November 18, 2013

Sleep

I pay quite a bit of attention to sleep because, among other reasons, my productivity as a blogger correlates fairly strongly with how much sleep I've gotten over the last three nights. For example, I've come to realize I don't need eight hours of sleep per night, I need eight and a half.

Benedict Carey, a fine human sciences reporter for the NYT, writes:
Sleep Therapy Seen as an Aid for Depression 
By BENEDICT CAREY 
Curing insomnia in people with depression could double their chance of a full recovery, scientists are reporting. The findings, based on an insomnia treatment that uses talk therapy rather than drugs, are the first to emerge from a series of closely watched studies of sleep and depression to be released in the coming year. 
The new report affirms the results of a smaller pilot study, giving scientists confidence that the effects of the insomnia treatment are real. If the figures continue to hold up, the advance will be the most significant in the treatment of depression since the introduction of Prozac in 1987. 
Depression is the most common mental disorder, affecting some 18 million Americans in any given year, according to government figures, and more than half of them also have insomnia.... 
The study is the first of four on sleep and depression nearing completion, all financed by the National Institute of Mental Health. They are evaluating a type of talk therapy for insomnia that is cheap, relatively brief and usually effective, but not currently a part of standard treatment. 
The new report, from a team at Ryerson University in Toronto, found that 87 percent of patients who resolved their insomnia in four biweekly talk therapy sessions also saw their depression symptoms dissolve after eight weeks of treatment, either with an antidepressant drug or a placebo pill — almost twice the rate of those who could not shake their insomnia. Those numbers are in line with a previous pilot study of insomnia treatment at Stanford. 
In an interview, the report’s lead author, Colleen E. Carney, said, “The way this story is unfolding, I think we need to start augmenting standard depression treatment with therapy focused on insomnia.” 
... Doctors have long considered poor sleep to be a symptom of depression that would clear up with treatments, said Rachel Manber, a professor in the psychiatry and behavioral sciences department at Stanford, whose 2008 pilot trial of insomnia therapy provided the rationale for larger studies. “But we now know that’s not the case,” she said. “The relationship is bidirectional — that insomnia can precede the depression.” 
... Several studies now suggest that developing insomnia doubles a person’s risk of later becoming depressed — the sleep problem preceding the mood disorder, rather than the other way around. 
The therapy that Dr. Manber, Dr. Carney and the other researchers are using is called cognitive behavior therapy for insomnia, or CBT-I for short. The therapist teaches people to establish a regular wake-up time and stick to it; get out of bed during waking periods; avoid eating, reading, watching TV or similar activities in bed; and eliminate daytime napping. 

I guess the idea is that your bed shouldn't be your electronic command and control center, it should be just for sleeping.
The aim is to reserve time in bed for only sleeping and — at least as important — to “curb this idea that sleeping requires effort, that it’s something you have to fix,” Dr. Carney said. “That’s when people get in trouble, when they begin to think they have to do something to get to sleep.” 
This kind of therapy is distinct from what is commonly known as sleep hygiene: exercising regularly, but not too close to bedtime, and avoiding coffee and too much alcohol in the evening. These healthful habits do not amount to an effective treatment for insomnia. 

In other words, while they can't hurt, they often can't help.

Still, there are a lot of subtle things some people need to be aware of, such as what flavor of ice cream before bed. I can no longer eat anything chocolate within, perhaps, five or six hours of bedtime.
Dr. Andrew Krystal, who is running the CBT-I study at Duke, called sleep “this huge, still unexplored frontier of psychiatry.” 
“The body has complex circadian cycles, and mostly in psychiatry we’ve ignored them,” he said. “Our treatments are driven by convenience. We treat during the day and make little effort to find out what’s happening at night.”

41 comments:

Anonymous said...

Laptops in bed definitely keep you awake longer than otherwise. The glowing light, radiation, and the instant and constant information stimulation of the internet have a huge effect. If you're reading in bed, it has to be a really damn good book to keep you awake. Otherwise you doze off and fall asleep pretty quickly.

Robert said...

It's well established by now that insomnia can be aggravated not only by laptops / tablets in bed, but by excessive computer use overall. I'm like Steve Sailer, I need eight and a half hours of sleep per night, though when I don't get that much (as is often the case), my default mode tends to be pretty disabling anxiety rather than, as mentioned in this article, depression. (Yes, anxiety and depression do overlap to a certain extent, but by no means wholly.)

