For this reason, coming up with effective therapies is paramount.
New research points to obstructive sleep apnea (OSA) as a potential culprit for treatment resistant depression and suggests that screening for and treating the sleep condition may alleviate symptoms of depression.
Dr. William V. McCall — chair of the Department of Psychiatry and Health Behavior at the Medical College of Georgia at Augusta University — is the first and corresponding author of the study.
He says, “No one is talking about evaluating for [OSA] as a potential cause of treatment resistant depression, which occurs in about 50% of [people] with major depressive disorder.”
Dr. McCall and team examined the rate of undiagnosed OSA in a randomized clinical trial of people with major depressive disorder and suicidal tendencies.
They recruited 125 people with depression, originally for the purpose of determining if treating their insomnia would improve their depression symptoms.
The original trial excluded people at risk of OSA, such as those taking sleeping pills, or people with obesity or restless legs syndrome.
The scientists tested the participants with a sleep study and found that 17 out of the 125 (nearly 14%) had OSA.
Dr. McCall and colleagues note that people who had OSA did not present with the usual indicators of OSA severity, such as daytime sleepiness. Also, 6 of the 17 people were non-obese women.
This is contrast with the demographic group usually at risk of OSA: overweight men.
“We were completely caught by surprise,” says Dr. McCall, “that people did not fit the picture of what [OSA] is supposed to look like.”
Also, 52 of the 125 participants had treatment resistant depression; 8 of those with treatment resistant depression also had OSA.
The researchers point out that underlying conditions — such as hypothyroidism, cancer, and carotid artery disease — may often be the cause of treatment resistant depression.
Therefore, many people with depression undergo a series of invasive and costly tests in an attempt to figure out the cause of depression treatment failure.
Such tests may include an MRI scan or even a spinal tap — but Dr. McCall and team urge for sleep tests first. “I am thinking before we do a spinal tap for treatment resistant depression, we might need to do a sleep test first,” he says.
“We know that [people] with sleep apnea talk about depression symptoms,” he goes on. “We know that if you have [OSA], you are not going to respond well to an antidepressant.”
“We know that if you have sleep apnea and get [a CPAP machine], it gets better and now we know that there are hidden cases of sleep apnea in people who are depressed and [have] suicidal [tendencies].”
Dr. William V. McCall
However, the study authors also acknowledge that other factors — such as the side effects of other medications, including beta-blockers and corticosteroids — may cause treatment resistant depression.
They also point out that suicidal tendencies are also a key factor, and the researchers suggest that a further area of investigation should be the question of whether or not treating sleep apnea will also reduce suicide ideation.
Comments Off on Sleep-disordered breathing tied to greater preeclampsia risk
by Vicki Cohn
Women with high-risk pregnancies who experience sleep-disordered breathing have an increased risk for preeclampsia, according to a study published in the American Journal of Obstetrics & Gynecology.
The prospective observational cohort study involved women with high-risk singleton pregnancies, author Stella S. Daskalopoulou, MD, MSc, PhD, of the department of medicine’s division of internal medicine at McGill University Health Centre in Montreal, and colleagues reported in the study.
High-risk factors included age of at least 35 years, BMI of at least 25 kg/m2, chronic hypertension, pre-existing diabetes or renal disease, conception via in vitro fertilization and personal or first-degree relative family history of preeclampsia.
Of the 235 women recruited between 10 and 13 weeks of gestation at two tertiary obstetric clinics in Montreal, 181 women completed questionnaires about their sleep based on the Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index and restless legs syndrome during each trimester.
Women identified with sleep disordered breathing (SDB), defined as three or more incidences of loud snoring or witnessed apneas each week, in the first or second trimester were diagnosed with mid-gestation SDB. Women identified with SDB in the third trimester were diagnosed with late-gestation SDB.
The researchers also conducted arterial stiffness, wave reflection and hemodynamic assessments between 10 and 13 weeks and again six more times at approximately 4-week intervals through the rest of the pregnancy.
Carotid-femoral pulse wave velocity (cfPWV), which is considered the gold standard for predicting arterial stiffness and is predictive of preeclampsia, and carotid-radial PWV were calculated to determine aortic and peripheral arterial stiffness, respectively.
According to the study, the 41 women (23%) who had SDB also had increased cfPWV across gestation independent of blood pressure and BMI (P = .042). Also, only women with SDB saw an association between excessive daytime sleepiness and increased cfPWV.
After 20 weeks’ gestation, women who had BP of at least 140 mm Hg/90 mm Hg were diagnosed with preeclampsia.
