Insomnia Can Trigger Depression, Study Shows

June 24, 2005 -- Insomnia has long been thought of as a symptom of depression, but new research shows it may actually trigger the mental disorder.

In one study, depressed seniors with insomnia were 17 times more likely to remain depressed after a year than patients who were sleeping well. The findings were presented Tuesday at the 19th Annual Meeting of the Associated Professional Sleep Societies in Denver.

In a separate study, seniors with insomnia and no history of depression were six times more likely to experience an episode of depression as seniors without insomnia. The association was strong for women and for people who suffer from a particular insomnia pattern that awakens a person repeatedly during the night.

Both studies were conducted by researchers from the University of Rochester Sleep and Neurophysiology Research Laboratory. Lab director Michael Perlis, PhD, tells WebMD that while the research focused on seniors, the findings could apply to anyone with chronic insomnia.

Self-treatment could worsen insomnia

Few people, including sufferers, health professionals and health authorities, recognize insomnia as a serious problem requiring treatment.
The kind of treatment that usually does take place is self-medication -a sleeping pill here, a little melatonin there, perhaps downed with some alcohol.
However, Prof. Hussain Habil, head of the Department of Psychological Medicine at University of Malaya, cautions that self-medication could worsen insomnia and cause more side effects than good ones.
"I have patients who became addicted to sleeping pills before they managed to get proper treatment from my clinic," Habil said.
The biggest problem with self-medication is that it overlooks one major aspect, which is identifying the cause of the insomnia. It could be caused by a multitude of factors, including medical conditions, psychological problems or environmental changes.
Psychiatrists treating insomnia usually prescribe non-pharmacological treatments first, before resorting to medication.

Non-pharmacological treatments include:

-Stimulus control therapy: to help the patient associate the bedroom with sleep and relaxation only.
-Paradoxical intention therapy: making the patient stay awake as long as possible to reduce anxiety about sleeplessness.
-Relaxation therapies: relaxation of muscles to reduce anxiety-associated arousal that could inhibit sleep.
-Cognitibehavioralral therapy: changing faulty beliefs and attitudes about sleep to reduce emotional stress and dysfunctional cognitions.
-Sleep restriction therapy: increasing sleep efficiency by restricting naps and time spent in bed not sleeping.
-Temporal control therapy: getting up at the same time every day, even during weekends.
-Sleep hygiene: tips to improve sleeping habits may be effective when used together with other therapies.

Medications are considered second-line treatment, because they tend to produce more side effects and have short-term benefits only.
Nonetheless, over-the-counter medications like antihistamines, or prescription medications like non-benzodiazepines and benzodiazepines, are sometimes needed in managing insomnia.

Treatment for insomnia

Many insomniacs rely on sleeping tablets and other sedatives to try to get some rest. Others use herbs such as valerian, chamomile, lavender, hops, and/or passion-flower.

Some traditional remedies for insomnia have included drinking warm milk before bedtime; taking a warm bath in the evening; exercising vigorously for half an hour in the afternoon; eating a large lunch and then having only a light evening meal at least three hours before bed; avoiding mentally stimulating activities in the evening hours; and paradoxically, making sure to get up early in the morning and to retire to bed at a reasonable hour.

Traditional Chinese medicine practitioners have been treating insomnia sufferers for thousands of years. A typical approach may utilize acupuncture, dietary and lifestyle analysis, herbology and other techniques, with the goal to resolve the problem at a subtle level.

Although they may seem unscientific, many of these remedies are sufficient to break the insomnia cycle without the need for sedatives and sleeping tablets. Warm milk contains high levels of tryptophan, a natural sedative. Using aromatherapy, including Lavender oil and other relaxing essential oils, may also help induce a state of restfulness.

The most commonly used class of hypnotics prescribed for insomnia are the benzodiazepines. This includes drugs such as diazepam, lorazepam, nitrazepam and midazolam.

The more relaxed you are the greater the likelihood of getting a good night's sleep. Relaxation techniques such as meditation have been proven to help sleep. They take stress from the mind and body which leads to a deeper more restful sleep.