Wednesday, June 26, 2013

Information about Normal and Abnormal sleep

I have been a pastor and a counselor for quite a while.  One of the first things I ask my  client is:
How did you sleep last night?  If you read the article, below you will know why I ask this.  One of my psychiatrists, Dr. Donald Goodwin, who was the chair of the University of Kansas School of Psychiatry and who died in 1999 once said to me; Steve, sleep disturbance is a litmus test for depression.| And the article below echoes his statement. when it says:  In fact, insomnia is one of the diagnostic hallmarks of an episode of major depression
Experts tell us that the fundamental biological manifestation of endogenous (also called major depression) depression consist of changes in the hypothamlic centers of the brain that govern food intake, sexual drive and circadian rhythms..  Circadian rhythms which involve the timing of the cycle of rest and activity are altered which results in symptoms being worse in the morning, (early morning awakening) and endocrine abnormalities such as increased stress hormones (cortisol.  .

Remember that  drugs like Lunesta and Ambien are not antidepressants, they are hypnotics.  Often people will mix them with Klonopin or Ativan.   Many psychiatrists believe these combinations of drugs can make things worse for a good night's sleep, most of them will tell you they should be  used short term.  But those who manufacture hypnotics want you to use them long term.

A medical doctor can deal with sleep problems but if you suspect a disorder of the mind, you should go to a psychiatrist rather than a primary doctor. In an age of speciality this only makes sense. 

If you would like to read more about the subject of depression and Steve and Robyn's Bloem story of dealing with it, please go to this link;
So back to the sleep question. It is important to determine what are the characteristics of the person's
sleep at night and during the day. All sleep problems do not constitute a mood disorder.  But where there is a mood disorder, there is a problem with sleep. This includes when a person is in mania or depression.  You might wish to study this more in depth.
 Steve Bloem

From John Hopkins University
Persistent trouble falling asleep at night, or waking up too early, is neither normal nor inevitable with age. Nonetheless, insomnia is a common complaint among older adults. According to the National Sleep Foundation, two out of every ten Americans sleep less than six hours a night -- and nearly 90 percent have symptoms of insomnia at least a few nights a week.

Insomnia leaves people feeling mentally "foggy," contributing to problems with memory and concentration, for instance. Insomnia also slows a person's response time -- and this is potentially dangerous, because it can affect driving ability and increase the risk of falls. In addition, insomnia is a risk factor for depression.

When age is a factor for insomnia. Many believe that older people sleep less at night because they need less sleep. But in fact the need for sleep stays the same as people age -- what changes is what's known as "sleep architecture."

Normal sleep consists of two major states: rapid eye movement (REM) sleep and non-REM sleep. Non-REM sleep is further divided into four stages, starting with Stage 1, the lightest level of sleep and progressing to Stage 4, the deepest. But as people hit middle age, the deepest levels of sleep -- Stage 3 and Stage 4 -- begin to decrease. This means that with aging, a greater portion of the night is spent in lighter levels of sleep, which increases the odds that an individual will wake up during the night.

When mood is involved. The relationship between sleep and mood disorders is complex. Insomnia not only contributes to the development of depression but it also is a classic sign of the disorder -- in fact, insomnia is one of the diagnostic hallmarks of an episode of major depression. In addition, insomnia is an independent predictor of suicide in someone who is depressed and of relapse in a person who has been successfully treated for depression.

In a National Institute of Mental Health study of nearly 8,000 people, those who had insomnia when the study began and at the one-year mark were far more likely to develop a new episode of major depression than those without insomnia. In contrast, those whose insomnia had resolved by the one-year mark had a much lower risk of depression.  Insomnia also is deeply intertwined with anxiety disorders. Panic disorder, post-traumatic stress disorder, generalized anxiety disorder and social phobia are all associated with sleep disruption and insomnia.

John Hopkins

Johns Hopkins White Paper: Depression and Anxiety