Women with mid-gestation SDB had an OR of 3.4 (95% CI, 0.9-12.9; P = .063) for preeclampsia, which increased to an OR of 5.7 (95% CI, 1.1-26; P = .028) for women who also experienced hypersomnolence. Women with late-gestation SDB had an OR of 8.2 (95% CI, 1.5-39.5; P = .009) for preeclampsia.
Additionally, the researchers reported a positive association between excessive daytime sleepiness and central arterial stiffness in women with SDB but not in women who did not have SDB. Women who reported SDB and excessive daytime sleepiness appeared to have a greater risk for preeclampsia than women with SDB alone as well.
However, women who had positive restless legs syndrome scores did not see increased odds for developing preeclampsia either in mid-gestation (OR = 1.23; 95% CI, 0.25-4.68) or late gestation (OR = 1.01; 95% CI, 0.21-3.75). The same held true for women who had positive Pittsburgh Sleep Quality Index scores in mid-gestation (OR = 2.11; 95% CI, 0.58-8.66) or late gestation (OR = 2.83; 95% CI, 0.65-19.81).
Overall, the researchers said, there was an association between SDB in the first or second trimester and greater central arterial stiffness starting at 10 to 13 weeks’ gestation for women with high-risk pregnancies.
Further, the researchers said, their results provide supporting evidence for arterial stiffness as an important mediator and promising surrogate endpoint for vascular dysfunction in preeclampsia, as well as for the need to screen for SDB throughout pregnancy.
After menopause, a person’s ovaries produce much lower amounts of certain hormones, including estrogen and progesterone. For some, this transition comes with sleep disturbances.
Insomnia refers to the difficulty falling or staying asleep. It is a commonTrusted Source experience in menopause and may occur as a result of hormonal changes.
It may also be a secondary result of the other symptoms of menopause, such as hot flashes.
Read on for more information on menopause and insomnia, including why it happens, how long it may last, and what medical treatments and complementary therapies are available.
Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.
Yes – insomnia is a frequent occurrence during perimenopause and menopause. Some people only experience mild or occasional sleep disturbances, but for others, the insomnia can be severe.
According to a 2018 article, 26%Trusted Source of people going through perimenopause and menopause experience insomnia that affects their daily activities.
Research on the exact cause of insomnia during menopause does not point to one clear cause. Several things may contribute to it, including:
Hormonal changes
Some evidence suggests that low hormone levels can increase the likelihood of insomnia during menopause.
According to the SWANTrusted Source, previous longitudinal studies have found a correlation between lower levels of estradiol and poorer sleep. This is especially true if the decline in hormones happens quickly, as it does after a person undergoes surgery to remove the ovaries.
Hot flashes
Sometimes, insomnia happens during menopause because of hot flashes or night sweats. These symptoms can disrupt sleep, causing frequent waking.
Hot flashes, which are one of the so-called vasomotor symptoms, are common in menopause, affecting 75–85%Trusted Source of people going through menopause.
Hot flashes cause a sudden sense of heat around the face and neck and often occur with sweating and a fast heartbeat.
Reduction in melatonin
Melatonin is a hormone that plays a key role in the sleep-wake cycle, helping keep people asleep. It is especially important at the start of sleep.
However, melatonin levels appear to decrease with age, which may cause sleep disturbances.
It is not clear whether there is a link between menopause and a decline in melatonin. Some evidenceTrusted Source suggests that there is and that individuals during postmenopause have less melatonin than those during premenopause.
Mental health
For many people, menopause signals a major change. It is also a sign that a person is getting older. This, along with the symptoms of menopause, can have an impact on an individual’s mental health.
How long insomnia lasts during and after menopause depends on many factors. Every person who goes through menopause has a different experience. Some will find that the symptoms last longer than they do for others.
A person’s hormone levels can start to change 7–10 yearsTrusted Source before a person’s last period. After this point, people can continue to have symptoms such as hot flashes for several years.
Estradiol levels continue to decline for the first 1–6 years in early postmenopause, which may result in continued symptoms.
It is of note, however, that there are treatments and therapies available that can reduce sleep difficulties. It is also important to address any other factors that may be contributing to poor sleep quality.powered by Rubicon Project
The main treatment for menopause-related insomnia is hormone therapy. This works by replacing the lost hormones, which can improve many menopause symptoms. People may find that they sleep better and experience fewer hot flashes while using this treatment.
Hormone therapy is available in topical gels, creams, and patches. People can also take it internally via tablets or an implant.
