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Matthew J. Edlund M.D.
Matthew J. Edlund M.D.

Want to Treat Depression? Get People to Sleep

Fix insomnia and better things happen.

Treatment of Depression Is Often Ineffective

The key to successful treatment of depression may be treating the insomnia that accompanies it.

What New Research is Changing Attitudes?

Rachel Manber at Stanford studied cognitive behavioral treatments for insomniac, depressed people. When their insomnia was fixed following CBT, depression treatment success doubled. Get them to sleep and they stopped being depressed. Other trials, including a recent one run by Colleen Carney are ongoing, and have reported the same results.

Why Is This News?

Depression afflicts 30% of Americans. Worldwide, it is second to heart disease in economic cost. The psychological costs are severe—to individuals, families, and countries.

Moreover, the types of treatment used in these studies are cheap, quickly effective, and can be used to improve far more symptoms than sleep. Better, people can do part of the work themselves—which improves outcomes and self-regard.

What Was the Treatment?

Biweekly CBT for insomnia over a month. Much of what was taught is really basic human biology. You get people to go to sleep at the same time each night and get up at the same time each day; move from the bed when not sleeping; calm down and rest in the period before sleep. When people did these few active steps they felt much better. Part of the CBT, honed over several decades of treating insomnia, was a simple principle—don’t turn sleep into a job. When you make sleeping into a form of work, sleep does not work.

Why Would Sleep Therapies Be More Effective Than Other Depressive Treatments?

They tap into what happens with depression—a near total lack of adaptability and resilience. The body looks and acts like it is shutting down. Immunity does not respond well to new bacterial and viral threats. Appetite derails—going up or down, sideways, becoming erratic. Fatigue begins and deepens. Eventually cognition—the ability to think, reason, solve problems—declines or plain disappears. Then people experience the misery of despair which cannot see its own end. They feel that they will never get better, and there is nothing that will make them better.

In effect depression means normal physiological regeneration slowly shuts down.

Sleep is required for many, many regenerative functions. Shut sleep down and the organism does not function well—or eventually function at all. Deprive animals of sleep for long enough and they die. However, get sleep up and running again and regeneration renews.

So How Is Sleep Related to Depression?

Yin and yang. Poor sleep eventually results in depression. Professor Angst of the University of Zurich showed through decades of studies that the longer the insomnia, the more certain the appearance of depression.

Similarly, if people are becoming depressed—say as a result of hypothyroidism or a severe personal loss—their sleep declines in effectiveness and consistency. Make depression worse and sleep worsens. Make sleep difficult or inconsistent and depressive symptoms appear and increase.

What Does This Say About Prevention of Mood Disorders?

Why have American rates of depression doubled and tripled in the last half century? Hypotheses number in the dozens. But this kind of study helps argue that sleep loss—the 90 minutes we’ve cut off each night during the last forty years of American life—may have a basic role to play in making the population more stressed—and ultimately more depressed.

And the same cognitive behavioral principles of timing of sleep, timing of light, calm and rest before sleep, can be applied across the nation—to pretty much anyone who is not physically ill.

The answer to health is proper regeneration. That also means recognizing the body as an ever learning, adapting, renewing system of information. Without proper sleep and regeneration, the system will break down—and depressive symptoms appear.

And now we know about that converse—that even nasty depressive episodes are treated more effectively if people are taught and trained to effectively sleep—again.

About the Author
Matthew J. Edlund M.D.

Matthew Edlund, M.D., researches rest, sleep, performance, and public health. He is the author of Healthy Without Health Insurance and The Power of Rest.

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