There are people who thrive, or who seem to thrive, on hardly any sleep. Hillary Clinton is one. Another recent example is the ex-Prime-Minister of Australia, Kevin Rudd, who at the peak of his powers could get by on only three hours' nightly sleep.

http://www.smh.com.au/federal-politics/political-news/plugged-in-247-paying-the-workaholic-price-20130104-2c8tf.html

But this hyperactivity caught up with him in the end. When he won the 2007 national election he looked reasonably fit. Six years later and out of office (he has just resigned from his Queensland parliamentary constituency), he looks like a heart attack waiting to happen: overweight, pasty-faced, bleary-eyed, and exhausted.

dearieme said...

Here's my recommendation for you. My mother would end the day with a cup of weak tea with a couple of teaspoons of sugar in it, and two biscuits (preferably digestives or ginger nuts). She always slept like a log. That's all there is to it, really. Well, except the nip of whisky, I suppose.

Anonymous said...

It's astonishing that sleep problems have been so ignored by psychiatry.

vultureofcritique said...

5-HTP before bed, perhaps 150 to 200 mg, should have an immediate effect.

You can also consider melatonin.

Neither of these medications are likely to be needed every single day.

In particular, you might find that 5-HTP works best if you take a vacation from it perhaps one week a month.

Jonathan Silber said...


Psychology today: all the rigor of sociology plus the power of the prescription pad.

Anonymous said...

I think sleep disturbance is like an aura before a migraine headache.

This is my experience. All of a sudden, I start getting bored and wanting to stay away from people. Then I have a few nights where I don't want to sleep and can't motivate myself to go to bed. Then a couple weeks low mood. This is a cycle that occurs 5-6 times a year now. I had depression when I was younger.

Rohan Swee said...

Robert: There are people who thrive, or who seem to thrive, on hardly any sleep. Hillary Clinton is one. Another recent example is the ex-Prime-Minister of Australia, Kevin Rudd, who at the peak of his powers could get by on only three hours' nightly sleep.

Yes, but what are they getting up to in those extra hours? Asleep, they wouldn't be doing any damage.

carol said...

Yeah I was happier when I was just working full time the day job, going to bed at the same time every night and getting lots of exercise.

In the Obama economy, not so much, with the multiple part time jobs.

I'll sleep when I'm old.

Ed said...

John Campbell in his biography of Margaret Thatcher suggested that her famous minimal sleeping habits also caught up with here in the end, contributing to the early onset of dementia.

Anonymous said...

Steve,

Only pussies sleep more than 7 hours a night.

Dan in DC

Jokah Macpherson said...

I think being able to get by on very little sleep is a useful trait to have in the modern world and I'm consequently envious of people who have it since I require a lot of sleep.

Meeting girls for example - If I stay out until 2:00 in the morning, I'm going to feel terrible the next day. Since even for the most socially savvy, meeting girls is to some extent an exercise in getting a large sample size, there's a good chance that I'll wind up throwing off my sleep schedule and feeling terrible for nothing. It's a lose-lose situation.

Anonymous said...

I am not sure how much sleep I need but probably somewhere between 9-10 hours. When I sleep only 8 hours I am a zombie, my thinking slows down to a large extent. I wish I would only need little sleep...

Anonymous said...

"Light therapy" is the solution to a lot of sleep problems. People these days spend a lot of their time in the evening staring into giant 55 inch TV's, or computers/laptops/tablets, and this suppresses the body's normal production of melatonin.

The simple solution is - stop doing that.

It turns out that it's light in the blue part of the spectrum which keeps you awake, so if you MUST work on your laptop in the evening consider installing something like f.lux.

Mr. Anon said...

"Robert said...

There are people who thrive, or who seem to thrive, on hardly any sleep. Hillary Clinton is one."

And she has achieved so much. Why, she has.....................................

Anonymous said...

http://blogs.villagevoice.com/runninscared/2013/11/brown_university_ray_kelly.php

Freedom of speech vs Fiefdom of screech

Bruce Charlton said...

@Steve

You might like my book Psychiatry and the Human Condition - where I put a lot down to sleep deprivation and disturbance

http://www.hedweb.com/bgcharlton/psychhuman.html

The problem is that there are no really good ways of stimulating deep, natural, restorative sleep (no good drugs) - except maybe ECT/ electroshock.

JeremiahJohnbalaya said...

First of all, my ancestors or the man above did not seem to include the wiring for depression in me. I just don't seem to get it; knock on wood.

