Insomnia And Depression: A Bilateral Relationship
Insomnia is incredibly common. 17% to as many as 50% of survey participants with insomnia lasting 2 weeks or longer developed major depressive episodes, according to this study. We sat down with Dr. M. Safwan Badr at the American Academy of Sleep Medicine to discuss the common sleep disorder and how it is related to depression.
“1/3 of our lives are spent asleep. It affects every aspect of our health. Otherwise why are we sleeping? There is tremendous value to it - to our brain, heart, emotional control - every aspect.”
Q: What is the connection between behavioral health and sleep?
A: “Sleep is critical for every aspect of mental and physical health. Sleep is vital for human life. Optimal sleep is essential for optimal health. That’s the broad theme.”
Q: Is there a connection between insomnia and depression?
A: “When we look at patients who present with insomnia there is a higher risk of depression or anxiety after 2 or 3 years. In that case, we work on sleep the same way we work on every aspect of the condition. Having optimal sleep is important to all mental health issues whether it’s cognition, memory, or impulse control.
Sleep duration is health – short self-reported iteration of sleep increases risk for depression. Anything less than 7 hours is an increased risk. Sleep duration is related to how the symptoms of depression will worsen with insufficient sleep. There’s also an inverse relation. Insomnia is improved when depression is treated. It’s a bilateral relationship.”
Q: What is the typical treatment for insomnia?
A: “For Insomnia the typical treatment is not sleeping pills. Most of these things have history that is questionable. The treatment of choice is cognitive behavioral therapy (CBT). It’s a non-pharma treatment. It is administered by behavioral therapists, clinical psychologists or social workers trained in this. We have a shortage of those in the community so there is also the benefit of using apps or virtual telepsych.”
Q: Are there things we can do address insomnia?
A: “There are things to do across the board that I see in my practice that stops 50% of insomnia issues.
Avoidance of caffeine for about 10 hours before bed time. “I recommend avoidance of caffeine after lunch.”
Smart phones are major sleep disruptors. “The light emanating from the screen or just the conditioning may keep you awake. I tell my patients that the phone should be beyond arm reach. This is exactly what I do. I would have to get out of bed and walk to it.”
The third thing is not to have any visual ques of the time. “A lot of times as patients see a clock on a screen or their bedside they immediately say ‘oh I hope I fall asleep.’ The minute you say that you increase your anxiety. Anxiety keeps you awake.”
We need to keep this in mind that the sleep environment needs to be safe, quiet and comfortable. “If you wake up and can’t fall asleep due to anxiety, I tell my patient to leave the bedroom, go a quiet room, and read from a book, not an electronic device.”
Alcohol is an enemy of sleep. “Having a glass of wine before bed to fall asleep every night is not good. Many think it’s the alcohol but it’s not. The sleep is poor quality and for people who have sleep apnea it can worsen. This is the thing. These external agents are not useful. The behavior is what needs to change. Good old-fashioned sleep is the important thing. There is no shortcut.”