The links between sleep and depression
Ever found yourself counting sheep in the middle of night while watching the interminable second hand skulk around the face of your alarm clock? It’s not only frustrating, but it’s can be stressful as well as exhausting. About 30 per cent of us report having difficulties with our sleep according to latest research.
We might be waking up too early, have trouble getting to sleep in the first place or - frustratingly - find ourselves wide-awake in the middle of the night for no obvious reason at all. For those of us who suffer from depression and anxiety these symptoms are usually acute and felt as particularly troubling.
Yet, surprisingly according to new research, it is not whether we have disturbed sleep or not, but how we think about the disturbance that can have the most detrimental effect on our mental well being. For instance, if we carry ideas that if we don’t have a full eight hours sleep then the next day will be ‘ruined’, or ‘we just won’t be able to cope’, then we may be ratcheting our risk factors in becoming depressed. In CBT (cognitive behavioral therapy) these thoughts are called catastrophizing cognitions and would be worked through and challenged with the therapist as being both and unrealistic and ultimately unhelpful.
The therapist might gently challenge the truthfulness of these thoughts and perhaps encourage diary-keeping on days after disturbed sleep. The sense of tiredness would be acknowledged and named, but importantly those achievements and results gained, even when the client was feeling tired. Such techniques will go some way lessen the power of those over whelming thoughts about not coping or the sense of a ‘wasted’ day.
“Despite the widespread interest and problems sleep difficulty has created, research into sleep, especially around anxiety and mood disorder has been lacking,” says David Baldwin, Professor of Psychiatry in the Faculty of Medicine at the University of Southampton. With his colleague, Thomas Foong, a senior trainee in psychiatry, Professor Baldwin has conducted research into the beliefs and attitudes towards sleep by both people with depression and their close families.
The researchers were interested in dysfunctional beliefs about sleep, those kinds of thoughts that might plague us just like those mentioned above – that somehow not getting enough sleep will cause us untold trouble the next day. Baldwin and Foong wanted to know if these kinds of thoughts are more common among depressed people. Alternatively, if people hold these thoughts are they more likely to fall into depression? Can these thoughts and attitudes be held by the families of depressed people, even though not all the family members may have depression?
‘We know that having unhelpful beliefs about sleep is a risk factor for poor sleep, which in turn increases the risk of depression returning,’ says Foong. ‘These unhelpful thoughts and feelings about sleep might be independent from depression, as they last longer than depressive symptoms and so might be a useful target for treating depressed patients,’ he adds.
Their research is still at an early stage and firm conclusions haven’t been drawn apart from understanding that negative thoughts about sleep don’t necessarily mean that you’re depressed or even mean you’re more likely to become so. However, depressive symptoms such as low mood and a sense of hopelessness are much more likely in people who experience disturbed sleep and disturbed sleep can continue even with the depression has lifted and may well - according to their research – contribute to the depression returning.
According to Baldwin and Foong, it looks likely that therapeutically working through a formerly depressed patient’s dysfunctional thoughts and feelings about getting enough sleep may help her avoid falling into depression again. ‘If greater attention is being paid to helping depressed patients cope with or adjust to troublesome sleep, we have the expectation this would reduce the risk of depression coming back,’ says Foong. At present, treatment for depression is largely focused on reducing well-known symptoms such as low mood, reduced energy and pessimistic thoughts.
People tend to assume that the beliefs and feelings about sleep would simply improve with time as the depression lifted. ‘Our findings imply this may not be the case,’ says Foong. He suggest that long-term outcomes – i.e. relief from depression might be better, if more attention is paid to discussing thoughts and feelings about sleep.
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