- Do depressed people need to sleep more?
That's what I'm gonna be talking about today.
I'm Dr. Tracey Marks, a psychiatrist, and this channel
is about mental health education and self improvement.
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Today's topic is based on a viewer question from Judith,
and she says, Hi Dr. Marks!
How much extra rest does someone with depression need
to get better compared to someone who's completely healthy?
Is any extra rest actually needed to get better?
If so, how do we know how much is too much and vice versa?
Thanks for your question Judith.
In actuality people who are depressed
do not need extra rest.
Depression can make you feel more tired and sleepy,
giving you the feeling that you need more sleep
because you're not well, but sleeping 10 hours or more
is considered hypersomnia or too much sleep.
And it doesn't help you get any better.
It's actually a symptom of your depression.
In fact, sleep deprivation is a treatment for depression,
and it's called wake therapy.
We've known for decades that if you keep a depressed person
awake for 24 hours, their symptoms resolve.
But the problem is, the improvement doesn't last very long.
It may last a day or two, or the symptoms
can return as soon as you get sleep.
So the next level of research
looked at how to get the improvement to last.
And here's what they came up with.
Researchers found that you can prolong the antidepressant
effect of sleep deprivation to last weeks or even months
by combining the staying awake part
with bright light therapy.
Why does this happen?
Your circadian rhythm is responsible
for controlling certain body processes
like your body temperature, your sleep wake cycle,
your hormone secretion, and even neurotransmitter secretion.
The neurotransmitter serotonin affects your emotional state.
The suprachiasmatic nucleus is what controls this rhythm,
and you can think of it as the pacemaker of your body clock.
This nucleus also has high concentrations
of serotonin and melatonin receptors.
So, when your rhythm is off,
not only does it affect your sleep,
but is also affects your body systems,
including your neurotransmitter secretion.
So wake therapy, which is a form of chronotherapy,
we call it, serves to reset your body clock,
similar to doing a hard reboot on your computer
when it starts acting up.
Here's how wake therapy works, and this is based on
a protocol used in a 2014 study by Benedetti and colleagues.
And I'll have a guide for you to download on how to do this.
Wake therapy is administered in one week blocks.
And you have alternating periods
of staying awake for 36 hours at a time.
So for example, let's say Monday is day one.
On Monday morning at 7:00am,
you use bright light therapy for thirty minutes.
Then you'll stay awake all day and all night.
On Tuesday you use bright light therapy
at 3:00am in the morning for another thirty minutes.
This will give you some energy
to stay awake for the rest of the day.
And then you'll remain awake all day Tuesday until 7:00pm.
You start preparing for bed around between 7:00 and 8:00pm.
Set your alarm so that you don't sleep
past 7:00am on Wednesday, and that's one complete cycle.
You'll complete this cycle two more times.
Then on the the seventh day,
you wake up at your desired time,
but it should be in the morning and not in the afternoon,
and you go to bed at your desired bedtime.
For the second week, you continue to use
the bright light therapy in the mornings
within 30 minutes of waking up.
Did you get all that?
No worries, see the link in the description
to download the guide on how to do this.
How can you stay up?
You start by doing things that keep you active,
like walking about, talking to people,
if you know people up this time of night,
or even cooking a meal.
You can take wake promoting agents,
like caffeine or Provigil, which requires a prescription.
If you're on antidepressant medication,
you would continue your medication.
If you start to drift or feel very draggy,
try splashing cold water on your face
and hands for a refresher.
The peak time for you to get sleepy
is between around 3:00 and 4:00am,
and that's why the protocol suggests
that you do the light therapy at this time.
But you can also plan to be actively engaged
at something between 3:00 and 4:00am.
That wouldn't be the time to plan
to watch a movie or read a book.
This therapy has been used for both
unipolar and bipolar depression.
Although with bipolar depression,
the studies used lithium therapy
along with the sleep deprivation and light therapy.
But if at anytime during the therapy
you start showing signs of mania,
like racing thoughts, impulsivity, or irritability,
you should stop the therapy and call your doctor.
The early manic symptoms may resolve
as soon as you stop doing the therapy,
or you may need to get an adjustment on your mood stabilizer
to get the mania to settle down.
Although there's been quite a bit of research
on chronotherapy and depression and bipolar disorder,
it's still not widely used.
As you can see, it takes a lot of effort and discipline,
and it probably works best for someone
with mild to moderate symptoms.
The person who's severely depressed
and barely able to get out of bed
may not be able to carry this out without a lot of help.
Also, sometimes when people get depressed,
and they sleep 10 to 12 hours a day,
and they feel extremely tired when they're awake,
and some people can even feel like their limbs are heavy.
If this is you, I would imagine this kind of therapy
would be a huge undertaking.
But it's still a good treatment,
but there are some practical barriers
that you have to get past to make this work.
Another obstacle is the need to allow for 30 minutes
in front of the light in the mornings.
That would be in that second week.
If you tend to get up just in enough time to get to work,
this will take some adjusting to factor in
an extra 30 minutes to sit idle in front of a light.
So that's wake therapy.
I have links to some light boxes in the description.
Share this video with someone who you think could benefit.
And leave me a comment too, I like hearing from you.
See you next time.
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♪ I am what I am today ♪
♪ 'Cause I did it my way ♪
♪ Nothin ya'll could say ♪
♪ In this life or the next one ♪