Doctors typically prescribe SSRIs for mental health conditions, but these medications can also reduce the frequency of hot flashes, which may help with sleep. However, it is of note that insomnia can also occur as a side effect of SSRIs.
For those who are experiencing mood changes, anxiety, or depression, talk therapy may help them understand and cope with these feelings. Lessening the impact of mental health conditions may also benefit sleep.
Doctors rarely prescribe sleeping pills to treat insomnia, as these can have serious side effects. Many are also addictive and are not suitable for managing a long-term sleep problem.
According to a 2019 review, no study has found that herbal or dietary supplements consistently help with menopause symptoms. However, there are many other ways people can try to make sleep easier during menopause.
Below are some evidence-based approaches:
Avoiding caffeine, nicotine, and alcohol
Smoking, consuming caffeine, and drinking alcohol can all make it more difficult to sleep. While it may seem that alcohol makes people drowsy, even a small amount reduces overall sleep quality.
A person can try to reduce or avoid any of these, especially in the afternoon and evening.
Aromatherapy
Aromatherapy may be helpful in inducing relaxation and reducing hot flashes.
In a clinical trial involving 100 women, researchers found that after 12 weeks of lavender essential oil inhalation, the participants had 50% fewer hot flashes.
Other studies have also found that aromatherapy together with massage was more effective than massage or aromatherapy by themselves.
Hypnosis
A 2019 review notes that there is evidence that hypnosis may reduce the frequency and severity of hot flashes by up to 50%.
Moreover, for people whose insomnia results from hot flashes, hypnosis may be a helpful complementary treatment.
Yoga
Some studies have found that yoga has a beneficial impact on the psychological symptoms of menopause. If a person is having difficulty sleeping due to stress or anxiety, yoga practice may help reduce these symptoms.
However, the results of other studies on yoga have been mixed. This is partly because there are many styles of yoga and numerous ways of practicing, which may lead to inconsistent results.
The following is a fantastic article describing the effects of sleep deprivation on your body, broken down by system. Medically reviewed by Stacy Sampson, D.O., Family Medicine — Written by Stephanie Watson and Kristeen Cherney on May 15, 2020
If you’ve ever spent a night tossing and turning, you already know how you’ll feel the next day — tired, cranky, and out of sorts. But missing out on the recommended 7 to 9 hours of shut-eye nightly does more than make you feel groggy and grumpy.
The long-term effects of sleep deprivation are real.
It drains your mental abilities and puts your physical health at real risk. Science has linked poor slumber with a number of health problems, from weight gain to a weakened immune system.
Read on to learn the causes of sleep deprivation and exactly how it affects specific body functions and systems.
In a nutshell, sleep deprivation is caused by consistent lack of sleep or reduced quality of sleep. Getting less than 7 hours of sleep on a regular basis can eventually lead to health consequences that affect your entire body. This may also be caused by an underlying sleep disorder.
Your body needs sleep, just as it needs air and food to function at its best. During sleep, your body heals itself and restores its chemical balance. Your brain forges new thought connections and helps memory retention.
Without enough sleep, your brain and body systems won’t function normally. It can also dramatically lower your quality of life.
Stimulants, such as caffeine, aren’t enough to override your body’s profound need for sleep. In fact, these can make sleep deprivation worse by making it harder to fall asleep at night.
This, in turn, may lead to a cycle of nighttime insomnia followed by daytime caffeine consumption to combat the tiredness caused by the lost hours of shut-eye.
Behind the scenes, chronic sleep deprivation can interfere with your body’s internal systems and cause more than just the initial signs and symptoms listed above.
Your central nervous system is the main information highway of your body. Sleep is necessary to keep it functioning properly, but chronic insomnia can disrupt how your body usually sends and processes information.
During sleep, pathways form between nerve cells (neurons) in your brain that help you remember new information you’ve learned. Sleep deprivation leaves your brain exhausted, so it can’t perform its duties as well.
You may also find it more difficult to concentrate or learn new things. The signals your body sends may also be delayed, decreasing your coordination and increasing your risk for accidents.
Sleep deprivation also negatively affects your mental abilities and emotional state. You may feel more impatient or prone to mood swings. It can also compromise decision-making processes and creativity.
If sleep deprivation continues long enough, you could start having hallucinations — seeing or hearing things that aren’t really there. A lack of sleep can also trigger mania in people who have bipolar mood disorder. Other psychological risks include:
You may also end up experiencing microsleep during the day. During these episodes, you’ll fall asleep for a few to several seconds without realizing it.
