Sleep deprivation as a treatment for depression. With endogenous depression. Despite promising results in the treatment of bipolar disorder, wakefulness therapy has been slow to catch on in other countries.

It is necessary to start in a timely manner, because exhaustion of the body against the background of worries and lack of sleep at the same time can lead to serious consequences. According to statistics, people who experience a depressive state have disturbed normal sleep.

After such nights one feels tired, apathetic, nervous, Bad mood and headaches. Not healthy sleep exacerbates an already severe psychological disorder.

Causes and signs of insomnia in depression

A person's sleep during depression is disturbed due to severe stress. Feelings and anxiety excite nervous system(NS), due to which the brain is always in an overexcited state, which means that it cannot turn off on its own.

The main symptoms of depression are:

irritability;
weakness;
apathy;
distraction;
hallucinations;
Red eyes;
nightmares;
frequent awakening;
long falling asleep;
inability to sleep.

Important! Recognizing insomnia, which is caused by depression, is quite difficult, because the symptoms are practically no different from the manifestations. psychological disorder. That is why it is recommended to seek the help of professionals.

Good sleep is an essential part correct operation the whole organism. Prolonged insomnia depletes the body. A person suffering from disorders may no longer distinguish the line between dream and reality.

Important! Treating insomnia should begin with its root cause - depression. As a rule, the approach to treatment should be complex.

Improving sleep with effective sleeping pills

Medications that are aimed at improving sleep have a clear goal - to overcome anxiety, relieve tension, stress and chronic fatigue. At correct reception the work of the National Assembly is normalized, the pulse is streamlined, the mood rises and the whole body gently relaxes.

List of over-the-counter sleeping pills:

doxylamine;
Circadin;
Reslip;
Melaxen.

It is worth noting that there are several types of insomnia (endogenous, dreary, hidden, apathetic, anxious), and a separate drug is prescribed for each type.

Above is a list of medicines for those who have insomnia is an infrequent visitor. If you have tried many drugs and nothing helps you, then you need to pay attention to stronger sleeping pills (Corvalol, Aminazine).

This method of treatment is also available to everyone, since the remedies are based on herbal ingredients and are freely available. There are many various medicines new generation, used today to normalize sleep most actively.

Consider the most effective:

Valerian;
motherwort forte
Novo passit.

Means practically have no side effects. However, there are cases when, if taken incorrectly, symptoms such as diarrhea, vomiting, and nausea appear. In such cases, the medicine should be stopped.

Tranquilizers are not only aimed at improving sleep, they also relieve anxiety, restlessness, tension and NS disorders.

Active drugs:

Noofen;
Afobazole;
Seduxen;
Adaptol;
Tenoten;
Phenazepam.

The remedy prescribed by the doctor should be used strictly according to the instructions or recommendations of the specialist.

Insomnia is one of the symptoms of depression, so there are some antidepressants that will not only improve the quality of sleep, but also eliminate stress, anxiety, worries, the causes of which are precisely the depressive state.

Effective drugs:

Trittiko;
Deprim;
Amitriptyline.

Important! Antidepressants are prescribed by a psychotherapist, since any medicine has its own side effects and in order not to worsen the condition by self-medication, it is better to seek help from a doctor.

Home remedies for insomnia in depression

Sleep disorders can also be treated with home remedies. Recipes traditional medicine passed down from generation to generation by our grandmothers. A person suffering from insomnia is always in search of the best and safest remedy for health.

Honey is the best natural remedy in the treatment of depression. Daily use fill the body with strength and vitality.

Consider ways to improve sleep with honey:

Dissolve in 200 ml warm water 1 tbsp honey. Mix well and drink before bed.
Squeeze the juice from one lemon into a glass. Add 2 tbsp. honey. Stir and add 1 tsp. crushed walnut. Use daily before bedtime, 1 tbsp.
Add 1 tbsp to a glass of kefir. natural honey. Mix and drink before bed. The duration of such treatment is up to 10 days.

In addition to honey, herbal preparations are considered to be an excellent sedative. Decoctions and infusions medicinal plants remove the excitement of the National Assembly, eliminate nervousness and anxiety.

Let's find out effective recipes:

Leaves of lemon balm, barberry, fragrant violet and lavender are mixed in the same proportion. Pour the mixture with boiling water (1 liter) and let it brew until cool. Take a strained decoction of 200 ml before bedtime.
Take 1 tbsp. valerian, peppermint, motherwort and hops. Pour 500 ml of boiling water over and let it brew for 2-3 hours. Three times a day you need to take a strained broth of 100 ml.
Thyme, calendula and motherwort are mixed in 2 tbsp. Fill the collection with boiling water (700 ml) and bring to a boil. After complete cooling, strain. Take 100 ml at bedtime.