But, my sleep issues are legendary. I could describe my problems (and possible solutions) ad naseum. But the basic solutions (losing some weight, not working on anything mentally challenging, the computer, or reading serious books right before sleep, and sticking to a schedule] are so obvious in retrospect that it's really sad to have wasted so much time on overnight sleep studies, pills, etc.

Other than the frustrations of waking up constantly, bizarre dreams, etc, by far and away the most interesting fact: I had literally lost the ability to fall asleep. I didn't know how to do it. I'm still not very good at it, but i'm getting better with practice. It's really weird to type/think the idea: I'd forgotten (or unlearned) how to make myself sleep.

JeremiahJohnbalaya said...

Oh, forgot one other bizarre thing. Years ago, when I was convinced I had really bad apnea, my body was literally afraid to fall asleep because of the inevitable choking sensation. It was like there was a part of my subconscious whatching out for the very initial onset of sleep and immediately prodding me to wake up.

Repeated overnight sleep studies showed no sign of apnea.

JeremiahJohnbalaya said...

insomnia can be aggravated not only by laptops / tablets in bed, but by excessive computer use overall.

Or playing guitar, or reading serious math books, or watching tv.

I use a little app call f.lux to dim my computer monitor, which is NOT in my bedroom. I turn off the tv early, I do a little light reading in bed (w/ a 30 minute dimming feature on my reading lamp).

Again, it seems(***) so obvious in retrospect: All this sort of stimulation before bed is not going to help you sleep.

(*** of course not all people are the same)

candid_observer said...

I do wonder what the ideal amount of sleep really is.

While I seem to profit from more than 8 hours sleep, it seems that the lowest level of mortality is seen in those who get only 7 hours of sleep.

Now that may be because a typical engaged worker can only manage to get 7 hours of sleep on average, and those who get more are, perhaps, usually not fully employed or not fully engaged in other activities that make them feel useful.

But I'd like to know what the deal is with the statistics on the ideal amount of sleep.

Anonymous said...

http://www.dailymail.co.uk/tvshowbiz/article-2509628/Charlize-Therons-adorable-son-Jackson-sports-mountain-man-vest-shopping-trip-Paris.html

Chelsea Clinton has one too.

They are trying to 'hatch' their own Obama.

Btw, how come celebs don't adopt Palestinian kids? There must be plenty of orphans after the bombings.

Anonymous said...

"There are people who thrive, or who seem to thrive, on hardly any sleep. Hillary Clinton is one."

If her "accomplishments" are any indication, I'd suggest you re-think your contention. Perhaps her decision-making would be much improved with MORE sleep.

carol said...

Gee I'm glad they finally figured out that insomnia causes depression, and not the other way around. Of course, to the psycho-pharma crowd *everything* is caused by this mysterious thing called Depression, and uneeda med for it.

panjoomby said...

i do all the stupid tropes they say - "bed only for sleep or that other thing, same time every night, no caffeine after noon, don't exercise right before sleep, bla bla bla" - it all works like crap. MD's need to quit taking people's money just to tell them BS like above.

CanSpeccy said...

Try a dose of magnesium at bedtime: 150 mg of magnesium citrate should help. Magnesium turns down the amplification on central nervous system glutamate receptors, thus helping shut down a busy mind. Then, to get you going in the morning, you could try a spoonful of glutamate.

Bill said...

The new report, from a team at Ryerson University in Toronto, found that 87 percent of patients who resolved their insomnia in four biweekly talk therapy sessions also saw their depression symptoms dissolve after eight weeks of treatment, either with an antidepressant drug or a placebo pill — almost twice the rate of those who could not shake their insomnia.

That's a pretty ridiculous control group. The results say that depressives with refractory insomnia are more likely to be refractory depressives than are depressives with easily treatable insomnia.

Paul Mendez said...

Interestingly, sleep deprivation has also long been known to be an effective short-term treatment for severe depression. (Not less sleep, but no sleep at all for a night.) It is sometimes used to snap suicidal patients out of a serious depressive episode long enough for counseling and drugs to take hold.

In college, I had a girlfriend who liked to stay up all night just for the fun of it and would sometimes talk me into keeping her company. We'd talk and listen to music, prowl around campus, drive out to the all-night truck stop for greasy eggs, watch the sun rise, then go off to class. It was fun having the whole world to ourselves. Once I got my second wind about 2:00am, staying awake was easy. (The key was no drugs or alcohol.) I experienced a giddy, floating-on-air feeling the rest of the day and then the best sleep of my life the next night.

