| Q: |
How does depression affect sleep?
| | A: |
Depression can cause sleep disturbances ranging from insomnia or
disturbing dreams to too much sleep time. Several factors are involved
in disturbed sleep including increased levels of anxiety and arousal,
abnormalities in circadian rhythm (some of which may be affected by
drugs used in treating mood disorders), and the fact that the brain and
neurochemical systems involved in regulating the sleep-wake cycle are
also involved in mood regulation. Both sleep disturbance and fatigue
have the greatest predictive value for the presence of a depressive
illness. Sleep studies on patients with depression show problems with
sleep continuity, decreased slow wave sleep, and abnormalities in REM
sleep, among other findings.
|
| Q: |
How are sleep disturbances treated in people with mood disorders?
| | A: |
If a major depression is present, you need to see a doctor or
psychiatrist. There are many different and effective medications for
treating depression. Not all people will respond to the same medication
and you might have to try several different medications to find the
ideal one. Most drugs for depression function by altering the brain’s
neurochemical balances. Many take several weeks to work and treatment
should continue for at least 6 months.
|
| Q: |
What other forms of treatment are there for depression?
| | A: |
Cognitive-behavioral and other talking therapies may be useful
adjuncts to treatment of depression depending on its severity. Sleep
deprivation and light therapy can be used as alternatives or in
conjunction with medication, even if the depression is nonseasonal.
However, these treatments must only be undertaken with appropriate
medical guidance.
|
| Q: |
How does schizophrenia affect sleep?
| | A: |
Schizophrenia is a devastating neuropsychiatric illness with a
prevalence worldwide of about 1 in 100. The precise cause of
schizophrenia is unknown. The impact on sleep of this illness is
variable. Patients with psychotic agitation can have long periods of
sleeplessness. Insomnia is the most common problem in schizophrenia and
is often characterized by a reduced total sleep time, sleep fragmented
by periods of wakefulness, and problems getting to sleep. Some patients
experience a reversal of their sleep-wake patterns, preferring to stay
awake all night and sleep during the daytime. Some patients experience
nightmares and also a greater frequency of hypnagogic hallucinations
(the visual hallucinations or dreamlike images that can occur at the
start of sleep). Substance and alcohol abuse can worsen these problems.
|
| Q: |
How do anxiety disorders impact on sleep?
| | A: |
One manifestation of an anxiety disorder is the presence of panic
attacks. These can occur during sleep and are characterized by an
intense feeling of fear and anxiety accompanied by palpitations, chest
pain, light-headedness, and nausea (among other symptoms). The presence
of nocturnal panic attacks can lead to a worsening of the anxiety
disorder and to all sorts of maladjustments with respect to sleep
hygiene and sleep. Many people with anxiety disorders also experience
depression and the major sleep problem is insomnia. Anxiety disorders
can be made worse by lifestyle habits, such as excessive caffeine intake
or smoking, so sleep hygiene measures can help with sleep. Other
treatments include medication and talking therapies, which often prove
to be very effective.
|
| Q: |
How is sleep affected in bipolar disorder?
| | A: |
During the manic episode there is a decreased need for sleep,
which is generally not perceived to be a problem by the patient. During a
depressive phase, sleep disturbances are just like those described for
depression (see How does depression affect sleep?).
Difficulty falling asleep, early morning awakening, and daytime fatigue
are common. Alternatively, some patients during the depressive phase
complain of excessive sleep, difficulty waking up, and excessive daytime
somnolence. Disturbing dreams may also be a feature of sleep. Upon
treatment, most sleep problems will end but insomnia can persist and
continue to be troublesome.
|
| Q: |
What is sleep-related eating disorder?
| | A: |
This disorder is also called nocturnal binge-eating disorder. The
person with the disorder experiences episodes of involuntary eating and
drinking during the night, often (like sleepwalkers) with little
recollection of their behavior. However, some sufferers appear to be
very alert and can recollect what happened in the morning. Generally,
high-calorie foods (carbohydrates and fats) are eaten. Often, food is
consumed in odd combinations or is toxic or inedible. An example is a
glass of soft drink mixed with dog biscuits. Usually sufferers don’t
have an appetite in the morning and can feel bloated. Weight gain is
common.
|
| Q: |
Are there any sleep problems associated with anorexia nervosa or bulimia nervosa?
| | A: |
When weight is subnormal, the patient usually sleeps less.
However, a complaint of insomnia is rare since the time is used by the
patient for other activities, such as exercise. Binge eating can result
in increased amounts of sleep and if it occurs at night, usually results
in the person sleeping through the early part of the day. Sleep walking
seems more common among people with eating disorders but this has not
been systematically studied.
|
Could I be Depressed?
The following questions
are based on a questionnaire known as the Zung self-rated depression
scale, and can be used to assess the presence and severity of mild
degrees of mood disorder. They can be used from adolescence onward. The
questions are not a substitute for a professional diagnosis, so if you
are at all concerned about your symptoms, then it is best to seek
medical advice–you can fill the questionnaire out and take it to your
doctor for further assessment.
Read each statement below
and place a tick in the column that applies to you. Each question
relates to how you have felt in the last week. Don’t take too long
thinking about your answer because the questionnaire is designed to
assess your mood and will be more accurate this way. Add up the number
of points you score. The maximum score is 80. Scores above 50 are
suggestive of depression. If you scored above 50, or are concerned that
you may be depressed, you must discuss this with a health professional.
Table | Make check mark in appropriate column | A little of the time | Some of the time | Most of the time | All of the time |
|---|
| I feel down-hearted and blue | 1 | 2 | 3 | 4 | | I feel best in the morning | 4 | 3 | 2 | 1 | | I have crying spells or feel like crying | 1 | 2 | 3 | 4 | | I have problems sleeping at night | 1 | 2 | 3 | 4 | | I still eat as much as I used to | 4 | 3 | 2 | 1 | | I still enjoy sex | 4 | 3 | 2 | 1 | | I notice that I am losing weight | 1 | 2 | 3 | 4 | | I have trouble with constipation | 1 | 2 | 3 | 4 | | My heart beats faster than usual | 1 | 2 | 3 | 4 | | I feel tired for no reason | 1 | 2 | 3 | 4 | | My mind is as clear as it used to be | 4 | 3 | 2 | 1 | | It is easy to do the things I used to do | 4 | 3 | 2 | 1 | | I feel restless and can’t keep still | 1 | 2 | 3 | 4 | | I feel hopeful about the future | 4 | 3 | 2 | 1 | | I feel more irritable than usual | 1 | 2 | 3 | 4 | | I find it easy to make decisions | 4 | 3 | 2 | 1 | | I feel that I am useful and needed | 4 | 3 | 2 | 1 | | I feel my life is pretty full | 4 | 3 | 2 | 1 | | I enjoy the things I used to do | 4 | 3 | 2 | 1 | | I feel that others would be better off if I were dead | 1 | 2 | 3 | 4 |
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