Insomnia is one of the diagnostic hallmarks of clinical depression. A high percentage of people who are depressed experience sleeplessness: interrupted sleep, difficulty falling asleep, and early morning waking. The relationship between sleep problems and depression is complicated because insomnia can also cause depression. According to a 2005 study published in the journal Sleep, people with insomnia were ten times more likely to develop depression and anxiety than those without sleep problems.
It is best to treat insomnia as soon as symptoms surface. Here are some treatment strategies.
1. Sleep Hygiene
One of the first steps toward better sleep involves following rules of sleep hygiene, such maintaining a consistent schedule during the day; waking up at the same time everyday even if you didn’t sleep; using your bed for sleep and sex only; going to bed only when you are tired; avoiding naps, especially close to bedtime; exercising during the day, but not within three hours of bedtime; adhering to a bedtime ritual that involves reading, a bath, or some other relaxing activity.
“Most people with chronic insomnia develop sleep-preventing behaviors and associations with the bedroom that make it more difficult to sleep,” writes Robert Rosenburg, D.O., in his Everyday Health blog, Sleep Answers. He uses a technique called Stimulus Control to try to break negative associations with the bedroom environment. People are instructed to go to bed only when sleepy. If they are in bed for 20 minutes and are wide awake, to get out of bed and do something relaxing in another room and when sleepy return to the bedroom.
2. Cognitive Behavioral Therapy
In cognitive behavioral therapy, a therapist helps a patient identify distorted thoughts and then reframe them into more realistic, positive statements. For sleep issues, this usually involves working with performance anxiety—the pressure felt to control the amount and quality of sleep. New ways of coping with stress are introduced, as well as strategies for reducing the typical frustration associated with sleep disturbances. A review in a 2015 issue of Sleep Medicine Research reported that CBT is effective at treating insomnia in patients with primary insomnia, but also in patients with comorbid symptoms of insomnia and anxiety disorders.
3. Sleep Restriction
Sleep restriction is often done as part of cognitive behavioral therapy. This strategy is designed to minimize the amount of time a person spends awake in bed. For example, a person initially goes to sleep very late at night, past a normal bedtime by a few hours. He or she always wakes up at a fixed time. The bedtime is progressively moved forward by increments of 10 to 15 minutes with a person’s sleep success. Patients keep a sleep log to help record progress.
4. Erase Sleep Myths
In their book, Quiet Your Mind and Get to Sleep, authors Colleen Carney, Ph.D. and Rachel Manber, Ph.D. list several sleep myths that contribute to insomnia and sleep anxiety. Identifying them helped me to relax a little bit about my sleep. Among them are these:
- Everyone requires eight hours of sleep to function during the day. Actually, there is a wide range of sleep needs, and the average amount of sleep needed for an adult is probably less than eight hours.
- If you’ve had good sleep, you should wake up feeling refreshed. The truth is that after waking, it’s natural to spend up to 30 minutes feeling groggy. This is called sleep inertia or sleep drunkenness, which is transient and is likely affected by the sleep stage from which you were awakened.
- If you wake up a couple of times during the night, even though you fall back to sleep pretty quickly, it must be having a negative effect. Not really. Brief awakenings are a normal part of the sleep process. In fact, the average number of awakenings per night is twelve. We are typically awake in bed for up to 30 minutes every night.
- If you spend more time in bed, you’ll get more sleep and feel better the next day. Sleep quality is more important than quantity. In addition to interfering with the sleep driver and your biological clock, spending extra time in bed may increase depression.
5. Find Sleep Support
I have found that teaming up with others who are experiencing sleep problems can relieve some of the anxiety felt around bedtime. For example, I swim with two women who have had sleep issues for the last ten years. Seeing them go on with their day despite inadequate rest inspires me to continue to put one foot in front of the other when I’m dragging and know that I’m not alone in this battle. It’s also helpful to have a safe place to vent about the fatigue. The American Sleep Association has an online forum that offers support to persons with sleep disturbances. Depression forums, like Project Hope & Beyond and those at Psych Central, have also groups dedicated to persons who experience insomnia as a result of depression symptoms.
6. Relaxation Training
There are several relaxation training programs available today. Some involve progressive muscle relaxation. Others include mindful meditation, hypnosis, or guided imagery. Mashable published a good list awhile back. Personally, I like the meditations by Jon Kabat-Zinn, PhD, founding director of the University of Massachusetts Medical School’s Center for Mindfulness in Medicine, Health Care, and Society in Worcester, as well as its stress reduction program. Dr. Zinn’s voice soothes me more than any other meditation guide. A friend of mine swears by the meditations found on the free app CALM. Of course, you don’t need a guide to meditate. Sometimes just paying attention to your breath on your own — concentrating on your belly as it rises with each inhale and lowers with each exhale — or concentrating on a bodily sensation is a great way of calming yourself down.
7. Bright Light Therapy
Bright-light therapy involves sitting in front of a therapeutic bright-light box for anywhere from 20 to 60 minutes a day. For best results, the light box should produce full-spectrum fluorescent light at an intensity of 10,000 lux. The purpose of the light is to reset circadian rhythms, the body’s internal biological clock that governs certain brain wave activity and hormone production.
Join Project Hope & Beyond, my depression community.
Originally posted on ThereseBorchard.com.
Therese Borchard is a Mental Health Writer and Activist living in Annapolis, MD
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