Volume 6, Issue 2

  • Depression and sleep

You feel like there’s no reason to get out of bed anymore. What’s the point of all this? You can’t get out of this dark cloud. Why is this happening? Will it ever end?

Everyone has felt sad or unmotivated at times in their lives. But while feeling down occasionally is normal, long term depression is not. In the past few decades, depression has become one of the most commonly diagnosed conditions in the world. Approximately 16% of Americans will suffer from depression in their lifetimes. Its symptoms can vary from feeling sad and unmotivated to irritability, anxiety, and insomnia. It is not something people can simply “snap out of” or will away on their own.

There can be many causes for depression including chemical imbalances in the brain, traumatic experiences, or physical and psychological diseases. Treatments exist for all these conditions, but there is one area that of health that is often overlooked when addressing the root causes of depression: Sleep Disorders.

There are several sleep disorders which may cause depression-like symptoms. Trouble falling or staying asleep, called insomnia, is very common for people suffering from clinical depression. In fact, a study conducted in 2005 by the University of North Texas found that people who suffer from insomnia have a ten-fold risk of developing depression compared to those who sleep well. (SLEEP, Nov 2005) Like the proverbial chicken and the egg, it’s hard to pin down which came first. Does the insomnia result from the depression, or is the depression coming from the lack of sleep? When people are deprived of sleep they often exhibit symptoms such as irritability, hopelessness and sadness, confusion, and loss of libido and energy. These symptoms are also classically associated with depression. So if you are experiencing chronic insomnia, know that you are at high risk for developing depression as well. Moreover, if you are being treated for depression, talk to a sleep specialist about getting screened for a sleep disorder.

Another common sleep disorder which may lead to depression is Obstructive Sleep Apnea. Sleep apnea is a condition that occurs when the muscles and tissue in a person’s airway collapse during sleep, causing sleep disruptions. These sleep disruptions may occur hundreds of times per night and result in similar symptoms as depression. Stanford University researchers found that people who suffer from depression are five times more likely to have Sleep Apnea than those without. A large scale study conducted by the Centers for Disease Control also recently found that “frequent snorting or stopping breathing was associated with probable major depression”. (SLEEP, April 2012) 

Fortunately, there is relief from depressive symptoms that doesn’t involve medications. The most effective treatment option for sleep apnea, Continuous Positive Airway Pressure (CPAP), was found to decrease depression symptoms by 94% after only 1 year of use. (AASM)

If you are feeling any of the symptoms of depression previously mentioned, tell your doctor. Make sure to bring up any sleep issues you may have and request a referral to a Sleep Specialist such as those at Oregon Sleep Associates. They can conduct simple tests to determine if your symptoms are indicative of a sleep disorder. Treatment of these disorders may actually help solve your depressive feelings and break out of the darkness.

Are Sleeping pills deadly?

Hypnotics such as Ambien, Sonata, and Lunesta are among the most prescribed medications in the country. It was estimated that in 2010 alone, prescription drug companies made $5 billion selling these types of medications. Hypnotics are widely used to treat insomnia but a new study calls attention to the possible detrimental effects of these medications.

The study was carried out by researchers from the Scripps Clinic Viterbi Family Sleep Center and the Jackson Hole Center for Preventive Medicine and published in the peer-reviewed medical journal BMJ Open. The research consisted of a large cohort study comparing death and cancer rates between two groups of patients: hypnotics users and people who had never taken the medications.

Despite how it was commonly reported by mainstream media outlets, the results do imply that sleeping pills directly cause death or cancer. Rather they suggest there could be a correlation between the medication and increased risks. The basic results of the study suggest that patients prescribed any hypnotic had increased risk of dying compared with patients who had never been prescribed hypnotics. The risk of dying increased in line with the amount of hypnotics they were prescribed:

  • Patients who were prescribed 1-18 pills of any hypnotic per year were 3.6 times more likely to die than matched patients not using the drugs.
  • Patients who were prescribed 18-132 pills a year were almost 4.5 times more likely to die.
  • Patients who were prescribed more than 132 pills a year were 5.3 times more likely to die.

It is important to stress this is only one study and is not indicative of a causal relationship between hypnotics and mortality. The results do support the idea that sleeping pills should be used only as temporary measure to address symptoms of insomnia, not as a long-term treatment. The medications are still a viable option when prescribed properly and used in conjunction with a comprehensive approach to treating sleep concerns. The sleep specialists at Oregon Sleep Associates use this approach to addressing your sleep issues. If you are having trouble sleeping, contact them today at 503-288-5201.