Bath treatments with addition essential oils or decoctions medicinal herbs in a depressive state, they bring complete relaxation. After the procedure, stress, worries, weakness and irritability disappear without a trace.

So, how can you take a bath:

Every day for 15 minutes you can take a bath with the addition of chamomile and pine needles. Chamomile flowers and pine needles boil for 2-3 minutes and pour into a filled bath. Needles will not prick, as they will soften well during boiling.
For three weeks, it is recommended to take a bath with the addition of valerian and calamus. herbal collection added dry to a filled bath.

Remember, the water temperature should be within 38 degrees. Do not overdo the procedure. 15-20 minutes will be enough.

While taking a bath, listen to quiet and soothing music, close your eyes and think about something pleasant. Have a cup after warm milk or tea and step into a clean bed for pleasant dreams.

The first sign that something is happening is Angelina's hands. Chatting in Italian with a nurse, she begins to gesticulate, imitate poking and moving her fingers in the air. As the minutes go by, Angelina gets more and more excited, and I notice a musicality in her voice that I'm sure wasn't there before. The wrinkles on her forehead soften, and the puckering and stretching of her lips, the movement of her eyes, tell me more about her state of mind than any translator could.

Angelina comes alive - just when my body begins to tire. It's two in the morning and we're sitting in a brightly lit kitchen in a psychiatric hospital in Milan eating spaghetti. I feel aching pain in my eyes and almost pass out, and Angelina won't go to bed for at least 17 hours, and I'm getting ready for a long night. To make sure I don't doubt her resolve, Angelina takes off her glasses, looks straight at me, and uses her fingers to part her wrinkled eyelids. "Occhi aperti," she says. The eyes are open.

This is the second of three nights where Angelina deliberately keeps herself awake.

It may seem like the last thing for a person with bipolar disorder who has spent the past two years in deep depression, and yet Angelina - and her doctors - hope that the measure will bring her salvation.

For two decades, Francesco Benedetti, head of the Department of Psychiatry and Clinical Psychobiology at the San Raffaele Hospital in Milan, has been investigating so-called wake therapy, combined with exposure to bright light and lithium, as a treatment for depression in cases where pills fail. help. Following him, psychiatrists in the United States, then Great Britain and other European countries begin to pay attention to the method, applying their variations in clinics. similar treatment. This "chronotherapy" seems to work - it starts an inert biological clock. In addition, the treatment sheds New World on the underlying pathology of depression and, in general, on the functioning of sleep.

“Sleep deprivation has the opposite effect on healthy people and people with depression,” says Benedetti. If you are healthy and do not sleep, you will be in a bad mood. But if you're depressed, sleep deprivation can cause an immediate improvement in mood and cognitive performance.

Still, the doctor adds that there's a catch: once you fall asleep and make up for those missed hours of sleep, there's a 95% chance the illness will return.

The antidepressant-like effect of sleep deprivation was first mentioned in a report published in 1959 in Germany. A young scientist from Tübingen, Burkhard Pflug, studied the effect in his doctoral work and subsequent research during the 1970s. By systematically depriving depressed patients of sleep, he confirmed that one night of wakefulness can pull a person out of a depressed state.

Benedetti became fascinated with this technique as a young psychiatrist in the early 1990s. A few years earlier, it went on sale, proclaiming a revolution in the treatment of depression.

However, drugs such as Prozac have rarely been tested in people with bipolar disorder. Since then, bitter experience has taught Benedetti that in the case of bipolar patients, antidepressants are in most cases ineffective.

Benedetti's patients were desperate for an alternative to such pills, and his boss, Enrico Smeraldi, had an idea in reserve. After reading a number of early papers on the topic of sleep deprivation therapy, he tested the theories on his own patients and received positive results. “We realized it was working,” Benedetti recalls. - Patients with monstrous medical histories immediately felt better. My task was to consolidate this improvement.”

He and his colleagues turned to the scientific literature for ideas. Some American studies have claimed that lithium can prolong the effect of sleep deprivation, and they have looked into this issue.

Physicians found that 65% of patients taking lithium showed a sustained positive response to sleep deprivation over three months - compared to just 10% of those who did not.

Because even nap could undermine the effectiveness of treatment, they also began to look for new ways to keep patients awake at night and drew inspiration from aviation medicine, which used bright lights to keep pilots alert. This increased the effectiveness of sleep deprivation - to the same extent as lithium.

“We decided to give the patients a complete set, and the results were excellent,” comments Benedetti. In the late 1990s, they were already routinely treating patients with triple chronotherapy: sleep deprivation, lithium, and light. Sleep was deprived every other day for a week, and exposure to bright light for half an hour every morning continued for another two weeks - a scheme they still use today.

