Bright Nights™ - Sleep and Depression
Bright Nights™ questions (ones that were not answered during the program)
Sleep and Depression, 10/24/06
1. Please describe/define characteristics of restorative sleep?
Restorative or deep sleep is characterized by very high amplitude, slow frequency EEG activity called delta. Deep sleep is also accompanied by reduced heart rate, respiration and metabolism. It is also important in immune system regulation and in body cell repair and is believed to be the most biologically necessary sleep state.
2. Does the absence of dreaming or the amount of dreaming relate to depression?
It is quite common to lose dream recall in the middle of an episode of depression. Dream recall may begin to return as the depression lifts.
3. What is the physiological mechanism thought to link depression with sleep disorders?
One of the most common links is in the neurotransmitter, acetylcholine, which is involved in both REM sleep regulation and the alertness/hyperarousal system in the brain stem. This can in turn decrease deep sleep and increase cortisol secretion.
5. Where can people with no health insurance get help?
There are several community mental health clinics in the Ann Arbor area. St. Joseph’s Hospital has a low fee clinic (734-786-2301) for depression, anxiety and panic. There is also an adult psychiatry clinic in Ypsilanti St. Joseph Mercy Neighborhood Health Clinic 734-544-6900 and for children and adolescents, the Corner Health Center in Ypsilanti, 734/484-3600.
6. Do you use massage, music, or other techniques for relaxing before sleep?
A regular and relaxing routine before bedtime is part of good sleep hygiene, and may be particularly important for people prone to insomnia. The regular routine can include preparations for bedtime, quiet music, massage, or just about anything that is enjoyable but not to activating. Work, anxiety- provoking activities, vigorous exercise, and large meals generally should be avoided just before bedtime.
7. Can irregular work hours and travel cause depression?
Irregular work hours and regular travel across time zones are likely to disrupt the circadian clock, which can lead to chronic poor quality sleep. Persistent poor quality sleep, if left untreated, may disrupt mood. There have been at least a half dozen studies showing the sleep disturbance independently increases the risk of depression, even after taking into account other symptoms of depression. But these studies only show an association between poor quality sleep and mood; there are no studies that yet show that sleep problems are causally related to depression.
8. What would you suggest as a treatment for a teenager who refuses/can’t sleep because of nightmares every night? This teenager stays up most nights with the lights on.
his teen should be evaluated by a mental health professional to determine the cause of the nightmares. Treatment of the primary cause may significantly reduce or eliminate the nightmares. There is also a treatment specifically focused at nightmare reduction, called imagery rehearsal therapy, which has shown some benefit with trauma survivors. This therapy could be used in conjunction with treatment of the primary cause of the nightmares, or after treatment of the primary cause if the nightmares do not subside and continue to cause distress.
9. Could you comment on the genetics that control sleep and how does genetic expression change with age?
There is a lot of family resemblance in sleep habits. Short sleeper parents tend to have children who are also short sleepers. At present, more than 40 genes that control sleep and circadian rhythms have been identified. Most of these genes exert their greatest influence early in developmental, before birth or in early childhood.
11. Please discuss good sleep practices.
See the Tips for Better Sleep 
on this website.
12. Beyond “Exercise, but not too close to bedtime,” is there any evidence for any specific exercise protocols to improve sleep, i.e., length, time of day, or intensity?
Some say that exercise at a regular time of day may be more helpful than exercise at random and different times of the day. Some recent studies have failed to confirm older advice that exercise near bedtime, even when intense, interferes with sleep quality. However, additional research is necessary to determine the optimal timing and intensity of exercise to improve sleep.
13. What can be done about constant hypervigilance that causes insomnia? Is this hypervigilance due to increased cortisol?
Although we think that hypervigilance or hyperarousal plays an important role in insomnia, we don’t yet have conclusive research to indicate that it specifically causes in insomnia. There have been at least a few small scale studies of people with chronic insomnia showing that there is an increase in cortisol around bedtime, when cortisol levels should be low. Thus, cortisol may be one of the chemicals that produces this hypervigilant state in many people with insomnia. One behavioral strategy that can be used to target hypervigilance is relaxation. There are a variety of physical and mental relaxation exercises that, if practiced regularly, can be effective strategies for managing hypervigilance. They can then be implemented into a nightly bedtime routine in conjunction with other calming and soothing activities before bed. It is important to note that relaxation alone is often not sufficient for long-term management of chronic insomnia, but can be an effective tool in combination with other cognitive-behavioral strategies.
15. What should an adult do to get a good night’s sleep? What are the things that must be avoided?
See the Tips for Better Sleep on this website.
