When I think of how important sleep is, I am reminded that sleep deprivation is often used as a form of torture. In an article titled “Why Sleep Deprivation is Torture: Prolonged Sleep Deprivation is a Cruel and Useless Method of Interrogation”, Kelly Bulkeley, Ph.D, notes that, “The first signs of sleep deprivation are unpleasant feelings of fatigue, irritability, and difficulties concentrating. Then come problems with reading and speaking clearly, poor judgment, lower body temperature, and a considerable increase in appetite. If the deprivation continues, the worsening effects include disorientation, visual misperceptions, apathy, severe lethargy, and social withdrawal.” He goes on to say that, “One of the first symptoms of sleep deprivation in humans is a disordering of thought and bursts of irrationality. Beyond 24 hours of deprivation people suffer huge drops in cognitive functions like accurate memory, coherent speech, and social competence. Eventually the victims suffer hallucinations and a total break with reality.”2
It is clear from the depiction above, that decent sleep is an absolute necessity. Often times, when a new patient meets with a doctor regarding depression, sleep is the first issue they attempt to get under control. This is often done with the support of medication. Prescription sleep medication should only be taken upon consulting with your doctor, as it could interfere with other medication that one is taking and may have side effects.
In my case, I became overmedicated. When I entered a partial hospitalization program, I explained that I struggled falling asleep, but once asleep I could stay asleep. The psychiatrist added a prescription antihistamine to my regimen. He believed that the antihistamine would help me fall asleep (induce drowsiness) and the sleep medication that I was previously on would keep me asleep, as it had been doing.
For several weeks the medication seemed to be just fine, and I was sleeping well. However, eventually there were two separate evenings in which I had to get up in the middle of the night. On these two occasions, I experienced fainting spells. The first evening was when our daughter woke in the middle of the night and thought my wife and I were still awake. She went downstairs to the main floor of the house, accidentally setting off the house alarm. I shot out of bed and made it downstairs to the alarm panel. I quickly canceled the alarm and grabbed the phone to call the alarm company to ensure that it had properly been canceled. As I waited for them to answer, I collapsed suddenly to the ground. I came to, I believe a minute or so later, with my face inches from the bottom of the coat rack. Little did I know, that fall would give me a permanent shoulder injury that I still deal with today. After getting up, I walked about six feet, falling to the ground and fainting a second time. After coming to, I again got to my feet, started up the stairs banging off of the stairwell walls like a ping-pong ball, and fainted a third time, falling through the cracked-open door to my bedroom. By this time, my two oldest daughters were in the room with my wife. I pulled myself up to the bed, lay down on my back, and told my wife I was just fine and needed some sleep. I was apparently as white as snow.
Since I serendipitously had to bring my daughter for a strep test the next day at Urgent Care, I decided I would mention my fainting spells. They checked me out, found nothing wrong, and asked me to call 911 if it happened again. Sure enough, two nights later, one of our two-year old twins was crying in the middle of the night. I got up to tend to Sam. I tried rubbing his back, singing to him (which understandably made him cry even louder), and rocking him. Nothing worked and he continued to kick at me. Getting frustrated, I turned to leave the room. Before I could take a step, I suddenly collapsed to the ground, fainting once again. This time, having fallen flat on my face, I ended up with a slightly bloody nose. My wife came quickly into the room when she heard the thud and attempted to wake me up for a good couple of minutes. After coming to and calling two family members who are doctors, my wife decided to contact 911. An ambulance arrived and two young EMTs were at my side taking my pulse and checking my vitals. After a short, bumpy ambulance ride through a Minnesota winter storm, I ended up in the Emergency Room (ER). I didn’t notice the sarcasm the ER doctor had used until I was walking back to my car. He had explained, “You don’t have to change your medications at all. All you’d have to worry about is death by bumping your head upon another fainting spell.” I quickly weaned off of the sleep medication.
Another possible side effect to be aware of with sleep medication is daytime drowsiness and confusion. It is my understanding that some of the sleep medication can build up in one’s system, making it difficult to wake up, causing drowsiness in the mornings, and adding to confusion. In my case, it was difficult for me to decipher whether some of the confusion and cognitive issues I was having were due to the medication or to the depression. Again, it’s important to take these medications under the consultation of a doctor and to let the doctor know of any possible side effects one may be having.
Some therapists believe that by treating insomnia alone through talk therapy, much of one’s depression may be cured. This type of talk therapy is called Cognitive Behavioral Therapy for Insomnia (CBT-I). According to the Mayo Clinic, “Cognitive behavioral therapy for insomnia is a structured program that helps you identify and replace thoughts and behaviors that cause or worsen sleep problems with habits that promote sound sleep. Unlike sleeping pills, CBT-I helps you overcome the underlying causes of your sleep problems.”1 The benefits of the CBT-I also seem to be long lasting. According to Colleen Carney, associate professor of psychology at Ryerson University in Toronto, “…those who successfully resolved their insomnia with cognitive-behavioral therapy were twice as likely to shake depression as well.”3 Some of the techniques used in CBT-I include:
- Stimulus control therapy
- Sleep restriction
- Sleep hygiene
- Sleep environment improvement
- Relaxation training
- Remaining passively awake
Typically, the therapist and patient would select a combination of some of the above-mentioned techniques to work on. There are many resources on the worldwide web that explain each of the above techniques in details.
Another way to get sleep under control without the use of medication or talk therapy is through better sleep hygiene. Although this is one of the possible techniques mentioned above that may be used in CBT-I, some people focus solely on improving their sleep hygiene on their own. Sleep hygiene involves changes in lifestyle that will increase your chances for a better night of sleep. Some of the common strategies to improve one’s sleep hygiene include:
- Limit naps during the day. Naps should be no longer than twenty minutes per day and should be taken well before your evening bedtime.
- Limit your caffeine intake. Do not consume caffeine after 2pm or so.
- Have a relaxing nighttime ritual such as reading, taking a warm bath, meditating or drinking some warm tea prior to going to sleep.
- Use the bed for sleep (and sex) only. Do not read or watch TV in the bed. It is important for your brain to make the connection that equates your bed to sleep.
- Do not use screens (computers, smart phones, TV, etc) just prior to going to bed. These stimulate the brain and make it more difficult to fall asleep.
- Exercise, but not immediately before going to bed. Exercising just prior to going to bed will increase your heart rate and, again, make it more challenging to fall asleep quickly.
- Be sure the room is dark and comfortable for sleep.
Whether it is with sleep medication under direction of a doctor, talk therapy, or better sleep hygiene, the importance of sleep when working towards recovery from depression cannot be over-emphasized.
- Bulkeley, K. (2014, December 15). Why Sleep Deprivation Is Torture. Psychology Today. Retrieved from https://www.psychologytoday.com/blog/dreaming-in-the-digital-age/201412/why-sleep-deprivation-is-torture
- Insomnia treatment: Cognitive behavioral therapy instead of sleeping pills. (2016, September 28). Retrieved from http://www.mayoclinic.org/diseases-conditions/insomnia/in-depth/insomnia-treatment/art-20046677
- Heitz, D. (2013, November 25). Therapy Provides ‘Critical Breakthrough’ for Depressed Insomniacs. Retrieved from http://www.healthline.com/health-news/mental-cognitive-behavioral-therapy-helps-insomnia-depression-112513