Broken nights that can lead to depression

by Denise Wagner on December 26, 2012

Patients who report feeling depressed may, in some cases, be suffering from sleep apnoea, and when this is treated the change can be dramatic, says Dr Thomas Stuttaford.

This year Sleep Disturbance Week -October 24 to October 30 -aptly includes the weekend that the clocks go forward and the ghosts walk while witches dance on Hallowe’ennight. Sleep discipline will then crumble as carefully built up night-time routines are disrupted.

Doctors, and their patients, are becomingly increasingly aware that the damage of a disturbed night isn’t confined to the hours spent counting sheep before seizing moments of restless sleep. The daytime consequences that follow night-time insomnia are legion. A new adverse effect of sleepless, or broken nights, has recently been analysed by Dr Daniel Schwartz, the director of the sleep centre of the University Community Hospital in Tampa, Florida (the study was published in the September issue of the journal Chest).

It has always been known that people who have obstructive sleep apnoea wake for a few moments in the cycle of snoring, apnoea, wakefulness, then back to sleep (apnoea means without breathing). Obstructive sleep apnoea occurs when the tongue or throat muscles block the airways. The tell-tale symptom that alerts the family to the trouble is the patient’s crescendo snoring. This snoring becomes progressively louder and louder, then there is a merciful pause while the snorer stops breathing for a moment. The patient wakes up, but for such a short time that it is forgotten.

The Florida team has shown there may be as many as 50 episodes of wakefulness a night. After such poor quality of sleep, the next day the patient feels worn out, lacks enthusiasm, is irritable, sleepy and has symptoms that are easily confused with those of a depressive illness. The investigations showed that four out of five of those with sleep apnoea also showed symptoms that are normally associated with depressive illnesses.

Most of these patients had had antidepressant medication but improvement came after specific treatment for sleep apnoea. Nearly all those who had continuous positive airway pressure, the standard treatment for sleep apnoea, felt very much better, lost their daytime sleepiness and found that their depression had miraculously lifted. Schwartz said that this didn’t imply that everyone who is depressed should routinely be evaluated for a sleep disorder, but it would be worthwhile for doctors to inquire about symptoms that might be suggestive of obstructive sleep apnoea.

Professor Stephen Spiro, of University College London, said that he had found it amazing how many patients, who had obstructive sleep apnoea treated with continuous positive airway pressure in the UCH sleep centre, had felt a sudden surge of renewed energy and a loss of their depressive symptoms once they were using one of these machines at night. He added that he was surprised that the association between sleep apnoea and depression wasn’t better known.

A previous survey carried out by the Medical Advisory Service found that 30 per cent of the population claimed to suffer from regular or recurrent insomnia; 94 per cent said that when they were having a period of insomnia it had affected their lives next day; and 70 per cent were prepared to say that these effects of prolonged sleeplessness were severe enough for them to say that it caused a serious loss of quality of life.

The initial sleep disturbance had often been triggered by either a physical problem that produced pain, or psychological troubles. Arthritis, especially in the spine or hips, is particularly likely to cause sleeplessness, as pain or stiffness in the joints makes it difficult to lie comfortably or to turn over with ease. The psychological triggers for insomnia include bereavement, domestic strife, a change to shift work, worries about children or stress either at home or in the office. A bad night resulted in patients feeling worn out the following morning, their ability to work was eroded by tiredness throughout the day and concentration was difficult.

Many attributed an accident to the sleeplessness that had ruined the previous night. Nine per cent of chronic insomniacs blamed tiredness the following day for the accident (a figure that rose to 11 per cent for those not working regular hours).

Women either suffered insomnia four times as often as men, or quite possibly were prepared to admit to it four times as often. The study showed that 75 per cent of women who said they had insomnia discussed it with their doctor, whereas only 58 per cent of men did so. There is also a relationship between the menopause and insomnia: 55 per cent of women between 45 and 65 had insomnia (the change in hormones can produce wakfeulness, while the night is a common time for vaso motor instability, such as hot flushes and sweating etc).

In both sexes, insomnia was more common in older people but upset their lives less (simply because they can sleep in the next day).

THE INSOMNIA EFFECT

Next-day symptoms and problems may include:

  • Feeling moody or depressed -experienced by 72 per cent of those with insomnia.
  • Loss of concentration -62 per cent.
  • Effect on work noted by others – 39 per cent.
  • Interpersonal relationships affected -32 per cent.
  • Involved in accidents -9 per cent (11 per cent if you work irregular hours).

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