Sleep Care

Depression and Sleep

Depression is a condition that affects the lives of roughly 20 million Americans. About 18% of people between the ages of 18 to 64 have been diagnosed with depression. It is usually more prevalent in women and older adults, and can affect a person regardless of their social standing or culture—a 2008 study of indigenous North American Indians found depression and sleep problems to be common among four hundred and thirty participants! Some symptoms of depression are ones that many individuals have briefly gone through at one time or another: sadness, forgetfulness, concentration problems, changes in weight or appetite, and low self-esteem. When these symptoms last for a prolonged period, however, depression may be considered as an underlying cause. Depression and Sleep Problems The relationship between depression and sleep problems is considered complex because the two share many similar symptoms, and it is often hard to identify which one may cause the other in an individual. Because of this, recording emotions in journals and keeping a sleep log can be very beneficial to a medical professional when developing an effective treatment plan. Insomnia is perhaps the most frequent occurring sleep problem associated with depression. Studies have found that insomniacs are ten times more likely to develop depression compared to those able to get a good night’s rest. Individuals with insomnia related to depression can experience insomnia in a variety of ways, such as not being able to get to sleep (called sleep onset insomnia) or having trouble staying asleep (called sleep maintenance insomnia). Fortunately, according to a 2010 study examining depression in insomniacs, treating depression-related insomnia results in not only significant improvement in sleep and overall quality of life, but improvement in the severity of their depression symptoms as well. Here are some theories explaining the link between insomnia and depression: Sleep loss/increased wakefulness could alter neurobehavioral functions, Insomnia derails normal circadian rhythm, leading to decreased mood and performance during the day, Decreased quality of life, and decreased social and workplace performance can lead to feelings of inadequacy, Lying awake in the dark may lead to depressive thoughts, Inability to sleep can trigger thoughts of helplessness and hopelessness. Sleep-disordered breathing, such as obstructive sleep apnea, is can also be significantly related to depression. A study of nearly 20,000 people in Europe found that individuals with depression were five times more likely to have sleep disordered breathing than those without. Fortunately, treating sleep apnea also can result in an improvement of depression—for example, a 2007 study examining patients with sleep apnea who used

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CPAP (Continuous Positive Airway Pressure—a common treatment for sleep apnea) for one year found consistent and stable improvement of depressive symptoms. Treating Depression and Improving Sleep Most treatment plans for depression involve a mix of medication and therapy. Some medications are effective in improving the emotional aspects of depression or balancing chemicals in the brain that affect a person’s mood. These tend to come from two classes of drugs: SSRI’s, such as Paxil, Zoloft, Celexa, or Prozac; and tricyclic antidepressants, such as

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Elavil. Other medications are used to address sleeping problems, such as insomnia, that are common to depression—particularly Trazodone, or sleeping aids such as Ambien, Sonata, Lunesta, Rozeram, or Restoril. The goal of therapy for depression is typically to improve a person’s life and coping skills to ward off future periods of depression. One therapy growing in popularity is Cognitive Behavior Therapy (CBT), which generally seeks to identify negative thoughts or behaviors that may start or continue depression and replace them with positive and healthy ones. Some research has found CBT to be as effective medications for treating depression, with the added benefit of no side effects. Other lifestyle adjustments can be beneficial when dealing with depression and sleep problems. Having a good support network to share negative feelings and stress, or even simply journaling, can help prevent the temporary negative feelings from becoming more permanent. Exposure to sunlight and regular exercise helps the body stay in a natural sleep/wake rhythm and produces endorphins, chemicals which are beneficial to a person’s mood. Developing and maintaining good sleep hygiene habits also goes a long way to warding off depression and helping an individual get restful sleep each night.

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