“This can be thought of not as depriving people of sleep, but as a modified or extended period of wakefulness from 24 to 48 hours,” says Benedetti. “People go to bed after two nights on the third, but when they finally fall asleep, they can sleep as much as they want.”

San Raffaele Hospital first introduced triple chronotherapy in 1996. Since then, almost a thousand patients have been treated in this way with bipolar depression- many of whom did not respond to antidepressant treatment. The results speak for themselves: according to the most recent data, 70% of patients with drug-resistant bipolar depression responded positively to triple chronotherapy within a week, and 55% showed a sustained improvement after a month.

Antidepressants may take a month or more to start working, and before that they may increase the risk of suicide. Chronotherapy, on the other hand, provides immediate and lasting relief from suicidal thoughts even after just one sleepless night.

Angelina was first diagnosed with bipolar disorder 30 years ago, when she was almost forty. The diagnosis followed a period of intense stress: the husband had problems at work, and they were worried about whether there would be enough money to support themselves and the children. Angelina plunged into a depression that lasted almost three years. Since then, her mood has fluctuated, but usually she is more bad than good. Angelina takes an arsenal of drugs - antidepressants, mood stabilizers, anti-anxiety pills and sleeping pills - which she does not like because it makes her feel sick, although she admits that she is sick.

She says that if I had met her three days ago, I would not have recognized her. Angelina did not want to do anything, she stopped washing her hair and painting, she began to smell. Thoughts about the future made her sad.

After the first night without sleep, Angelina felt in herself more strength, but this feeling subsided after restorative sleep. And yet today she felt enough strength and desire to visit a hairdresser before my arrival. I compliment Angelina as she strokes her dyed golden curls and thanks me for noticing.

At three o'clock in the morning we move into a lighted room, and it seems that we have arrived at the height of noon.

The bright rays of the sun break through the windows above us, and their light falls on the chairs arranged in a row against the wall. Of course, this is an illusion: the blue sky and the bright sun are just painted plastic and very bright lighting, but the effect of them is still very invigorating.

It seems that I am lying in a sun lounger during the day, the heat is just not enough.

When I had spoken to Angelina seven hours earlier with the help of an interpreter, she had responded with complete stone face. Now, at 3:20 am, she smiles and even tries to speak to me in English, which she supposedly does not know. By dawn, Angelina tells me that she has begun to write the history of her family, and offers to stay with her in Sicily.

How can something as simple as staying awake at night cause such changes? Understanding this mechanism is not easy: we still do not fully understand the nature of depression and the function of sleep (both phenomena involve several various areas brain). However latest research shed light on some things.

The brain activity of people with depression during sleep and wakefulness looks different than the brain activity of healthy people.

During the day, it is believed that wake-promoting signals from the circadian rhythm system (our internal 24-hour biological clock) help us resist sleep, and at night they are replaced by signals that stimulate sleep. Brain cells also function in cycles: they are more excited in response to stimulation during wakefulness, and during sleep this excitement subsides. However, in patients with depression and bipolar disorder, these oscillations are blunted or absent.

Depression is also associated with altered rhythms of hormonal secretion and body temperature - and the more severe the condition, the greater the degree of impairment. These rhythms are also regulated by the body's circadian system, which is controlled by a set of proteins encoded by "clock genes". They are responsible for hundreds of different cellular processes, allowing them to check time with each other, as well as turn on and off. The circadian clock ticks in every cell in your body, including brain cells, and is coordinated by an area of the brain called the suprachiasmatic nucleus that responds to light.

“When a person is severely depressed, their circadian rhythms are flat, melatonin doesn’t rise in the morning, and cortisol doesn’t drop in the evening as it should.”

Steinn Stengrimsson, psychiatrist at the University Hospital in Gothenburg, Sweden, explains. He is currently conducting trials of wakefulness therapy.

Healing from depression is associated with the normalization of these cycles. “I think depression may be one of the consequences of this flattening of circadian rhythms and homeostasis in the brain,” says Benedetti. “By depriving depressed patients of sleep, we are restoring the cyclical process.”

But how does this recovery take place? It is possible that depressed patients simply need this desire to sleep to trigger a sluggish system. It is believed that the urge to sleep occurs due to the gradual release of adenosine in the brain. It builds up throughout the day and attaches to adenosine receptors in neurons, causing a person to feel sleepy. Drugs that act on these receptors have the same effect, while drugs that block them, such as caffeine, discourage sleep.

To find out if this process underlies the antidepressant effect of prolonged wakefulness, scientists at Tufts University in Massachusetts injected mice with symptoms of depression with a substance that stimulates adenosine receptors - mimicking what happens during sleep deprivation. After 12 hours, the rodents felt better - scientists figured this out by measuring how long they spent trying to escape if they were forced to swim or hung by their tails.

