When people reach middle age sleep disturbances become more commonplace. Insomnia is estimated to affect around 8-10 percent of the population constantly and the figure increases if we account for things like physical illness, pain, emotional upsets, work worries and of course depression.
People possibly worry too much about sleep. Most of us have been brought up in the belief that only a good solid night of sleep provides what’s necessary for rest and recuperation. A cat-nap during the day can help to compensate for lost sleep, for example, and some perfectly healthy people have adapted well to alternate sleep patterns because of their job. Still, those of us lucky enough to enjoy consistent sleep may find it difficult to imagine acceptable alternatives. Sleep experts point to two important two important characteristics of sleep - time taken to get to sleep and continuity of sleep. People with depression tend to show marked differences to healthy people with regard to these characteristics.
Estimates put sleep disturbances as high as 75 percent in people with depression. In fact various types of sleep disturbances can occur. Despondent people find they can’t stop thinking when all they want to do is drop to sleep. Their thoughts churn repeatedly as they play out different scenarios in their mind. In depression, irritability and agitation play a more significant role. Sleep continuity tends to suffer as the person wakes frequently then finds difficulty getting back to sleep. Nightmares are common with despondency. Early morning waking is common during depression and often at the point when the body temperature is at its lowest. Whether depressed or not, very early waking can enhance the sense of fatigue felt later.
Sleep is measured in terms of stages 1-4, with stage 1 being preceded by dream sleep (REM sleep). As we fall to sleep we move from dream sleep to the light sleep associated with stage 1. Sleep then becomes progressively deeper. People with depression often miss out on periods of deep sleep and this explains why they feel so tired in the morning. Characteristically, they experience cycles of waking and superficial sleep, with many more periods of dream sleep with unpleasant dreams. This unfortunate pattern can sometimes be broken for a period if the person stays awake for one or two nights. The level of fatigue this induces encourages the person into a state of deep sleep fairly quickly. This allows the brain to recuperate and, not surprisingly, the person feels their mood lifted as a result.
Both antidepressant medication and ECT can have positive effects on sleep. In those for whom it works, dream sleep is reduced and continuity of sleep allowing deep sleep is increased. In states of low mood or mild depression self-help techniques are useful and possibly better alternatives:
- Clock watching simply enhances the sense of sleep being lost so just turning the face of the clock the other way can help.
- Instead of fighting to get to sleep get up and do some reading. Don’t get involved in anything stimulating such as turning on your pc or watching TV. Something calming and even monotonous is better.
- Make sure the bedroom is cool but not too cold and dark.
- If your depression is accompanied by anxiety of the dark then use a night light in preference to a say a shaft of light from the hallway.
- Get rid of noise by using ear plugs if necessary.
- Let some fresh air circulate.
- Stick to a routine of getting ready for bed. At least an hour before going to bed, do a little reading, have a bath or listen to relaxing music.
- Cut out coffee, tea, cigarettes and alcohol up to several hours before retiring. Alcohol does encourage sleep but encourages superficial sleep and regular waking.
- Some people find that a little exercise before sleep helps.
- Don’t go to bed hungry. Have a hot milk and maybe a biscuit or pastry. Carbohydrates help boost the absorption of tryptophan, necessary for building the mood-regulator serotonin.