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Sleep and Depression

The relationship between sleep and depression is complicated. In many ways, science is just beginning to grasp how the two conditions interact and affect one another. In recent years there’s been an important change in the fundamental way this relationship is viewed by clinicians and scientists. Where once insomnia and other sleep difficulties were regarded only as a consequence of depression, the sleep disorder is now increasingly recognized as also contributing to depression itself. It is true that depression can and often does interfere with sleep. But the relationship between sleep and depression is now commonly regarded as bi-directional, with each condition capable of influencing the other. A significant body of research indicates that insomnia and other forms of disrupted sleep elevate sharply the risks of depression and other mood disorders.

New research shows results that indicate treating insomnia among people with depression may dramatically boost rates of recovery. This is important news and could dramatically change and broaden treatment for millions of people who suffer the debilitating effects of depression. The study being presented is one of 4 major research endeavors sponsored by the National Institute of Mental Health and dedicated to furthering our understanding of the impact of disrupted sleep on the course of depression.

In particular, this group of studies—all of which are expected to be published in 2014—explores the use of cognitive behavioral therapy for insomnia, often referred to as CBT-I. CBT-I is a form of talk therapy designed specifically to address the sleep disorder. Working regularly with a therapist, patients identify issues, emotions, and behaviors that may impede their sleep. They also learn skills and routines designed to improve sleep. These sleep-improving strategies include:
  • Implementing regular bedtimes and wake times
  • Developing strong sleep hygiene habits
  • Use of relaxation and visualization exercises
  • Avoiding naps
  • Using sleep restriction to avoid prolonged periods of time spent in bed and awake
  • Keeping sleep diaries 

Also critical to the goal of CBT-I is the easing of anxiety and stress about one’s ability to fall asleep and to sleep well.

CBT-I has some terrific inherent advantages. It is a relatively low-cost treatment option. The course of treatment often can be a short-term one: once patients receive the help they need to change their approach to sleep, they can stop the therapy and continue to sleep well.

The results of this new sleep-depression research—the first in a series of studies we’ll be seeing results from—are already being hailed as potentially transformative to the treatment of depression.

Excerpt from an article by Michael J. Breus, PhD