WESTCHESTER, Ill. – Mental Health Awareness Month, observed throughout May in the United States, increases awareness about mental illness such as depression. Mental illness is a significant health concern and, if left untreated, can have serious consequences. Depression is the most common mental illness, and recent studies have demonstrated the link between depression and poor sleep. The American Academy of Sleep Medicine (AASM) warns those suffering from a sleep disorder to see a sleep specialist for treatment without delay, and to not allow it to escalate into a more serious, and potentially life-threatening, health concern.
Arthur J. Spielman, PhD, a professor of psychology at the City College of New York, an adjunct clinical professor of psychology at the Cornell University Weill Medical College, associate director of the Sleep Disorders Center at New York Presbyterian Hospital at Cornell, and a member of the AASM board of directors, acknowledges that it has long been established that insomnia is one of the most common symptoms of both dysthymic disorder (mild to moderate form of depression) and major depressive disorder (a severe form of depression). However, says Dr. Spielman, there is evidence that the reverse of this can also be true.
“For many years, it was assumed that insomnia was produced by depression or, in diagnostic parlance, secondary to the depressive disorder,” says Dr. Spielman. “This view was first challenged by a research study in the late 1980s that showed that individuals with insomnia and free of depression that were untreated were more frequently depressed one year later. Following this paradigm-shifting study, there have been seven other studies that have reached similar conclusions. It is now well established that insomnia is a risk factor for depression.”
Donna Arand, PhD, clinical director of the Sleep Disorders Center at Kettering Hospital in Dayton, Ohio, and research assistant professor at Wright State University Boonshoft School of Medicine, adds that individuals with insomnia have a four- to five-fold greater risk of developing major depression.
“Once depression has occurred, insomnia typically precedes recurrent bouts of depression,” says Dr. Arand. “In addition, insomnia is a predictor of acute suicide among people with mood disorders. However, both depression and insomnia are treatable, and individuals experiencing either symptom should seek treatment.”
A study in the April 1 issue of the journal SLEEP confirms the persistent nature of insomnia and the increased risk of subsequent depression among young adults with insomnia. The study, which focused on 591 young adults, found that insomnia lasting two weeks or longer predicted major depressive episodes and major depressive disorder at subsequent interviews. Seventeen to 50 percent of subjects with insomnia lasting two weeks or longer developed a major depressive episode in a later interview. “Pure” insomnia and “pure” depression were not longitudinally related to each other, whereas insomnia comorbid with depression was longitudinally related to both.
“We used to think that insomnia was most often just a symptom of depression. However, a growing body of evidence suggests that insomnia is not just a symptom of depression, but that it may actually precede depression. In other words, people who have insomnia but no depression are at increased risk for later developing depression,” says Daniel J. Buysse, MD, of the University of Pittsburgh, lead author of the paper.
In addition to being a risk factor for a depressive episode, persistent insomnia may perpetuate the illness in some elderly patients, and especially in those receiving standard care for depression in primary care settings, another study published in the April 1 issue of the journal SLEEP points out. The study was conducted on 1,801 elderly patients (60 years of age or older) with major depressive disorder and/or dysthymia, and found that patients with persistent insomnia were 1.8 to 3.5 times more likely to remain depressed, compared with patients with no insomnia. The findings were more robust in patients receiving usual care for depression than in patients receiving enhanced care. The findings were also stronger in subjects who had major depressive disorder as opposed to those with dysthymia alone.
“Even when depression was identified and treated in the primary care setting, the older adults in this study were more likely to remain depressed if they also exhibited persistent insomnia. The finding that this risk was higher in the usual-care group suggests that enhanced depression care may partially mitigate the perpetuating effects of insomnia on depression,” says Wilfred R. Pigeon, PhD, assistant professor of psychiatry at the University of Rochester Medical Center in Rochester, New York, study author.
Adults with insomnia are not the only ones at risk for a depressive episode. A study in the journal SLEEP in 2007 found that sleep-disturbed children are more severely depressed and have more depressive symptoms and comorbid anxiety disorders compared with children without sleep disturbance. The study, performed on 553 children with a depressive disorder, found that 72.7 percent had sleep disturbance, of which 53.5 percent had insomnia alone, nine percent had hypersomnia alone and 10.1 percent had both disturbances.
