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Sleep Medicine

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The Wall Street Journal reported recently on the topic of sleep deprivation as to which cities around the World are the most and least sleep deprived. Brisbane leads the way with the earliest bed time and earliest wake up time.

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According to new research, risk of being obese by age 21 was 20 percent higher among 16-year-olds who got less than six hours of sleep a night, compared with their peers who slumbered more than eight hours.

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As we get older there is a strong relationship between reduced amount and quality of sleep. Recent research has found specific cluster of neurons that have linked insomnia and more sleep fragmentation. The reduction of these neurons can be from normal aging but has also been seen in Alzheimers disease.

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A bedtime routine might sound like something that's only necessary for the grade-school set, but following a nightly schedule can greatly improve the sleep of adults, too. Sleep experts recommend establishing a bedtime routine, both to calm and relax you as you get ready to sleep and so you aren't inadvertently giving yourself jet lag.

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Researchers at NYU Langone Medical Center and elsewhere, using a mouse model, have recorded the activity of individual nerve cells in a small part of the brain that works as a "switchboard," directing signals coming from the outside world or internal memories. Because human brain disorders such as schizophrenia, autism and post-traumatic stress disorder typically show disturbances in that switchboard, the investigators say the work suggests new strategies in understanding and treating them.

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The death rate from asthma in Australia has fallen by almost 70 per cent since the 1980s, according to a new report released by the Australian Institute of Health and Welfare

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Sleep and Depression

A look at the relationship between mood and sleep.

Do you have trouble sleeping at night? Do you sleep too much during the day?

While these problems may be caused by external factors (eg; noise, light) or temporary stresses (eg.; new baby, starting a new job), it is important to understand that these troubles may also be connected to your moods.

In some cases, these sleep problems may be related to a condition called depression.

What is Depression?

What is Depression?

Increasingly, depression is being recognized as a condition that involves how our body functions, how we feel about ourselves and also how we respond to events in our lives. Trouble falling asleep and or staying asleep are important features of depression.

Other symptoms may include:

  1. Down or low moods, feeling sad most of the day, nearly every day
  2. Loss of interest or inability to experience pleasure in things that generally had been pleasurable before
  3. Sharp changes in weight, either significant weight loss or weight gain
  4. Loss of energy
  5. Difficulty concentrating or making decisions
  6. Thoughts that life isn’t worth living, even to the point of actively considering ending one’s life
  7. Anger outbursts, irritability, nervousness

Some people with depression experience only a few of these symptoms. If you have trouble sleeping and also have two or more of these symptoms, inform your health care professional.

The Connection Between Sleep and Depression

Research has told us that depression and sleep are strongly linked. In fact, 20% of depressed people also have sleep disturbances. It is important to consider sleep disorders when you are feeling depressed as anti-depressants will not treat the cause.

There are a number of different sleep disorders that may cause or increase depression.

Obstructive Sleep Apnoea

People with untreated Obstructive Sleep Apnoea are 5 times more likely to develop depression.

Obstructive Sleep Apnoae (OSA) is a common sleeping disorder, characterised by pauses in breathing during sleep. Each pause in breath is called an ‘apnoea’ and in more severe cases can occur hundreds of times a night. Due to the frequent awakenings, people with OSA often experience fatigue which can lead to depression.

Click here to read more on Obstructive Sleep Apnoea

Insomnia

The link between insomnia and depression is very strong, as insomnia can cause depression and depression can also cause insomnia.

There are a number of causes and treatments for Insomnia, which may also be successful treatments for depression.

Periodic Limb Movement Disorder

Periodic limb movement disorder (PLMD) occurs when a person’s leg muscles twitch during sleep causing him or her to sleep poorly. Sometimes other parts of the body twitch as well, causing you to awake during the night and preventing you from feeling rested in the morning.

Read more on Periodic Limb Movement Disorder

It’s important that you realize that trouble sleeping (for any reason) can promote feelings of depression including suicide ideation

Age

Depending on your age, depression may also affect your sleep differently. For example, a relatively younger person (under 40 years of age) may experience trouble falling asleep, while people over 40 may have trouble remaining asleep. Both can be features of depression.