Rem behavior disorder diagnoses delayed

Screaming, running, fighting, kicking, dancing and driving. These are things we normally wouldn’t associate with sleep. But for some members of the population, activities such as these take place every night, all while asleep. They suffer from REM Behavior Disorder, a mysterious affliction that despite dramatic symptoms, tends to be under-diagnosed.

REM Behavioral Disorder, or RBD, is a sleep disorder in which a person physically acts out their dreams while in REM sleep. REM is Rapid Eye Movement sleep, the stage in which the skeletal muscles of the body essentially shut down and the brain becomes very active. It is thought that most dreaming occurs during REM sleep and muscles may be deactivated to prevent these dreams from being acted out. But in some people, the system that “paralyzes” these muscles doesn’t always function correctly. In these cases, bizarre and sometimes dangerous behavior may occur. Some patients simply wander around completing tasks they would normally do while awake. Others however may experience more intense dreams and can be seen violently fighting off invisible foes, shouting, and even jumping out windows.

There are effective methods of treating RBD, but according to a recent study reported in the Journal of Clinical Sleep Medicine, many people do not seek treatment for the condition. In fact, patients wait on average nine years before seeking treatment. Reasons vary for the delay, with most people (59%) not thinking the symptoms were serious enough, some (56%) citing the behavior as infrequent, and others (47%) hoped the symptoms would go away or were not aware of the disease. Concerned or fed up bed partners were often responsible for spurring the decision to seek treatment.

Some may question why RBD patients should seek treatment if the behavior is infrequent or not of concern to the patient. However, RBD can become quite serious when the actions take on dangerous or violent aspects. Driving while sleeping can put many people’s lives at risk and patients have been known to be seriously injured or killed by acting out dreams. Early identification of the condition is also important because studies have shown that RBD may be a precursor to Parkinson’s Disease. A research project conducted through the University of Minnesota found that 38% of patients diagnosed as having RBD developed Parkinson’s or similar neurological disorders within 5 years of the study. Seven years later, the researchers looked at the same group and found that 65% had developed Parkinson’s Disease. (SLEEP 25,8)

Having RBD does not necessarily mean you will develop Parkinson’s. It is also important to note that sleepwalking and sleeptalking are not considered related to RBD. These instances are more common in the general population and usually occur during deep sleep stages, not REM. However, if you or anyone you know show symptoms of RBD such as acting out dreams on a regular basis, contact your doctor.

Dangers on the road for tired truck drivers

The backbone of our economic infrastructure is based on open access to readily available goods. To keep this system working properly, we rely upon an extensive network of freight transportation, including the trucking industry. In fact, trucking accounts for70 percent of all freight transported annually in the U.S.,  $671 billion worth of manufactured and retail goods. Truckers work hard to stay on schedule, sometimes to the detriment of their health.

Drowsy driving is a constant danger for truck drivers. The long hours and monotonous routes lend themselves to fatigue. Coupled with a lack of exercise and unhealthy truck stop dining, the risk for both obesity and sleep related health risks is high. 

Truck drivers are not the best judges at diagnosing their own sleep apnea, a new study reports. Research showed that self-diagnosis and symptom reports fell far short of determining sleep apnea when compared to home testing. Only 4 percent of 517 commercial vehicle drivers in Australia reported an earlier diagnosis of sleep apnea. The study found another 41 percent when drivers were tested with home monitors.

Obstructive sleep apnea (OSA) has been associated with a higher risk of motor vehicle crashes. In December, the Federal Motor Carrier Safety Administration (FMCSA) announced new rules for the maximum hours of work per shift and mandatory rest periods for truck drivers. The FMCSA reduced by 12 hours the maximum number of hours a truck driver. Truck drivers also were mandated a break of at least 30 minutes after every eight hours worked.


The truckers in the Australian study worked an average of 65 hours a week. When surveyed, 40 percent of the drivers said they had trouble staying awake while driving in the last month. Of the commercial operators diagnosed with sleep apnea, less than half used continuous positive airway pressure (CPAP) therapy. CPAP is the first-line treatment for sleep apnea.
The study appears in the April edition of the journal SLEEP.