perform double duty for patients by helping them sleep and elevating their mood, though some people taking these drugs may have trouble sleeping. Newer antidepressant medicines that affect multiple serotonin receptors besides the serotonin transporter include Viibryd and Trintellix.
- Tricyclic antidepressants
- Serotonin/norepinephrine reuptake inhibitors like Effexor, Pristiq, Khedezla, Fetzima, or Cymbalta, that affect the functioning of brain circuits involved in mood regulation that communicate using chemicals such as serotonin and norepinephrine
- Novel antidepressants such as bupropion and mirtazapine .
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Persistent Irritability Or Mood Swings
Depression can cause us to experience outbursts and mood swings. One minute were angry, the next were crying uncontrollably or we shut down and go numb. Changes in our mood can switch in a moments notice. Sometimes these changes can be triggered by small or insignificant challenges, while other times they can come about unprovoked. If you notice a pattern of irritability or mood swings that last more than a few days, it may be linked to depression.
Not Wanting To Leave The House
Some people with depression can be housebound for weeks or longer. There are plenty of reasons for this, depending on who you ask. For some, its self-hatred. For others, crushing fatigue. Depression has this power to zap not only your will, but also your physical ability to leave the house.
The energy required to go grocery shopping is out of reach. The fear that every person you run into will hate you is real. This thought loop of uncertainty creates an environment where its almost impossible to get out the front door.
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Being Convinced Everyone Hates You
In life, some people will like you and some people will not. This is normal, right? In a healthy mindset, most people will accept the positives with the negatives. But depression is like the devil on your shoulder, whispering until people hate themselves and are convinced that everyone else hates them too.
Depression points out every tiny, perceived, possible slight and uses this as evidence that everyone hates you. This perception of hate tends to make people with depression feel even more depressed.
Addressing Sleep Problems Makes A Difference
If you sleep poorly and feel depressed, anxious, or less emotionally responsive, there are many treatments that can help. First, look at your sleep habits and see if there are steps that you can take on your own to improve the quantity and quality of your sleep. See Adopt Good Sleep Habits for tips on how to improve your sleep. If problems persist, you may wish to see a medical provider and ask about an evaluation for sleep problems and mental health concerns. After an evaluation and diagnosis, your provider can advise you on the best course of treatment. Options may include behavioral or other forms of therapy and/or medications. You can read about and watch a video of a behavioral sleep consultation in the Healthy Sleep module.Even if you do not have underlying sleep problems, taking steps to ensure adequate sleep will lead to improved mood and well-being. Sheila, a Boston district attorney and mother, became sleep deprived due to the conflicting demands of a full-time job and caring for her young children. She began to feel cranky, irritable, and uncharacteristically depressed. When she got both of her children on a consistent sleep schedule, she herself started sleeping an average of seven to eight hours a night and her mood improved considerably. Read more and watch a video about this in Sheila’s Balancing Act.
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The Link Between Sleep And Mood
You probably know firsthand that sleep affects mood. After a sleepless night, you may be more irritable, short-tempered, and vulnerable to stress. Once you sleep well, your mood often returns to normal.Studies have shown that even partial sleep deprivation has a significant effect on mood. University of Pennsylvania researchers found that subjects who were limited to only 4.5 hours of sleep a night for one week reported feeling more stressed, angry, sad, and mentally exhausted. When the subjects resumed normal sleep, they reported a dramatic improvement in mood.1Not only does sleep affect mood, but mood and mental states can also affect sleep. Anxiety increases agitation and arousal, which make it hard to sleep. Stress also affects sleep by making the body aroused, awake, and alert. People who are under constant stress or who have abnormally exaggerated responses to stress tend to have sleep problems.
Sleep and Mood
How Could Something As Simple As Staying Awake Overnight Bring About Such A Transformation
When Id interviewed her seven hours earlier, with the help of an interpreter, Angelinas face had remained expressionless as shed replied. Now, at 03:20, she is smiling, and even beginning to initiate a conversation with me in English, which shed claimed not to speak. By dawn, Angelinas telling me about the family history shes started writing, which shed like to pick up again, and inviting me to stay with her in Sicily.
How could something as simple as staying awake overnight bring about such a transformation? Unpicking the mechanism isnt straightforward: we still dont fully understand the nature of depression or the function of sleep, both of which involve multiple areas of the brain. But recent studies have started to yield some insights.
