Sleep Disruption and Depression
It is accepted that sleep disruption is common in the elderly. Many see sleep problems as inevitable as we age. Sleep patterns do change as we age but that does not mean that there is nothing wrong. Studies have shown that sleep disturbances contribute to morbidity and mortality. “Despite the almost standard management of sleep disturbance, insomnia is not always in itself a primary diagnosis: it may be a cause, a symptom or an epiphenomenon of illness” (Livingston, Blizard and Mann, 1993).
There are several studies that show that there is a relationship with sleep disruption and depression. Sleep Disturbance studies frequently indicate underlying depression and this is reinforced if mental health issues are present. Studies also point to sleep disturbance being a predictor of future depression. “Insomnia is the most frequent sleep disturbance in depressed patients, and such sleep impairment is viewed as a symptomatic dimension of current depression. Sleep disturbance often lingers and its persistence can represent a residual phase of a major mood disorder. Alternatively, emergence of disturbed sleep may serve as a precursor or prodrome of depression that occurs later in life” (Cho, et. al., 2008).
People who have difficulty sleeping have less energy to carry out their daily activities. They are more irritable and cannot focus as well. Frequently, people are frustrated they either cannot get to sleep or stay asleep. “Even small levels of sleep deprivation over time can chip away at your happiness. You might see that you’re less enthusiastic, more irritable, or even have some of the symptoms of clinical depression, such as feeling persistently sad or empty. All these alterations to your mood can affect not only your individual mental health, but your relationships and family dynamics as well” (National Sleep Foundation, 2018).
“The link between sleep and mood has been seen over and over by researchers and doctors. For example, people with insomnia have greater levels of depression and anxiety than those who sleep normally. They are 10 times as likely to have clinical depression” (National Sleep Foundation, 2018).
Sleep deprivation has been shown that it does something to our brains which make us more susceptible to depression. “Even though scientists still don’t fully understand what causes depression or sleep disorders, they have found neurochemical links between the two. Corticotropin-releasing factor (CRF) is a neuropeptide and is found in elevated levels in people with depression and anxiety disorders. It also is found in high levels in many insomniacs. The hypothalamic-pituitary-adrenal (HPA) axis is stimulated perhaps excessively in both depressed people and insomniacs” (Tuck, 2017).
“The more a person experiences insomnia and the more frequently they wake at night as a result, the higher the chances of developing depression” (National Sleep Foundation, 2018). “It is easy to think of reasons why insomnia might lead to depression: it is extremely frustrating and causes a person to lie awake at night and ruminate on unpleasant thoughts. Then, the excessive daytime sleepiness the following day reduces their general quality of life” (Tuck, 2017). “Sleep deprivation makes it difficult for the brain cells to communicate effectively, which, in turn, can lead to temporary mental lapses that affect memory and visual perception” (Mathewson, 2017) making it more difficult to navigate through a life where someone is already aware of changes in their physical health and their ability to care for themselves independently.
Sleep disturbances can be related to medical or psychological issues. Whether it is a medical or psychological issue, leaving sleep disturbances unattended, can lead to unintended medical and/or psychological problems. There are some sleep tips that are important for all seniors to follow in order to get good quality sleep. Roepke and Ancoli recommend not spending too much time in bed, maintaining consistent sleep and wake times, getting out of bed if unable to fall asleep, restricting naps to 30 minutes in early afternoon, regular exercise, spending more time outside, without sunglasses, especially late in the day, increasing overall light exposure, avoiding caffeine, tobacco and alcohol after lunch and limiting liquids in the evening.
If sleep difficulties continue it is important that this be explored with your physician to determine the cause of the disruption and address those issues and thus preventing additional problems developing due to ongoing sleep disturbance.
Cho, H. J., Lavertsky, H., Omstead, R., Levin, M. J., Oxman, M. N., Irwin, M. R. (2008). Sleep Disturbance and Depression Recurrence in Community-Dwelling Older Adults: A Prospective Study. Retrieved from: https://ajp.psychiatryonline.org/doi/pdfplus/10.1176/appi.ajp.2008.07121882
Livingston, G., Blizard, B., Mann, A. 1993. Does sleep disturbance predict depression in elderly people? A study in inner London. Retrieved from: https://bjgp.org/content/bjgp/43/376/445.full.pdf
Mathewson, S. (2017). Here’s What Happens in the Brain When You Don’t Get Enough Sleep. Retrieved from: https://www.livescience.com/60875-sleep-deprivation-sluggish-brain-cells.html
National Sleep Foundation. 2018. The Complex Relationship Between Sleep, Depression & Anxiety. Retrieved from: https://www.sleepfoundation.org/excessivesleepiness/content/the-complex-relationship-between-sleep-depression-anxiety
Roepke, S. K. and Ancoli-Israel, S. (2010). Sleep Disorders in the Elderly. Retrieved from: http://pdfs.semanticscholar.org/cf97/d5a166d051ca684f84a21c45ddd543c8f1c0.pdf
Tuck Advancing Better Sleep. (2017). Depression and Sleep Disorders. Retrieved from: https://www.tuck.com/depression-and-sleep/