Depression
Feelings of sadness, disappointment, or hopelessness can be a healthy reaction to life’s challenges. Usually, these feelings come in episodes, are tied to thoughts of challenging situations, only last for a short period, and do not interfere with school, work, and relationships. In depression, these feelings follow a different pattern. They persist for more than two weeks, are felt nearly every day, and remain for most of the day.
Individuals with depression may find it difficult to fall asleep and stay asleep during the night. They can also have excessive daytime sleepiness or sleep too much. At the same time, sleep problems can exacerbate depression, leading to a negative cycle between depression and sleep that can be challenging to break. Poor sleep may even provoke depression in some people. This complex relationship can make it challenging to know which came first, sleep problems or depression.
Understanding the relationship between sleep and depression can be an essential step in improving sleep quality and managing depression.
What we offer at Sleep and Brain
At Sleep and Brain, we conduct a detailed clinical history and specialized physical examination to evaluate if a sleep disorder is underlying your depression. We prudently assess for sleep disorders as exampled below:
Sleep-Disordered Breathing
The repetitive breathing interruptions cause arousals that heighten the sympathetic nervous system (i.e., fight-or-flight system) and dampen the parasympathetic nervous system (i.e., rest and digest system). Your body is not designed to remain in a chronic state of stress; it wears down, and depression may ensue.
Restless Legs Syndrome
Restless, tingly legs with an urgency to move them can masquerade as anxiety, often co-existing with depression. Conversely, sleep deprivation from restless legs can lead to stress, further increasing your vulnerability to depression.
Periodic Limb Movement Disorder
You may unknowingly kick your legs intermittently during sleep. The limb movement can disrupt sleep and cause arousals that heighten sympathetic tone, a hallmark of depression.
Insomnia
Insomnia, defined as difficulty falling asleep, staying asleep, awakening too early, or non-restorative sleep, is commonly linked to depression. Depression can be both a cause and a result of insomnia.
Narcolepsy
Daytime sleepiness and sleep fragmentation is a cardinal symptom of both narcolepsy and depression. Many people with depression alternate between insomnia and hypersomnia during a single depression period.
Depression is marked by a state of heightened sympathetic tone. We may recommend sensitive home sleep testing with peripheral arterial tonometry to quantify your sleep patterns and evaluate sleep-disordered breathing and sympathetic arousal frequency.
Laboratory sleep testing, performed in your home, may be necessary to evaluate depression and additional sleep disorders. Sleep in depression exhibits a prolonged sleep latency, shallow fragmented sleep, and precocious morning awakening. Additionally, slow-wave sleep is typically reduced, the REM sleep latency shortened, and the duration of the first REM sleep period prolonged.
We offer sophisticated testing to elucidate areas of brain imbalance. A brain map can also assess which networks between brain areas are improperly functioning. Together, the data allows us to determine if the brain imbalances support a diagnosis of depression versus something else.
Understanding the cause of you or your child's sleep problems is essential to customize a treatment regime for both the sleep disorder and depression. Treating sleep problems may improve depression because, as mentioned, disordered sleep symptoms can mimic and exaggerate depressive symptoms. We direct treatment toward the sleep disorder as exampled below:
Removing the tonsils, expanding the palate, and starting CPAP can help anxiety and disordered sleep symptoms.
Iron and dopamine deficiencies can cause RLS, PLMD, and, in part, depressed mood. We treat RLS with iron supplements, medication, and non-medication therapies.
Identifying and eliminating the cause of awakenings from sleep
Utilizing light therapy to advance or delay your sleep cycle
In addition to treating an underlying sleep disorder, we institute robust sleep hygiene interventions, as partly described below, to make going to bed a pleasant experience and reduce anxiety:
Ensuring your bedroom environment is conducive to sleep
Eliminating sources of sleep interruption like light and noise
Optimizing your diet as food can promote and hinder sleep
Assessing your nighttime habits and rituals
Our scientifically-based cognitive-behavioral therapy for insomnia therapy is a rigorous, 4-week program is vital to treat insomnia linked to depression.
A state of hyperarousal, frequently marked by worry, is a critical factor of insomnia. CBT-I reduces negative thoughts about going to bed, a type of anticipatory anxiety that challenges healthy sleep schedules. Even after falling asleep, you may awaken with anxiety in the middle of the night. CBT-I reorients negative thinking and helps you return to sleep when your mind races with worry. We also utilize relaxation techniques as part of our CBT-I to reduce anxiety and make it easier to fall asleep quickly and peacefully. Guided imagery, deep breathing, and mindfulness meditation are just a few approaches to putting your mind at ease and improving your sleep and depression.
Brain TMS has advanced into treating anxiety and multiple disorders associated with depression, such as restless leg syndrome, anxiety, and insomnia. We personalize a TMS protocol based on your unique brain map.
Several medication classes treat depression, including anti-anxiety drugs, antidepressants, and beta-blockers. However, these medications mitigate symptoms rather than cure the underlying cause. We judiciously use medications to treat an identified underlying cause.