The brain activity of people with depression looks different during sleep and wakefulness than that of healthy people. During the day, wake-promoting signals coming from the circadian system our internal 24-hour biological clock are thought to help us resist sleep, with these signals being replaced by sleep-promoting ones at night. Our brain cells work in cycles too, becoming increasingly excitable in response to stimuli during wakefulness, with this excitability dissipating when we sleep. But in people with depression and bipolar disorder, these fluctuations appear dampened or absent.
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Mechanisms Of Sleep Regulation And Disturbances In Depression
Research over the past 25 years has revealed that the sleep-wake cycle is regulated by two separate but interacting processes, the circadian process and the homeostatic , or recovery process.
The C process is that which regulates the daily rhythms of the body and brain. Circadian patterns of activity arc found in many organs and cells, and the main circadian pacemaker is found in a group of cells in the suprachiasmatic nucleus of the hypothalamus. These cells provide an oscillatory pattern of activity which drives rhythms such as sleep-wake activity, hormone release, liver function, etc. This drive from the SCN is innate, self-sustaining, and independent of tiredness or amount of sleep. It is affected markedly by light and to some extent by temperature. Bright light in the evening will delay the clock, and bright light in the morning is necessary to synchronize the clock to a 24-hour rhythm in constant light or darkness the cycle length is about 24.3 h. All animals have such a clock, and the period and timing appear to be dependent on particular genes, which are similar in fruit flies and mammals.
Oversleeping Helps Me Escape Depression
For as long as I can remember, I have always been someone who needs a lot of sleep. Bouts of depression exacerbate this trait. During my major depressive episodes, I could sleep upwards of 18 hours a day. When I woke up, I wanted more. The more I got, the more I wanted… the more I needed. It was like an addictive drug. It was also like a veil over the pain I was feeling.
Like no other symptom of depression, sleep helped me escape from all the others. It was so easy, too. Just close my eyes and drift away. No pain. Total avoidance. Which is why this was the hardest symptom for me to combat.
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What Causes Excessive Sleepiness
Any condition that keeps you from getting good quantity and quality sleep at night can cause excessive sleepiness during the day. Daytime sleepiness may be the only symptom you know, but other signs, such as snoring or kicking, may be occurring while youre asleep.
For many people with sleep disorders, its a bed partner who observes other key symptoms. Regardless of the cause, its important to have your sleep condition evaluated if daytime sleepiness is keeping you from making the most of your day.
Among the more common causes of excessive sleepiness are:
Not Sleeping With Depression
We’re expected to be awake most of the time. The trouble is, not sleeping with depression is horrendously painful. It is the pain that makes pain scream. And there tends to be nowhere to hide. Depression checks behind rocks, it seems.
And the thoughts or the lack of thoughts that go with that depression haunt every blink. This ridiculous struggle not to die moment after moment. Don’t slit your wrists. Don’t overdose. Don’t jump off a building. It’s all so entirely exhausting.
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Talk To Your Doctor About Depression And Sleep Issues
If youre experiencing depression, sleep disturbances, or both, its important to seek help.
Its also important to talk to your doctor if youre experiencing depression and hypersomnia, or excessive sleepiness. The Centers for Disease Control and Prevention found that fewer than 20 percent of Americans who had moderate depressive symptoms had seen a mental health practitioner in the previous year. Medicines and therapy usually can help reduce depression and improve sleep.
Its also possible theres a more direct link between sleep and depression. People successfully treated for obstructive sleep apnea experienced lasting and reduced depression symptoms, according to the NSF. A sleep study can determine whether or not you have sleep apnea.
Before seeing a doctor about depression and sleep issues, its helpful to track your sleep for a few weeks so you can share examples of your sleep schedule, sleep quality, and how you felt emotionally during that time.
The doctors at UPMC can help you sleep better and tackle your depression. Whether youre suffering from depression and sleeping a lot or not getting nearly enough rest, theres no need to suffer alone.
How Depression Impacts Daily Life
Living with depression on a day-to-day basis can have a significant impact on quality of life. In addition to the low mood and persistent feelings of sadness, depression can leave the individual feeling unwell. This combination of symptoms will often result in reduced functioning at work and at home.
Sleep disruptions, including sleeping too much or sleeping too little, will wreak havoc with concentration, energy and stamina, memory functions, appetite, and can further intensify feelings of despair. When depression causes a person to literally not want to get out of bed all day it can cause a domino effect in all other realms. Hypersomnia may even lead to excessive absences at work and declining work performance overall.
Excessive sleeping also has a negative impact on the family dynamic. When mom or dad is holed up in bed the children who are depending on the parent may not have access to the care they deserve. This places more pressure on the well parent to take up the extra burden, which can have an effect on the relationship. Eventually, the impact of depression will touch all aspects of life.
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