We also know that sleep deprivation has other effects on the depressed brain. It provokes changes in the balance of neurotransmitters in areas that regulate mood, and restores normal activity in areas responsible for processing emotions, strengthening the connection between them.

Benedetti and his team found that if wakefulness therapy triggers a lazy circadian rhythm, then lithium and light therapy help maintain this process. Lithium has been used as a mood stabilizer for many years - with no one really understanding how it works, but it is known that the substance provokes the expression of a protein called Per2, which is responsible for the molecular clock in cells.

Bright light, meanwhile, changes the rhythms of the suprachiasmatic nucleus, and also more clearly increases activity in the areas of the brain responsible for processing emotions. The American Psychiatric Association claims that light therapy is as effective as most antidepressants in treating non-seasonal depression.

Despite promising results in the treatment of bipolar disorder, wakefulness therapy has been slow to catch on in other countries.

"The cynic will say it's because it can't be patented," says David Veal, a psychiatrist at the South London and Maudsley NHS Foundation Trust.

Indeed, Benedetti never received funding from drug companies for his chronotherapy trials. Instead, until recently, he relied on government funding, which was often lacking. His current research is funded by the European Union. Benedetti sarcastically remarks that if he had followed the usual path and accepted industry money to conduct clinical trials with his patients, he probably would not be living in a small two-room apartment now and driving a 1998 Honda Civic.

The addiction to drug solutions has contributed to the fact that chronotherapy is unknown to many psychiatrists. In addition, it is difficult to find a suitable placebo for sleep deprivation or bright light, which means that there are no large randomized trials testing results in the placebo group. Therefore, skepticism about the effectiveness of such treatment is widespread. "While interest is growing, I don't think it's commonly used routinely these days - more evidence is needed for its effectiveness, and there are practical difficulties with things like sleep deprivation," comments John Geddes, professor of epidemiological psychiatry at the University of Oxford.

But even under these conditions, interest in the processes underlying chronotherapy is beginning to grow. In the UK, USA, Denmark and Sweden, psychiatrists are exploring chronotherapy as a treatment modality. general depression. "Many of the studies that have been done are very unrepresentative," says Veal, who is now planning to conduct a study at a London hospital on the feasibility and feasibility of such therapy. “We need to demonstrate that it is feasible and that it can work for people.”

On the this moment studies are mixed. Klaus Martini, who researches non-drug treatments for depression at the University of Copenhagen in Denmark, published the results of two studies that looked at the effectiveness of sleep deprivation in the treatment of general depression in combination with daily morning exposure to bright light and regular time going to sleep.

In the first study, 75 patients were given the antidepressant duloxetine [sold in Russia under the name Simbalta]. - Approx. trans.] in combination with either chronotherapy or daily exercise. After a week, 41% of the participants in the chronotherapy group experienced half the symptoms compared to 13% of the second group.

After 29 weeks, 62% of the awake group showed no symptoms compared to 38% of those in the exercise group.

In Martini's second study, severely depressed inpatients who did not respond to drug treatment were offered the same set of chronotherapy (in addition to drugs and psychotherapy). After one week, patients in the chronotherapy group were significantly better than patients who received standard treatment, however, in the following weeks, the control group caught up with the former.

No one has yet compared wakefulness therapy directly to antidepressants, nor has it been tested against light therapy or lithium alone. But even if it only works for a minority, many people with depression - and psychiatrists - may find the idea of drug-free treatment appealing.

"Here I am a supporter drug treatment, and I still like having the drug-free option,” says Jonathan Stewart, professor of clinical psychiatry at Columbia University in New York. He is currently trialing wakefulness therapy at the New York State Psychiatric Institute. Unlike Benedetti, Stewart does not allow patients to sleep for only one night: “I don’t think many people will agree to stay in the hospital for three nights, plus this requires a lot of medical staff and resources.” Instead, it applies "phase advance", where in the course of days after sleepless night the time of going to bed and waking up is pushed back by more early term. Stewart treated 20 patients with this regimen, and 12 showed a response - most within the first week.

Such therapy may also serve as a preventive measure: recent studies indicate that adolescents whose parents manage to insist on going to bed earlier are less at risk of depression and less prone to suicidal thoughts.

As with light therapy and sleep deprivation, the exact mechanism is unclear, but researchers believe there is a greater overlap between sleep time and natural cycle light and darkness is of great importance.

However, "phase advance sleep" is not yet widely used. Stewart admits he's not for everyone. “In the case of those with whom it works, it is miraculous healing. But, just like with Prozac, not everyone gets better from it, he agrees. “My problem is that I can’t know in advance who he will help and who he won’t.”

Depression can hit anyone, but we're seeing growing evidence that genetic variations that can disrupt the circadian system make some more vulnerable. Some changes in clock genes are associated with increased risk development of mood disorders.