Furthermore, the study found that across sleep-disturbed children, those with both insomnia and hypersomnia had a longer history of illness, were more severely depressed and were more likely to have anhedonia, weight loss, psychomotor retardation and fatigue than those with either insomnia or hypersomnia.
“We know that depression is associated with sleep problems. But what this study shows is that, in depressed youths, not all sleep problems are the same,” says Xianchen Liu, MD, PhD, of the University of Pittsburgh, lead author of the study. “Insomnia is the most common problem, but having a combination of insomnia and sleepiness is ‘double trouble’. Youths having both of these had more severe depression than youths with just one sleep problem. This means that we should carefully ask depressed youths about the specific type of sleep problem they’re having. It may also mean that we should think about different treatments to specifically target an individual’s sleep problem.”
It is recommended that infants (three to 11 months) get 14 to 15 hours of nightly sleep, while toddlers get 12 to 14 hours, children in pre-school 11-13 hours and school-aged children between 10-11 hours. Adolescents are advised to get nine hours of nightly sleep and adults seven to eight hours.
The emergence of insomnia should motivate the patient and the patient’s doctors to initiate treatment for insomnia, adds Dr. Spielman.
“Insomnia treatment is quite successful these days because of the effectiveness of cognitive behavioral therapy and new hypnotic medications,” says Dr. Spielman. “When insomnia is addressed quality of life improves, fatigue is reduced and the risk of future depression is reduced. All very good reasons to seek out treatment for this common sleep disturbance.”
The AASM offers the following tips for adults and adolescents on how to get a good night’s sleep:
• Follow a consistent bedtime routine.
• Establish a relaxing setting at bedtime.
• Get a full night’s sleep every night.
• Avoiding utilizing bed for activities other than sleep or intimacy.
• Avoid foods or drinks that contain caffeine, as well as any medicine that has a stimulant, prior to bedtime.
• Do not bring your worries to bed with you. Bedtime is a time to relax, not to hash out the stresses of the day.
• Not napping during the day. If you must snooze, limit the time to less than one hour and no later than 3 p.m.
• Do not go to bed hungry, but don’t eat a big meal before bedtime either.
• Avoid any rigorous exercise within six hours of your bedtime.
• Make your bedroom quiet, dark and a little bit cool.
• Get up at the same time every morning.
The AASM offers some tips to help your child sleep better:
• Follow a consistent bedtime routine. Set aside 10 to 30 minutes to get your child ready to go to sleep each night.
• Establish a relaxing setting at bedtime.
• Interact with your child at bedtime. Don’t let the TV, computer or video games take your place.
• Keep your children from TV programs, movies, and video games that are not right for their age.
• Do not let your child fall asleep while being held, rocked, fed a bottle, or while nursing.
• At bedtime, do not allow your child to have foods or drinks that contain caffeine. This includes chocolate and sodas. Try not to give him or her any medicine that has a stimulant at bedtime. This includes cough medicines and decongestants.
Parents who suspect that their child might be suffering from a sleep disorder are encouraged to consult with their child’s pediatrician or a sleep specialist. Adults and adolescents are encouraged to consult with their primary care physician or a sleep specialist.
More information is available from the AASM about:
SleepEducation.com, a patient education Web site created by the AASM, provides information about various sleep disorders, the forms of treatment available, recent news on the topic of sleep, sleep studies that have been conducted and a listing of sleep facilities.
AASM is a professional membership organization dedicated to the advancement of sleep medicine and sleep-related research.
To arrange an interview with an AASM spokesperson, please contact Jim Arcuri, public relations coordinator, at (708) 492-0930, ext. 9317, or firstname.lastname@example.org
SLEEP 2008, the 22nd Annual Meeting of the Associated Professional Sleep Societies and the world’s largest annual gathering of sleep scientists and sleep medicine professionals, will take place in Baltimore, Maryland, from June 9-12, 2008. SLEEP 2008 will bring together an international body of 5,000 leading researchers and clinicians, who will present and discuss over 1,100 new findings and medical developments related to sleep and sleep disorders. The deadline to register is Friday, May 30, 2008. Contact Jim Arcuri at (708 ) 492-0930, ext. 9317, or email@example.com for more information or to register for a free press pass. More details, including the program schedule and a list of invited lecturers, are available at www.SleepMeeting.org.