One of the aspects of depression that’s particularly difficult is the sleep disturbance which accompanies it and often continues after the traditional symptoms of depression have finally gotten better. When studied in the laboratory, the sleep of depressed person is short, shallow (with less deep slow-wave sleep), and frequently interrupted by awakenings. Additionally, there are abnormalities of the timing of rapid eye movement sleep and intensity of eye movements during REM. Dreams often have a depressive tone, and some sleep scientists speculate that there is a dysfunction of a normal process in which they provide emotional healing. In any event, instead of sleep being a time of rest and recovery, it becomes a period of discomfort, from which a depressed person awakens in the morning unrefreshed. It can be made even more complicated if an antidepressant, which is designed to help the mood disorder, itself contributes to the poor sleep. In this posting, we will talk about what can be done to ease this difficulty.
There has been an evolving process in how sleep doctors view sleep disturbance in the context of depression or other illnesses. In years past, the notion was that if you find such a “cause” for insomnia: treat it, and the sleep will take care of itself. Thus if a person is kept up by the pain of arthritis or has sleep disturbance from depression — pain medicine or antidepressants should be the primary treatment, and sleep will naturally improve. In more recent years, this has changed, partly because the sleep disturbance can have features that separate it from the depression. As we mentioned before, often the sleep difficulties can persist long after the mood symptoms have improved, and indeed their presence may be associated with a higher risk of developing another depressive episode later. Also, it turns out that treating the sleep difficulty may improve the mood symptoms as well, as we will discuss later. The bottom line is that sleep doctors have begun to recognize that insomnia is a free-standing disorder, which may or may not occur in the context of another illness. When it does occur along with depression, for instance, the suggestion is that both should be treated.
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