Stress can also exacerbate the problem. Our response to it is largely controlled by the hormone cortisol, which is tightly regulated by the circadian rhythm, but cortisol itself directly affects the setting of our circadian clock.

So if you have a weak "internal clock", the additional burden of stress can upset the whole system.

Depressive symptoms can be induced in mice by constantly exposing them to a painful stimulus such as a blow. electric shock from which they cannot hide - this phenomenon is called "learned helplessness". In the face of constant stress, animals eventually give up and demonstrate depressive behavior. When UC San Diego psychiatrist David Welsh analyzed the brains of depressed mice, he found disruption of circadian rhythms in two key areas of the reward circuit, a system that plays a critical role in the development of depression.

However, Welsh also demonstrated that disturbances in the circadian system themselves can cause depressive symptoms. When he turned off a key clock gene in healthy mice, the animals looked exactly like the depressed mice he had previously studied. “These do not need to learn to feel helpless, they are already helpless,” the scientist comments.

So if disrupted circadian rhythms are the likely cause of depression, what can be done to prevent it? Is it possible to strengthen the circadian clock in order to increase psychological resilience instead of treating depression symptoms with sleep deprivation?

Martini thinks so. He is now studying whether a regular regimen can prevent the return of the disease in patients with depression after they are cured and discharged: “Usually, this is where the trouble starts. After discharge, the depression returns.”

45-year-old Peter from Copenhagen struggles with depression with adolescence. As with Angelina and many others with this disorder, the first episode was followed by stress and upheaval. The sister who raised him left home when he was 13, leaving him with an indifferent mother and father, who himself suffered from severe depression. Not long after, my father died of cancer - another blow. The father hid the sad forecast and shared it only a week before his death.

Peter was in the hospital six times, including a month in April last year. “In a way, being in the hospital is a relief,” he says.

However, Peter feels guilty towards his sons of seven and nine years old: “The youngest said that while I was in the hospital, he cried every night because I was not there and I could not hug him.”

When Martini told Peter about his research, he gladly agreed to take part. The idea was to strengthen circadian rhythms by making his sleeping, waking, eating and eating patterns more regular. physical activity and increased time spent outdoors in daylight.

For a month after leaving the hospital in May, Peter wore a device that tracked his activity and sleep, and regularly filled out questionnaires about his mood. If there were deviations in his routine, he would receive a call and tell him what had happened.

I meet Peter and joke about the tan on his face. He obviously took his device seriously. Peter laughs: “Yes, I go for walks in the park, and if the weather is good, I take the children to the beach or the playground, where I am exposed to sunlight - and this improves my mood.”

These are not the only changes in his life.

Now Peter gets up every day at six in the morning and helps his wife with the children. He has breakfast even if he is not hungry, usually muesli with yogurt. He does not sleep during the day and tries to go to bed at ten in the evening.

If Peter wakes up at night, he practices "nonjudgmental awareness," a technique he was taught in the hospital.

Martini downloads the data to the computer. It confirms an earlier rise and fall and demonstrates an improvement in the quality of sleep, which is reflected in mood. Immediately after release average was from 6 to 10, but after two weeks it rose to a constant 8–9, and once it was even 10 points. In early June, Peter returned to work. “The routine really helped me,” he admits.

Martini has only recruited 20 patients so far, but is aiming for 120 patients. psychological condition). However, in any case, there is evidence that correct mode sleep can help mental well-being, it becomes more and more.

According to a study published in September 2017 in the Lancet Psychiatry (the largest randomized psychological intervention trial to date), insomniacs who underwent 10 weeks of cognitive behavioral therapy to address their sleep problems showed significant reduction paranoia and hallucinatory experiences.

Their symptoms of depression and anxiety also improved, they had fewer nightmares, they felt better, and they functioned better.

Sleep, routine and daylight. Such simple formula, and it is easy to take for granted - and therefore underestimate. But imagine that it could actually reduce the incidence of depression and help people recover more quickly from illness. Not only will this improve the quality of life for countless people, but it will also save money in healthcare.

Benedetti cautions that wakefulness therapy should not be attempted at home by yourself. Especially for those who suffer from bipolar disorder, because sleep deprivation can trigger a manic episode (although, in his experience, the risk is less than with antidepressants). In addition, refraining from sleep is not easy, and some patients temporarily relapse into depression or enter a period of mixed mood, which can be dangerous. A mixed state often precedes an attempt to commit suicide.

A week after my sleepless night with Angelina, I call Benedetti to inquire about her well-being. He says that after the third sleep deprivation, Angelina went into complete remission and returned with her husband to Sicily. They are celebrating their 50th wedding anniversary this week. When I asked her if her husband would notice a change in her condition, Angelina expressed her hope that he would notice a change in her appearance.

