Sleep disorders/disturbances are one of the most prevalent presenting complaints faced in a primary care setting, and is typically caused by depression amongst other factors. Insomnia can appear in other associated conditions such as mixed depression and anxiety (or either alone), pain and other medical conditions. Studies have revealed that 30-40% of patients in a community (reporting insomnia) presenting with insomnia, suffer from an underlying psychiatric disease. On the other hand 40- 60% of patients suffering with insomnia display symptoms of depression. Sleep disturbances are a crucial/important significance, patients suffering from insomnia exert a (poorer response to treatment and it also results in a higher incidence of suicidal ideation.
(As insomnia and depression are so closely interrelated, suggests it to be a prominent clinical feature of depression).
Sleep disturbances can enhance the susceptibility to and trigger episodes of depression. It seems that a relationship between poor sleep and susceptibility to depression exists. Changes to daily routine, e.g. jet lag, circad... can significantly disrupt an individual's sleep routine, which may precipitate depressive episodes.
What are the symptoms of depression associated with poor sleep?
​Typically, individuals display diurnal symptoms i.e. the symptoms of peak at morning, and gradually improve throughout the remainder of the day. Arousal is also heightened throughout the day, it is thought that this is consequence of the brain stem activity enhanced and the hypothalamus' ability to maintain wakefulness. Hypersomnia is a typical characteristic of both depression and bipolar. Depressed individuals undergo 3 phases of insmomnia which are :
-
Initial insmonia (unable to initiate sleep)
-
Mid insomnia (difficulty remaining asleep)
-
Terminal insomnia (waking up early)
Sleep hygiene is a measure which can aid good sleep by encouraging patients to eradicate or decrease factors which may distrupt the sleep-wake cycle, or trigger episodes of depression.
-
Establish a fixed sleep and wake time, and avoid napping thoughout the day
-
Establish, as much as possible a daily routine involving meals, exercise, work, sleep and wake time
-
Take measures to create a good sleeping environment e.g. reduce noise and lights
-
Sleep in a cool environment rather than a warm one as people tend to sleep better in such conditions
-
Engage in regular exercise, but avoid just before bed time
-
Avoid caffeine e.g. chocolate, cofee etc, 8 hours before sleep,
-
Avoid alcohol as this decreases quality of sleep, 6 hours before sleep
-
Avoid stimulants such as nicotine 2 hours before sleep
-
Avoid "clock watching", by putiing any clocks out of sight
-
Adopt relaxation techniques such as: breathing exercises, listen to soft music, read, have a warm bath
-
​Avoid stressful activities, e.g. arguments, intense work, or other such activities before going to sleep
Sleep hygiene measures
