No sleep, no rest for my tormented soul

Anyone who at least once did not sleep for a long time, knows what this means: there is lethargy, reduced attention, a bad mood, a strong physical fatigue. Available stimulants like caffeine stops working (this is the mechanism of action is quite limited), and the only way is still just to take a break and relax.

Chronic sleep deprivation and insomnia (of which we spoke in detail in a material “Well your words lull”, prepared for world day of sleep in the past year) to surface symptoms added even more deep and serious conditions and diseases.

For example, among the consequences of lack of sleep secrete cardiovascular disease, nutrition and metabolism (from eating to type II diabetes), and various mental disorders. Last but not least, sleep deprivation is closely linked with depression, and this on its own is surprising because sleep deprivation is often used to treat it, and sometimes quite successfully.

At least, this is indicated by the meta-analyses. One held in 2017, focused on 66 studies published from 1974 to 2016: this States that sleep deprivation is effective in 50 percent of patients in randomized studies with a control group and 45% in other studies. The effect of lack of sleep on depression did not depend on which experimental technique was used, what drugs were the patient, as well as its sex and age.

The study authors called the effect is significant, but given the fact that spin variables, which would provide the desired effect, could not be found, the result can be called random — of course, if we consider using sleep deprivation as a binary variable. In other words, when psychiatrists prescribed to depressed patients compulsory treatment sleep, it can either help or not — as lucky.

The sleep deprivation is still considered sufficiently effective method for the treatment of depression, and why this is so (even if it is intuitively clear that the lack of sleep probably is harmful), we need to understand.

To experimentally intervene

The relationship between quality of sleep and mental disorders are quite complex. First, the relationship between them is bidirectional: insomnia and hypersomnia — excessive sleep duration and daytime sleepiness, are considered as symptoms of depression and factors are largely influencing its development.

First of all why depression is necessary to restore normal sleep hygiene: do not eat for several hours before bedtime, going to bed at the same time, sleep recommended for age number of hours (for an adult is about seven to eight hours a day) and not to postpone the weekend in anticipation of a cumulative effect.

It is clear that it can be quite difficult; in this case, patients with depression are being prescribed drugs from the group of neuroleptics or other substances with anti-anxiety (trouble is, as you know, does not come alone with depression are at higher risk of development of anxiety) or sedative effect.

But for the first time that sleep deprivation may be therapeutic effect in depression, discovered and studied by the German psychiatrist Walter Schulte in the early 1970-ies. He observed three patients with diagnosed depressive disorder: two teachers and one doctor. Each of them told Schulte that after a sleepless night of work or sports they feel an improvement in their mental state.

Of course, to base a whole psychiatric practice to three cases impossible, so after the first statements about the benefits of sleep deprivation (after Schulte and two of his colleagues managed to achieve a significant effect in 23 of 34 patients), scientists began to actively conduct research.

The first task was to establish exactly how many hours of sleep deprivation necessary in order to achieve at least some effect, and at what time to begin the experiment. Usually, therapy of sleep deprivation involves the whole day (or even more: sometimes up to 36-40 hours) forced wakefulness: the patient awaken at about midnight, after which he sleeps the entire next day and sometimes even the whole next night.

With such therapies precluded admission of any CNS stimulants (even coffee), and it is recommended to combine the forced insomnia therapy light (however, both are considered branches of aromaterapii — artificial “settings” cycles of sleep and wakefulness).

The effect comes quite quickly: at sleep deprivation in a patient with depression is immediately observed visible improvement. However, this is quite deceptive success: studies indicate that 50-80 percent of patients, the condition comes back to normal depressed after they finally sleep.

While 10-15 percent of patients improving, on the contrary, are manifested only after sleep following the deprivation. At 2-7 percent of patients may get worse, and depression can be symptoms of mania (sleep deprivation, therefore, is not recommended for people with bipolar disorder — even in a depressed phase).

Some blurring effect can be explained by the fact that a day or more without sleep — still quite painful to the body. Therefore, scientists tried to reduce the time of forced wakefulness to a few hours a night. For example, it is possible to Wake the patient in the night and not to let him sleep a couple of hours. This study was conducted in the early 1990-ies, but forced awake until five in the morning after waking up at three in no special effect was given.