Hope. It seems to me that after Angelina has lived more than half of her life without her, the return of hope is the most best gift for her golden wedding.

Depression and sleep disorders are closely related, and this relationship is mutual: how chronic disorder sleep can lead to the development of depression, and depression can cause (or rather: almost certainly cause) sleep disturbances.

Sleep disturbances in depression

It has been known for a very long time that sleep disturbances are observed in depression. This was noted by almost everyone who studied depression, for example, Areteus of Cappadocia, who lived in the distant 2nd century AD. e. Currently, according to various statistics on clinical evaluations sleep disorders in depression occur in 83-100%, and according to the results of polysomnographic studies - in 100%.

Many researchers claim that sleep disturbances may precede other symptoms of depression. Sleep disorders (in particular, phase IV deficiency) often persist after the disappearance clinical signs depressive state.

Patients with depression sleep less, fall asleep longer, wake up more often and for a longer period during the night. The distribution of sleep phases changes: the sum of more superficial (first and second) phases prevails and the sum of deeper (third and fourth) phases decreases. The most characteristic violations of REM - sleep phases(the so-called "fast", "paradoxical" dream). The first REM - periods are excessively long, the intervals between them are shortened, the number of REM - periods is increased. During REM - periods are noted unusually frequent movements eyeballs, the transition between REM - sleep and awakening occurs suddenly.

Changes in the phase of REM sleep affect the nature and severity of dreams in patients with depression:

depression and sleep

For dreary states a decrease in dreams is characteristic, which appear in the form of painful, depressing sensations, static types of gloomy content, memories of the events of an unsuccessful past.

In apathetic states dreams are single, leaving no impression, memories of dreams are extremely scarce.

For Anxious Depressions characterized by dreams with a plot of persecution, threats, catastrophic events, more often of a visual nature. characteristic frequent change plot, transience of events, real content with a focus on the future.

From the type of leader depressive syndrome(sadness, anxiety, apathy) depends not only on the nature of dreams, but also on the nature of sleep disturbances:

dreary depression

For dreary depressionmost characteristica decrease in the level of wakefulness before falling asleep with an “unnatural” feeling of self (as after taking alcohol or medication), final early awakenings (2-3 hours before the usual time - “sleep cuts off”) with a lack of vigor and activity upon awakening.

Difficulty falling asleep is often characterized as follows: "I want to sleep, but sleep does not go." Falling asleep lasts about an hour, painful thoughts, bitter thoughts are characteristic. Sleep is perceived as superficial, with the perception of what is happening around, a feeling of physical discomfort.

Patients often stay in bed after waking up. eyes closed without changing the position of the body, and indulge in painful experiences. Awakening is assessed as painful, with a feeling of annoyance, hopelessness, oppressive pain, physically felt in the chest. Sleep does not bring a feeling of rest, during the day - lethargy, fatigue, headaches.

Apathetic depression

For apathetic variants of depression characterized by final late awakenings (later by 2-3 hours or more from usual time), morning and daytime sleepiness, loss of a sense of boundaries between sleep and wakefulness. Many spend in bed without sleep most day, the state of drowsiness is called laziness. Sleep does not bring a feeling of rest and vigor, but it does not burden.

anxiety depression

For anxious depression characterized by reduced drowsiness, when falling asleep - increased mobility difficulty falling asleep due to anxious thoughts, superficial sleep, repeated awakenings in the middle of the night due to insufficient depth of sleep and disturbing dreams. Instantaneous awakenings are characteristic, "as from a push."

There may be awakenings with shortness of breath and sweating after a dream. Possible (in 20%) final early awakenings (1-1.5 hours before the usual time).

More than 50% of patients note that they do not get enough sleep, do not rest during sleep.

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Yoga exercises help with sleep disorders and depression:

With any kind of depression, sleep is disturbed: an oppressed psyche causes a sleep disorder, and vice versa, chronic sleep deprivation leads to depression.

By According to statistics, sleep goes wrong in 83% - 100% of people prone to this disease. Patients reasonably complain about sleep disturbances, the duration of which is not much less than that of healthy people, but its structure is thoroughly disordered.

Common features of sleep in depression:

falling asleep is difficult and tiring,
nocturnal awakenings are more frequent and prolonged than in a normal healthy state,
stages superficial sleep prevail over the stages of deep,
rapid eye movements in REM sleep are more frequent,
fourth stage slow phase sleep is half as long as usual,
fast (paradoxical) sleep is replaced by drowsiness,
electroencephalogram in REM sleep registers sleep spindles, and in wakefulness - delta waves inherent in deep sleep,
waking up earlier in the morning.

