There is a close connection between sleep and depression: sleep or dozing in bed does not lead to recovery for some patients, but to a worsening of the depressive symptoms. This is shown in the latest study by the Depression Research Center of the German Depression Aid Foundation. Sleep deprivation in clinics or a slight reduction in bedtime, which sufferers can do at home, are thus supportive ways of treatment.
Years ago, experts already reported that people who sleep too little in the long term can increase their risk of depression. But not only too little sleep, but also too much sleep can have negative effects and worsen depressive symptoms, according to a new study.
According to a recent announcement, a new analysis of longitudinal data collected by the German Depression Relief Foundation together with IT partners shows how close the relationship between sleep and mood is. As part of a pilot project funded by the German Federal Ministry of Education and Research (STEADY project), 22 study participants suffering from depression used an app to document their bed and sleep times as well as their depressive symptoms over an average of 173 days. It was found that a longer bed or sleep time was associated with a statistically significant worsening of the depression in eleven of these patients. In six of them, a previous longer bedtime leads to more depressive symptoms and may even cause them.
Deterioration of depression
“If patients understand the connection between depression and bedtime, individual therapy recommendations can be derived from this in consultation with the therapist. If, for example, a patient observes that he/she feels even more exhausted after long periods of bed or sleep, a reduction in bedtime to around 8 hours can be useful,” explains Prof. Ulrich Hegerl, Chairman of the German Depression Aid Foundation and holder of the Senckenberg Professorship at the University of Frankfurt/M., the results of which were published in the specialist journal “JMIR Mental Health”.
As the Stiftung Deutsche Depressionshilfe writes on its website, about every fourth woman and every eighth man is affected by depression in the course of their lives. With regard to the signs of the disease, depressions are quite similar in both sexes. According to the experts, depressive patients always feel exhausted and have a great longing for restful sleep. For some, however, sleep has a depression-increasing effect. Then sleep reduction can have an antidepressive effect.
The mechanism underlying this can be well illustrated by the example of overtired children: Tired children suddenly become overactive and are full of energy. The body actually needs sleep, but the tired child counteracts this by creating a stimulant environment that prevents them from falling asleep. People with attention deficit hyperactivity disorder (ADHD) also have an increased tendency to fall asleep, as studies have shown. In a quiet environment, for example during school lessons, the organism tends to fall asleep and counteracts this by creating a stimulus-intensive environment through hyperactivity and distractibility, similar to that of overtired children.
Depression is the opposite: depressive persons are often affected by a chronically increased alertness. Patients feel permanently tense as before an exam, cannot relax and find it difficult to rest despite tiredness. Those affected counteract this by withdrawing and avoiding all other external stimuli such as social contacts or loud music. They tend to go to bed earlier, stay in bed longer in the morning and lie down during the day – always hoping to relax and regain their strength. However, this is where a vicious circle begins: because sleep leads to an increase in depression for many of those affected, because after sleep alertness is strengthened and tension is particularly high. In many depressive patients, the symptoms are therefore strongest in the morning.
For many patients, a behavior that counteracts the increased wakefulness and promotes sleep is very helpful. Sleep deprivation is an established form of treatment for depression, which is now offered in many clinics. Patients stay awake for a whole night or the second half of the night and should not sleep the next day. The majority of patients experience a sudden brightening of the mood in the early hours of the morning and the exhaustion and hopelessness that has often existed for months subsides. However, this effect only lasts until the next sleep. “The sleep deprivation shows the ill person that the depression can be broken through and thereby gives hope again,” says Hegerl. Sport is also a good supporting measure for depression, as exercise makes tired and counteracts the high level of alertness.
Longer sleep can make depression worse
Patients can observe how bedtime and depressiveness are related. In addition they should note daily in a table, how long they were in bed (0-10 hours) and how the mood or drive was the next day (from 0 -10). “It is helpful for patients to notice that the mood is usually worse when they stay in bed longer. They can clarify with their doctor whether it would be sensible to go to bed later despite feeling exhausted and get up earlier in the morning and limit the bedtime to about 8 hours,” advises Prof. Ulrich Hegerl. (ad)
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