Sleep disorders as core symptoms of depression

David Nutt, Sue Wilson, Louise Paterson, David Nutt, Sue Wilson, Louise Paterson

Abstract

Links between sleep and depression are strong. About three quarters of depressed patients have insomnia symptoms, and hypersomnia is present in about 40% of young depressed adults and 10% of older patients, with a preponderance in females. The symptoms cause huge distress, have a major impact on quality of life, and are a strong risk factor for suicide. As well as the subjective experience of sleep symptoms, there are well-documented changes in objective sleep architecture in depression. Mechanisms of sleep regulation and how they might be disturbed in depression are discussed. The sleep symptoms are often unresolved by treatment, and confer a greater risk of relapse and recurrence. Epidemiological studies have pointed out that insomnia in nondepressed subjects is a risk factor for later development of depression. There is therefore a need for more successful management of sleep disturbance in depression, in order to improve quality of life in these patients and reduce an important factor in depressive relapse and recurrence.

Figures

Figure 1.. Hypnograms from a normal subject…
Figure 1.. Hypnograms from a normal subject (upper) and a depressed patient (lower). The depressed patient has a shortened REM sleep latency, very little slow-wave (stages 3 and 4) sleep, particularly in the first sleep cycle, more awakening, and a long period of waking at about 0430.
Figure 2.. Evolution of slow-wave activity over…
Figure 2.. Evolution of slow-wave activity over the night in a normal subject (upper) and a depressed patient (lower). In the normal subject the amount of slow-wave activity is high in the first nonREM period, then diminishes over the night. In the depressed patient, the highest activity is in the second non-REM period.

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