The official code for psychiatric diagnosis indicates that insomnia is a symptom of depression. This implies that depression causes a disruption of the normal sleep process. However, sensitive clinicians have long noted that sleep changes often precede mood shifts, both toward depression, and, in the case of bipolar disorder, toward hypomania or mania. Surely we are looking here at a bidirectional process in which the two problems are linked, perhaps by way of an underlying cause.
Specifically, the therapy concentrates on encouraging patients to regularize wake-up times, resist daytime napping, and avoid nighttime TV/computer time.
The researchers had their depressed patients keep records of when they got in bed to try to sleep, when they actually fell asleep, how often they became alert in the middle of the night, and when they finally woke up.
But what is actually happening before patients start following the new rules, and what changes as a result?
INDIRECT VS. DIRECT THERAPY
The new research shows that you are less likely to lie in bed for hours wishing for sleep, and then suffer disturbed, unrefreshing sleep if you take these behavioral measures. They work by indirectly adjusting the brain’s circadian rhythm toward its normal state. However, taking direct measures to shift the inner clock into sync with optimum sleep time might considerably strengthen the therapeutic impact. We’re talking about light therapy (in the morning) and light reduction (in the evening). These are simple home treatments that can reduce reliance on both antidepressant meds and sleeping pills.
We are not disparaging the very hopeful news that the combination of antidepressant meds and talk therapy can speed relief from depression. However, we are suggesting that direct control of the inner clock accesses the underlying mechanism, is therapeutic in its own right, and can reduce reliance on drugs.
Michael and Ian are co-authors of the 2013 Penguin paperback, Reset Your Inner Clock. They invite you to follow them on Twitter for news updates, opinions, and challenging Q-and-A’s. If you want to stay on top of body-clock matters, light therapy, and more — and take advantage of confidential, online self-assessments of inner clock time, depression, and seasonality — you should become part of the nonprofit Center for Environmental Therapeutics community. Email PTuser@cet.org so we can stay in contact.