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.

Make check mark in appropriate columnA little of the timeSome of the timeMost of the timeAll of the time
I feel down-hearted and blue1234
I feel best in the morning4321
I have crying spells or feel like crying1234
I have problems sleeping at night1234
I still eat as much as I used to4321
I still enjoy sex4321
I notice that I am losing weight1234
I have trouble with constipation1234
My heart beats faster than usual1234
I feel tired for no reason1234
My mind is as clear as it used to be4321
It is easy to do the things I used to do4321
I feel restless and can’t keep still1234
I feel hopeful about the future4321
I feel more irritable than usual1234
I find it easy to make decisions4321
I feel that I am useful and needed4321
I feel my life is pretty full4321
I enjoy the things I used to do4321
I feel that others would be better off if I were dead1234
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