Updated: Oct 25, 2019
You likely already know that the average North American is significantly underslept. Physicians and other health care practitioners may be particularly at risk for inadequate sleep due to on-call and shift work, or family caregiving activities. Chronic sleep deprivation has been shown to create an enhanced risk of depression, as well as the potential for worsening depression and increasing relapse rates (1), (2). There are also known links between hypersomnia and depression, especially in the setting of sleep apnea (3). How might inadequate sleep create these effects? There is animal evidence that sleep deprivation causes desensitization of serotonergic receptors, which take time to recover even with unlimited recovery sleep (4).
How can you improve your sleep?
First, by attending to circadian rhythms and optimizing that sometimes tantalizingly elusive dance of hormones.
aim for 7-9 hrs of sleep each night (the second week of a 2 week vacation with unlimited sleep may tell you how much sleep you normally need)
have a set wake and bedtime all days of the week (no sleeping in and staying up late on weekends!)
limit screen time and exposure to artificial light for at least 2 hrs before bed, including the possible use of blue-light filters on screens and/or blue-light reduction glasses
have a meal with balanced carbohydrate, protein and fat at supper so that your blood sugar doesn’t dip through the night
sleep in a cool room (around 16-20C is helpful)
block all light sources from the bedroom, including alarm clocks and phones, using blackout shades if necessary
avoid alcohol and recreational drugs before bed- it disrupts sleep patterns and depth
There are many other factors in a decent night’s sleep. In depression, early morning waking is common and oh so frustrating. Keep the bedroom a space for sleep and intimacy only- if you’re not asleep, get up and hang out in a quiet dim room, reading (not on a device!), listening to relaxing music, or perhaps using mindfulness to observe your internal chatter. Try writing down your repetitive thoughts or worries so they’re ‘out of your head’. When you feel sleepy, return to bed and repeat as needed. Try not to nap for more than 30 minutes in a day if you are not sleeping well at night. If restful sleep continues to elude you, other potential strategies include a mid-night snack and avoiding evening exercise (other than a post-dinner walk), and evaluation for sleep apnea.
What strategies might work for you?