Personally, I have found that over-sleeping leads to lethargy and depression which leads to more over-sleeping and so on and so on. So, I try to err on the side of too little rather than too much sleep. My rule is to get out of bed as soon as I wake up, no matter what time that is. Going back to sleep means I'll wake up groggy and depressed, and probably have nothing but bad dreams while I'm at it.

There is historic evidence that before artificial light was common, most people experienced "segmented sleep." They'd go to sleep as soon as it got dark, sleep for 3 or 4 hours, wake up from this "first sleep" and do stuff (like have sex, pray or housework) for 2 or 3 hours, then go back to "second sleep" until morning light. I keep wanting to give this a try, but haven't had the willpower.

Paul Mendez said...

One other thing:

I've found that melatonin is very helpful when I need to go to bed extra early in order to wake up extra early. If I have to leave the house at 4:00am for a 6:00am flight, I can't just go to bed a few hours earlier -- I'd lay there wide awake and wind up getting even LESS sleep from worrying about how little sleep I'm getting. Taking 6mg's melatonin 45 minutes before I want to go to sleep seems to work, but it might just be the placebo effect.

Anonymous said...

Has Sailer won any plunge competitions in his sleep?

carol said...

sleep deprivation has also long been known to be an effective short-term treatment for severe depression.

I've stayed awake 24 hrs+ quite by accident and it does work wonders. Rather like severe jet lag, where you sleep so well every night for a week.

Anonymous said...

I think that insomnia related to depression or PTSD is adaptive. It gives one "quiet time" to think about solutions to the problem that caused the depression or PTSD. It becomes a problem when the insomniac's epiphany is that there is no solution.

John said...

In law school, I was always amazed that the top students, the real stars of the class, not only made the time to study, but also, to then go out to things in the evening, or to work at an internship or a job. I could simply not keep up. It's not like I'm stupid, but studying would tire me out, and the last thing I wanted to then do was to socialize. I don't know whether the ability to function so highly is a moral thing, depending upon one's habits and efforts. I think you're more or less just born that way.

canspeccy said...

Correction: that should be 150 mg of magnesium as magnesium citrate, i.e., about 1.5 grams of magnesium citrate.

And even if it doesn't make you sleep, it will correct a magnesium deficiency if you are one of the 30 or 40% of Americans thought to consume less than the average daily requirement of 400 mg of Mg. Makes one wonder, in fact, whether the epidemic of mental illness in America, with about half the population diagnosed at one time or another is not simply the result of a mineral deficiency.

Anonymous said...

http://www.dailymail.co.uk/tvshowbiz/article-2509628/Charlize-Therons-adorable-son-Jackson-sports-mountain-man-vest-shopping-trip-Paris.html

Good thing they tell you he's adorable in the headline. I suspect a child with some of the Charlize Theron DNA would be a lot more so.

Anonymous said...

Makes one wonder, in fact, whether the epidemic of mental illness in America, with about half the population diagnosed at one time or another is not simply the result of a mineral deficiency.

Maybe Americans just have Grain Brain. Nothing a bacon and eggs breakfast can't cure.

Pepe said...

I was a child stutterer.

As an adult, I've suffered from insomnia. But it's not so bad since I realized there's a relation between the two:

Thinking too much about something that should come natural.




Anonymous said...

Top students/athletes/politicians/etc use stimulants by the bucketload to mysteriously function on 3 hours a day of sleep. The haggardness is generally the drugz catching up.

Anonymous said...

To John at 2-55 - I went to a pretty good law school 15 years ago, for a second career, and I am convinced that there are no law school "stars". There are people who have been familiarized for a long time with the algorithm for making law professors happy that someone is interested in their hobby, and who can recite at test-time chapter and verse at the preferred pace regarding the ins and outs of the law professor's hobbyland arguments,but the myth of the genius lawyer is just that, anyone who is that good at law school at the age of 23 or so should, in a more ethical world, have been doing something better and challenging with their life. (My excuse was - second, not first, career, and I wanted to raise a family). Case in point - John Roberts, super successful LSAT taker, law student, and lawyer, was asked last year to write an important and difficult constitutional argument, but it was outside the parameters of his nerd-like hobby understandings, and he utterly failed. Also, Steve, if you think you need 8 and a half hours of sleep, you probably need nine with a twenty-five minute nap in the afternoon.

vetr said...

On the other hand, who is going to tell John Roberts that more sleep is not going to do it and that all his overimpressed teachers and supporters were wrong and that he is not up to the job and that he should retire next time there is a philosophically reasonable president?

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