Of course, it is possible that your sleep problems are not related to snoring. OSAS or PLMD.

If sleep problems are your main symptom, it is well worth talking to your healthcare professional, who may help you understand what is causing your sleep difficulties.

Referrals to a sleep disorders centre for consultation can provide useful information about your condition.

Where is my nearest sleep disorder centre?

What happens at a Sleep Disorders Centre?

In many cases, the sleep disorders specialist will complete an interview with you. This serves to provide a complete history of your sleep and related problems. Most patients also complete a short (two-week) sleep diary to record their sleep difficulties. In addition, some specialists also provide questionnaires for you to complete. Together, these procedures can significantly help diagnose specific sleep and or depression problems.

If the sleep specialist determines that your sleep troubles are the likely result of snoring, OSAS, PLMD or another disorder, a sleep laboratory evaluation can provide very useful information about your condition. If depression seems to be causing the sleep problems, testing in the sleep laboratory may also be helpful, because people with depression may enter dreaming sleep quickly after falling asleep and show deep sleep later on. The opposite tends to happen with people who are not depressed.

If Depression is Causing my Sleep Problems, What can I do?

If your sleep problems are related to depression, the key to improving your sleep is treating the depression and using good sleep hygiene measures first.

Effective treatments for depression include:

  • talk therapy (ie; counselling, psychotherapy)
  • medication therapy.

Some people recover from depression with psychotherapy alone, but many require both counselling and medication therapy. If medication therapy is recommended, several excellent antidepressants are currently available. Your healthcare professional or sleep medicine specialist may initiate these treatments or refer you to a psychologist or psychiatrist who specializes in these forms of treatment.

Sleep Hygiene

Regardless of whether your sleep problems are related to depression, sleep can often be improved by following the practices of good sleep hygiene. Sleep hygiene is a recipe of simple habits and behaviours that help keep you “on schedule” to sleep better.

  • Sleep in a dark, quiet room
  • Use the bedroom only for sleep and sexual activity (not for watching TV or balancing the checkbook)
  • Keep your bedroom temperature cool and comfortable
  • Only go to bed when you are relaxed
  • Have a regular routine for preparing to sleep (brush teeth, put on pyjamas etc)
  • Try to have dark curtains for the bedroom windows or to wear eye shades for sleep
  • Use “white noise” to block out other noises
  • Disconnect - Turning off the phone, disconnecting the doorbell or putting up a “Do Not Disturb” sign can also help you sleep.

If diagnosed with depression, treating the condition and using good sleep hygiene will help you take the first steps to achieve a greater feeling of well being.

Tips On How to Sleep Well...

There are some general guidelines that help promote good sleep.

  1. Go to bed only when you are sleepy.
  2. If you are unable to fall asleep after about 20 minute, get out of bed.  Leave your bedroom and do something relaxing. Come back to bed only when you are sleepy.
  3. Use your bed for sleep, sex and to recover from illness.
  4. Wake up at the same time every day, including weekends and holidays.
  5. If you have trouble sleeping at night, avoid napping during the daytime. If you need to take a nap, make it less than one hour and take it before 3pm.
  6. Begin rituals to help you relax before bedtime, such as taking a warm bath or reading for a few minutes.
  7. Exercise on a regular basis, but do it earlier in the day.
  8. Maintain a regular daily schedule to keep your brain’s internal clock running smoothly.
  9. Eat a light snack before bedtime, but avoid a big meal.
  10. Avoid caffeine, alcohol and cigarettes late in the day.
  11. Set aside time during the day to get all of your worries out of your system.
  12. Avoid sleeping pills or use them cautiously under the supervision of a doctor.
  13. Never drink alcohol while taking sleeping pills or other medications.
  14. Talk to your doctor or a sleep specialist if you have an ongoing problem related to your sleep.
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