Despite the fact that meta-analyzes indicate the absence of any accurate side variables, which would provide the desired effect of sleep deprivation, the individual studies still claim that to be effective, such method must be observed for several conditions.

For example, sleep deprivation is most effectively works on patients with endogenous depression, and not depression caused by external factors. In addition, should be considered and the variation of mood of the patient during the day: most effective sleep deprivation works for those who feel better in the evening and not during the day.

The mechanism of the therapeutic effect of sleep deprivation if you’re not installed. For example, the recent study say about the role of the neurotransmitter adenosine, which accumulates in the brain during the day and ultimately responsible for the fact that we feel tired and fall asleep.

Other studies point to the involvement in such therapy serotoninergicheskoy system — chief in the pathology of depression. While taking the drug pindolola, blocking autoreceptor of serotonin and improves the effect of antidepressants from the group of selective inhibitors of reverse takeover serotonin, sleep deprivation more efficiently improves mood in depression.

A logical reason for the effectiveness of the lack of sleep I think his comparison with the intake of psychostimulants (e.g., amphetamine). Indeed, if lack of sleep is sometimes observed similar to the drugs effects (you may recognize this: sometimes during a long Wake of strength and energy as though getting bigger).

In fact, and in another case in the brain increases the concentration of monoamines (primarily, though not serotonin, and dopamine), thereby stabiliziruemost the work of the limbic system, and mental well — being improves. Such a theory is quite fit with what the effect of sleep deprivation is often unstable and short — like psychostimulants. However, it is still only a theory.

Take with caution

Despite the relatively long history of study and application in psychiatric practice, sleep deprivation is still an experimental method for the treatment of depression and is not included in the standard treatment recommendations, on a par with drugs-antidepressants and psychotherapy. This is evidenced by the fact that sleep deprivation depression cure is often only in controlled conditions (under medical supervision), so that in sleepless nights there are many adverse effects.

One of the most serious is the possible increase in the risk of developing Alzheimer’s disease even from one night spent without sleep. A key role in the development of the disease play two proteins: beta-amyloid that forms plaques in the brain, and Tau protein that contribute to the formation of intracellular neurofibrillary cords.

Studies show that just one sleepless night significantly increases the concentration of beta-amyloid in the brain, and Tau-protein in the blood. The mechanism of such action or is in any other case not fully known, and it is also unclear whether there is actually any negative effects.

It is also interesting that lack of sleep leads to increased feelings of loneliness and social isolation. The effect is, however, rather psychological: lack of sleep makes people look for various ways to escape from accumulated fatigue, which increases the need to communicate. Other people, on the contrary, not enough sleep find people more repulsive and don’t want to go with him on contact.

There is quite a clear conflict that prevents communion with others and hence there is loneliness. And it is with depression (of course, if before it was not, as loneliness is one of the most common psychological disorder symptoms) definitely do not need.

In addition, a recent study showedthat a sleepless night reduces the activity of the prefrontal cortex, responsible among other things for cognitive control. With the decrease in cognitive control, in turn, significantly increased anxiety — and it can significantly worsen the condition of depression.

However, be aware that the use of sleep deprivation for the treatment of insomnia and the same methodology for behavioral research, things are different. The last involved healthy people without mental disorders; they, like show research therapy, sleep deprivation involving control groups, lack of night rest only increases irritability and does not work the way effect on people with depression, even in the short term.

Therefore, it is logical to assume that the negative behavioral and mental aspects of the lack of sleep people with depression may not bring about the severity of the presence of mental disorders on the effectiveness of the sleep deprivation talking and scoping study. But don’t forget about the average efficiency of 50 percent (as, however, that pharmacological treatment of depression figures are about the same).

So, despite the fact that sleep deprivation can actually help to improve the symptoms of depression, to experiment this way with your body, brain and mental state we don’t advise: I’d rather do this the attending psychiatrist.

Leave a Reply

Your email address will not be published.