Sleep Disorders – Causes: Depression and other psychological triggers
Mental illnesses are almost always associated with sleep problems. In depression, they are particularly pronounced, quite typical is the early morning awakening
Neurotransmitters in the brain, such as serotonin and norepinephrine, which are among the regulators of waking and sleeping, among other things also control the state of mind, perception and thinking. Fluctuations and failures in the responsible nerve centers have a changing effect on the psyche. Likewise, external influences such as persistent negative stress, grief, unresolved traumatic experiences, unknown triggers or degenerative processes provoke disturbances in the nervous functions.
This in turn can lead to mental or psychiatric illnesses. How close the connection between sleep and psyche is, clearly shows the possible consequences of a lack of sleep. For example, a lack of sleep caused by sleep apnea can lead to depressive moods, thought disorders, and even hallucinations.
Depression is most commonly associated with sleep disorders. Other important illnesses here are anxiety disorders, addictions such as alcoholism, eating disorders, personality disorders such as borderline syndrome, schizophrenia and dementia.
For so-called primary or chronic insomnia , initially no clear causes can be found. However, they are often based on increased mental tension and anxiety related to one’s own sleep. Affected individuals closely monitor the amount and quality of their sleep and overstate possible fluctuations. This leads to fears and worries that actually lead to sleep problems. During the day irritable mood and tiredness predominate, often combined with inner restlessness. Here behavioral measures are usually very effective.
Depression: restless nights, early awakening
While depressive moodiness passes, depression sets like a shadow over the entire life of those affected. It is often not possible to find specific causes for mental illness. Stressful life events, familial predisposition, physical illnesses as well as apparently chronic sleep problems can promote the onset of depression. In some depressive sufferers, however, there are no indications of possible triggers. Usually, several factors play together.
Physicians divide depression into different forms and degrees of severity. Depression can be phased or persistent. Bipolar depression is characterized by the change from manic and depressive phases. Investigations in the sleep laboratory showed that the entire course of sleep can be disturbed in depressive illnesses. In addition, sometimes the deep sleep phases are reduced, and the REM sleep is violent and uncontrolled (see chapter “Why sleep is so important” ). People with severe depression are particularly at risk of committing suicide.
Symptoms : Striking is the combination of lack of drive, tiredness during the day and nocturnal restlessness. Depressed people often wake up very early in the morning and can not fall asleep anymore, often burdened with brooding, worry and guilt. Some sleep too much during the day. Significant symptoms such as deep depression, lack of feeling, impaired concentration and performance, social withdrawal occur.
Likewise, many physical complaints, such as headache , dizziness, gastrointestinal problems, respiratory problems , heart attack or arrhythmia, sweating. In certain forms of depression, inner restlessness and dryness or restless activity are expressions of mental disorder.
In bipolar depression, despondency and mental-spiritual rigidity are followed by periods of exaggerated elation and performance. In this manic phase, those affected sometimes only have an extremely low need for sleep.
So-called seasonal depressions, such as winter depression, are typically associated with extended night sleep times, sometimes well over 12 hours, and an increased need for sleep also during the day (hypersomnia). Cravings and listlessness are other complaints.
Diagnosis : An essential first step is that the affected persons themselves acknowledge their emotional problems and then describe them to their doctor. Often the symptoms give the family doctor the necessary information. He will clarify through physical examinations whether there is no disease that could be responsible for the sleep disorder and the depressive symptoms. A sleep disorder such as sleep apnea (see chapter “Snoring, sleep apnea” ) or a nocturnal movement disorder (see chapter “Restless Legs” ) can also trigger depression.
If depression is suspected, the family doctor will refer his patient to a psychotherapist or psychiatrist for further diagnosis. To determine whether there is sleep apnea or sleep-related movement disorders, the examination by a sleep specialist may sometimes be indicated.
Therapy : The treatment depends on the form and severity of the depression. With a personalized combination of psychotherapy and possibly medication, mostly antidepressants, depression can usually be treated very well. Sometimes a stay in a psychosomatic clinic helps the patient to find and continue the appropriate therapy pathway.
Since some (sedative, sedative) antidepressants are also used successfully as sleep aids anyway, the sleep problems usually improve with the treatment. However, drive-enhancing antidepressants can in turn lead to nocturnal restlessness. This will be considered by the doctor when choosing and using the drug.
For persistent illnesses additionally controlled sleep deprivation treatments were successful. For mild, seasonal depression, light therapy may also be effective (see chapter “Life situation, shift work” ). The counselor “Depression” informs you in detail about forms of depression, causes, symptoms, diagnosis and therapies.
Anxiety disorders: Tense even in sleep
Fears often occur together with depression and disturb the night sleep sometimes considerably. The anxious tension, in which the affected persons are permanently or in phases, continues to be effective during sleep. Common anxiety disorders are panic disorders and phobias, with phobias (the fear of something, a situation, an animal and the like) often associated with panic attacks. The attacks involve a number of physical symptoms. Another form is persistent chronic anxiety. A particular problem is that those affected try to reduce their fears by resorting to alcohol and sedatives. This creates an addiction that only adds to sleep problems and fears.
Symptoms : In chronic anxiety disorders, there is an ongoing inner restlessness that sometimes leads to over-excitement and leads to falling asleep and staying asleep. At night, movement disorders in the legs, such as Restless Legs Syndrome , may also occur. Phobias cause panic anxiety in certain situations. The physical signs of panic attacks include tremors, feelings of insecurity such as “weak knees”, dizziness , difficulty breathing, chest tightness, palpitations, sweats , headaches.
Diagnosis and therapy : The first contact person is the family doctor. The exact diagnosis and therapy is then carried out by a psychotherapist or psychiatrist. Behavioral therapies have proven to be very successful. In part, the specialists also use drugs such as low-dose neuroleptics and certain antidepressants. If the sufferer suffers from pronounced sleep problems, the doctor will take this into account when choosing medicines. More information about various anxiety and anxiety disorders can be found in the guide “Angst”.
Other triggers for sleep disorders: addictions, psychosis
Addictive diseases have a strong influence on the entire sleep process. In psychoses such as schizophrenia, the sleep phases are often noticeably changed.
– alcohol addiction
After drinking alcohol, the night’s sleep is generally interrupted, especially towards tomorrow, when the alcohol is broken down and withdrawal symptoms appear. On the other hand, the nerve damaging effect of alcohol also shortens the deep sleep. The REM sleep is often particularly restless and associated with nightmares. The consequences are particularly pronounced when someone is alcohol addicted.
For a successful exit from the addiction, the insight of the person affected is fundamental. With withdrawal therapy in an addiction clinic and the participation in self-help groups, it can succeed to permanently overcome the addiction.
Read more about alcohol addiction, its consequences and possible therapies in the guidebook “Alcohol dependence”.
– schizophreniaIn-depth information about the condition, causes, symptoms, diagnosis and therapy is provided by the guidebook “schizophrenia”.This psychosis-related disease is usually associated with insomnia. Deep sleep is reduced, REM sleep changes. In addition, there is often an excessive need for sleep during the day. The treatment options for this severe psychiatric illness have improved significantly in recent years.
Chronic ear noises: continuous sounds that keep you awake
Psychosomatic illnesses such as tinnitus, which are based on misdirected nerve signals, often leave the affected person unable to rest at night. The constant sounds or noises in the ear and head are especially disturbing at night.
Other possible complaints are hypersensitivity, hearing loss , concentration problems . In a chronically complex tinnitus sufferers increasingly suffer from pain, tension, insomnia and often also anxiety and depression .
Find out more about the forms, causes, consequences and therapies of ear noises in the guide “Tinnitus”.