Depression, depending on the cause of occurrence, is divided into endogenous and reactive:

Reactive - provoked by a traumatic situation,
Endogenous - internal causes.

With endogenous depression

a person falls asleep safely, but suddenly wakes up at night and spends the rest of it in a gloomy state, tormented by a vague and very heavy feeling of fear, guilt, longing and hopelessness. This mood can cause suicidal thoughts.

Patients complain about the lack of normal rest, the head is constantly occupied with thoughts. Apparently these thoughts are the “thoughts” of superficial sleep. Normal falling asleep gradually also goes wrong and the patient has to take sleeping pills.

Their wakefulness is replaced by a prolonged drowsiness with frequent awakenings, or immediately by a fast sleep. In the morning they doze or stay awake, while healthy people sleep fast and dream.

In depression, the sleep pattern demonstrates increased activity of awakening mechanisms and suppression of the fourth phase. slow sleep. With a severe degree of the disease, paradoxical sleep occurs more often than usual, but due to repeated awakenings, it cannot be fully realized.

After treatment, he returns to normal, but the fourth stage often does not return and sleep remains superficial.

It should be noted that endogenous is the most severe of the 59 types of depression. This is due to hereditary factors and metabolic disorders.

Latent depression

Hidden or masked (bodily) depression is often undiagnosed. However, early morning awakenings, "broken sleep", decreased vitality and expressions of active emotions serve characteristic symptoms even in the absence of a painful mood.

The main complaint with this form of the disease is. The name is fully justified - depression is masked physical ailments, often severe.

seasonal depression

This type of disease has a seasonal focus: it manifests itself with a reduction daylight hours in autumn and winter in people prone to this, more often in women. seasonal depression 5% of the world's population suffers.

Typical symptoms:

increased morning and daytime sleepiness,
overeating, desire for sweets. The result is an increase in body weight.
sleep duration compared to summer period, increased by 1.5 hours,
night sleep is incomplete and does not bring rest.

Sleep pattern in various depressive syndromes

dreary depression characterized by:

a breakdown at the end of the day (feelings akin to a hangover),
difficult falling asleep, lasting about an hour, accompanied by painful thoughts and bitter reflections,
sensitive sleep, control over the outside world does not weaken, which does not give a feeling of rest,
very early awakening (2-3 hours earlier than usual),
unwillingness to get up after waking up, the patient lies for a long time with his eyes closed,
broken state after lifting.

Such an abnormal dream increases the feeling of hopelessness and oppressive pain, it does not bring a feeling of freshness and relaxation. As a result, wakefulness proceeds sluggishly, often with headaches.

Apathetic depression:

waking up 2-3 hours later than usual
constant sleepiness - morning and afternoon,
the boundaries between wakefulness and sleep are blurred.

Patients are ready to spend the whole day lying in bed, calling drowsiness laziness. Sleep does not bring good rest, but this is not considered a problem.

Anxious depression:

drowsiness is reduced
disturbing thoughts cause long falling asleep,
shallow sleep, restless dreams,
frequent awakenings, sudden awakenings are possible, accompanied by sweating and shortness of breath from an unpleasant dream.
Early awakenings (1 hour -1.5 earlier than usual).

Most patients complain that sleep does not bring rest.

The nature of dreams in various depressions

Any kind of depression fast sleep, responsible for dreams, is disturbed. This affects the character and plots:

dreary state- rare dreams are painful, gloomy and monotonous, filled with stories about an unsuccessful past life.

Apathetic state- rare, isolated dreams are poorly remembered and emotionally scarce.

anxiety state - plots change frequently, events are fleeting, directed to the future. Dreams are filled with catastrophic events, threats and persecution.

CLASSIFICATION OF THE CAUSES OF SLEEP DISTURBANCES
(proposed A.M. Wayne, an outstanding Russian somnologist, and K. Hecht, a German scientist)

Psychophysiological.
Insomnia in neuroses.
At endogenous diseases psyche.
When abused psychotropic drugs and alcohol.
When exposed to toxic factors.
For diseases endocrine system (diabetes, for example).
Organic diseases of the brain.
Diseases of the internal organs.
As a consequence of syndromes that occur during sleep (sleep apnea).
As a consequence of the disruption of the wake-sleep cycle (suffering of owls and larks, shift workers).
Shortened sleep, constitutionally determined (Napoleon and other short-sleeping personalities. However, it is a stretch to classify them as suffering from lack of sleep).

The materials of the book by A.M. Wayne "Three Thirds of Life".

Elena Valve for the Sleepy Cantata project.

If you have been diagnosed with acute depression, you may find it difficult to sleep. obvious reason this is not. There is only a link between sleep disturbance and depression. In addition, insomnia, or the inability to sleep, is one of the main causes of depression.

