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Sleep
Disorders Accompany Depression
Do you find
yourself sleeping 12 or 14 hours at
a time? Is your husband staying up
all night? If you have been
accepting these strange sleep
patterns as part of your depression
or bipolar disorder, you may be
pleased to learn that changing the
way you sleep might significantly
improve your condition.
What may
surprise you is that reduced sleep
isn't just a symptom of mania - a
short night can actually
precipitate manic and hypomanic
episodes.
Studies have
found that 25 to 65 percent of
bipolar patients who had a manic
episode had experienced a social
rhythm disruption prior to the
episode. "Social rhythm disruption"
is some disturbance in routine
affecting the sleep/wake cycle; it
can be as simple as staying up extra
late to watch a movie on television
or getting wrapped up in an
interesting online chat session, or
as serious as being unable to sleep
due to a family member's serious
illness or death. "For reasons we
have yet to learn, people with
bipolar disorder seem to have more
delicate internal clock mechanisms,"
said Dr. Ellen Frank, co-author of
one of the studies. And once a
sleep-deprived person has gone into
mania, if he then feels less need
for sleep (parasomnia) and, by
staying awake perhaps 20 or more
hours a day, is actually
contributing to making the mania
worse.
Some
scientists believe that the reason
the incidence of bipolar disorder
has risen in modern times is the
development of bright artificial
light. Once upon a time, most
people's sleep/wake cycles were
regulated by the sun. Artificial
light changed all that, and made it
more likely that people who have a
genetic predisposition toward
bipolar disorder would actually
develop the condition.
Interestingly, 85% of patients with
unipolar depression report that they
suffer from insomnia, even though
bipolar patients tend to experience
hypersomnia - excessive sleeping -
during depressive episodes.
Hypersomnia is also a characteristic
of Seasonal Affective Disorder -
along with decreased quality of
sleep, which is also found in
depressive patients, whether
insomniac or hypersomniac. This
poor-quality sleep can, in turn,
lead to fibromyalgia, a painful,
nondegenerative muscle disorder. All
these patients can benefit from good
"sleep hygiene" - a disciplined
regularizing of sleep/wake hours.
Depressed patients and those with
fibromyalgia are also often treated
with antidepressants such as
amitriptyline and trazodone, which
have sedating effects.
Patients
suffering from insomnia and
hypersomnia are told to go to bed at
the same time each day, and get up
at the same time. Naps are
forbidden. Insomniacs should not
stay in bed if they can't sleep, but
are to get up at the same time no
matter how little sleep they have
had. Hypersomniacs are advised to
gradually reduce the amount of time
spent sleeping to a normal amount by
using an alarm clock.
Preliminary
studies indicate that aggressive
readjustment of the sleep/wake cycle
may be of particular help for
treatment-resistant rapid cycling
bipolar disorder. Such therapy may
begin by enforcing complete light
and sound deprivation for as many as
14 hours per night, which can be
gradually reduced once the patient's
moods are seen to stabilize.
Doctors
point out the need to involve the
patient's family in the effort to
regularize the sleep/wake cycle.
Family members should be taught
about the patient's vulnerability to
changes in daily routine. After all,
a husband's "Oh, honey, I know the
party will last all night but can't
we do it just this once?" could send
"honey" straight into a manic
episode. Family members also need to
learn the signs of an episode's
onset, whether manic, hypomanic or
depressive, and be prepared to
intervene before the mood
swing becomes full-blown.
If you or a
loved one suffer from any type of
mood disorder, pay attention to the
sleep/wake patterns of the person
involved. If you identify insomnia,
hypersomnia, poor-quality sleep
and/or reduced need for sleep, this
should be brought to your/your loved
one's doctor's attention right away.
Treating the sleep disorder is very
likely to improve the mood disorder,
too.
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