But it is impossible to argue that sleep problems do not exist separately from depression. Insomnia, one of the most common sleep disorders in the United States, affects one in three residents. Women are more likely to suffer from insomnia than men, and the older a person gets, the more insomnia gets worse.

Scientists believe that an adult needs 7-9 hours of sleep per day. But even without the presence of depression, the average American sleeps an average of about 6-7 hours a night. But if depression is added to this, then sleep problems become more complicated.

How are depression and sleep disturbances related?

The inability to sleep is one of the main causes of depression. Another of her symptoms is increased drowsiness.

Sleep disturbance does not always lead to depression, but this problem must be considered in the diagnosis. Lack of healthy sleep caused by illness or mental state may exacerbate depression. Insomnia that continues long time also indicates the presence of depression.

What is acute depression?

Acute or clinical depression it's a mood disorder. A person is sad, experiencing a feeling of helplessness, uselessness and hopelessness. Of course, every person sometimes feels sad and depressed. But if these feelings do not go away for a long time, even more, while aggravating, they begin to affect your daily life.

Why is healthy sleep important for the body?

Normal healthy sleep has a tonic effect on the body. And if your sleep becomes inadequate, it leads to increased tension, inattention and irritability.

Sleep disturbance can be caused by emotional trauma, metabolic disorders, or other physical illness. Inadequate sleep leads to fatigue. Tired quickly, you play sports less often and, in the end, refuse to visit at all sports hall. As a result, you will find yourself in a state of pathological laziness with impaired sleep function, which, in turn, will cause a manifestation like physical disorders and mood disorders.

What is insomnia?

Insomnia is a condition in which a person has difficulty falling asleep and maintaining deep sleep all night long. In this case, a person loses the ability to get a healthy, restorative sleep, which affects his everyday life and performance. Insomnia may be indicative of depression or other mental illness. If you find it difficult to fall asleep, you often wake up at night and then cannot fall asleep again for a long time, then you have insomnia.

Depression that goes untreated leads to overwhelming feelings of hopelessness, oppression, worthlessness, and guilt. In turn, these feelings keep you awake. The brain is in an overexcited state, remembering again and again experienced events that are beyond your control. These experiences cause fears and fears that keep you awake, decreased activity throughout the day, and distorted perceptions of sleep function.

How to treat depression and sleep disorders?

Treatment for depression depends on the severity of the illness. For example, the most effective method treatment is a combination of psychotherapy and medication. While antidepressants work to help improve mood, psychotherapy helps manage symptoms of depression on a perceptual level. In the same way, psychotherapy helps to cope with insomnia.

What kind medical preparations treat depression and sleep disorders?

Your doctor may prescribe antidepressants such as Selective inhibitors serotonin reuptake. In addition to this, they assign sedatives and sleeping pills - medicines that help you sleep.

Which antidepressants are effective in treating sleep disorders?

Selective serotonin reuptake inhibitors such as Zoloft, Prozac and Paxil. These antidepressants have a dual effect, favorably influencing mood and helping to fall asleep easily and quickly.
Tricyclic antidepressants (including Pamelor and Elavil).
Sedative antidepressants (Trazodone).

Which sleeping pills are the most effective?

To improve the quality of your sleep, your doctor will prescribe the following sleeping pills:

Ambien
Lunesta
Restoril
Sonata

Are there alternative methods treatment for insomnia?

When taking antidepressants, stick to following tips, and soon your condition will improve:

Meditate, listen to light music or read a book before bed. This will help divert your thoughts from painful problems and help you relax before going to bed.
Help yourself by writing a to-do list for tomorrow. This will help alleviate the feeling of worry that you will forget to do something important. Then say to yourself, "I'll think about it tomorrow."
Exercise regularly, but no later than a few hours before bedtime. Daily exercise helps improve sleep and relieve anxiety associated with the fear of being unable to sleep.
very often high brain activity When a person ponders and relives certain events in life over and over again, it can cause insomnia. In such cases, yoga and deep abdominal breathing will help.
Don't drink coffee at night alcoholic drinks and don't smoke before bed. If you are taking any medications, check to see if they cause insomnia. For example, analgesics used for headaches contain caffeine.
If you cannot sleep, do not lie in bed and do not toss and turn. Just get out of bed and do something. As soon as you feel sleepy, go back to bed.
Use the bed only for sleep and sex. Do not watch TV or read books in bed. Thus, your subconscious mind will perceive the bed as a place to sleep, and not to be awake.
Accept hot shower before bed to improve sleep while the body cools down.
Keep the bedroom temperature cool.
Use earplugs and eye masks if noise and light are disturbing your sleep.
Hang blackout curtains in your bedroom if the light from the street annoys you.
Use a smooth noise generator if you are unable to sleep due to ambient sounds.

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