Microsleep is out of your control and can be extremely dangerous if you’re driving. It can also make you more prone to injury if you operate heavy machinery at work and have a microsleep episode.
While you sleep, your immune system produces protective, infection-fighting substances like antibodies and cytokines. It uses these substances to combat foreign invaders such as bacteria and viruses.
Certain cytokines also help you to sleep, giving your immune system more efficiency to defend your body against illness.
Sleep deprivation prevents your immune system from building up its forces. If you don’t get enough sleep, your body may not be able to fend off invaders, and it may also take you longer to recover from illness.
The relationship between sleep and the respiratory system goes both ways. A nighttime breathing disorder called obstructive sleep apnea (OSA) can interrupt your sleep and lower sleep quality.
As you wake up throughout the night, this can cause sleep deprivation, which leaves you more vulnerable to respiratory infections like the common cold and flu. Sleep deprivation can also make existing respiratory diseases worse, such as chronic lung illness.
HEALTHLINE CHALLENGEBuild a routine for better sleep
Most of what affects your sleep happens when it’s still light. Learn healthy habits for superior shut-eye in our 12-day Clean Up Your Sleep Challenge.Enter your emailJOIN IN
Along with eating too much and not exercising, sleep deprivation is another risk factor for becoming overweight and obese. Sleep affects the levels of two hormones, leptin and ghrelin, which control feelings of hunger and fullness.
Leptin tells your brain that you’ve had enough to eat. Without enough sleep, your brain reduces leptin and raises ghrelin, which is an appetite stimulant. The flux of these hormones could explain nighttime snacking or why someone may overeat later in the night.
A lack of sleep can also make you feel too tired to exercise. Over time, reduced physical activity can make you gain weight because you’re not burning enough calories and not building muscle mass.
Sleep deprivation also causes your body to release less insulin after you eat. Insulin helps to reduce your blood sugar (glucose) level.
Sleep deprivation also lowers the body’s tolerance for glucose and is associated with insulin resistance. These disruptions can lead to diabetes mellitus and obesity.
Sleep affects processes that keep your heart and blood vessels healthy, including those that affect your blood sugar, blood pressure, and inflammation levels. It also plays a vital role in your body’s ability to heal and repair the blood vessels and heart.
People who don’t sleep enough are more likely to get cardiovascular disease. One analysis linked insomnia to an increased risk of heart attack and stroke.
Hormone production is dependent on your sleep. For testosterone production, you need at least 3 hours of uninterrupted sleep, which is about the time of your first R.E.M. episode. Waking up throughout the night could affect hormone production.
This interruption can also affect growth hormone production, especially in children and adolescents. These hormones help the body build muscle mass and repair cells and tissues, in addition to other growth functions.
The pituitary gland releases growth hormone throughout each day, but adequate sleep and exercise also help the release of this hormone.
The most basic form of sleep deprivation treatment is getting an adequate amount of sleep, typically 7 to 9 hours each night.
This is often easier said than done, especially if you’ve been deprived of precious shut-eye for several weeks or longer. After this point, you may need help from your doctor or a sleep specialist who, if needed, can diagnose and treat a possible sleep disorder.
Sleep disorders may make it difficult to get quality sleep at night. They may also increase your risk for the above effects of sleep deprivation on the body.
The following are some of the most common types of sleep disorders:
To diagnose these conditions, your doctor may order a sleep study. This is traditionally conducted at a formal sleep center, but now there are options to measure your sleep quality at home, too.
If you’re diagnosed with a sleep disorder, you may be given medication or a device to keep your airway open at night (in the case of obstructive sleep apnea) to help combat the disorder so you can get a better night’s sleep on a regular basis.
The best way to prevent sleep deprivation is to make sure you get adequate sleep. Follow the recommended guidelines for your age group, which is 7 to 9 hours for most adults ages 18 to 64.
Other ways you can get back on track with a healthy sleep schedule include:
limiting daytime naps (or avoiding them altogether)
refraining from caffeine past noon or at least a few hours prior to bedtime
going to bed at the same time each night
waking up at the same time every morning
sticking to your bedtime schedule during weekends and holidays
spending an hour before bed doing relaxing activities, such as reading, meditating, or taking a bath
avoiding heavy meals within a few hours before bedtime
refraining from using electronic devices right before bed
exercising regularly, but not in the evening hours close to bedtime
reducing alcohol intake
If you continue to have problems sleeping at night and are fighting daytime fatigue, talk to your doctor. They can test for underlying health conditions that might be getting in the way of your sleep schedule.
It’s no secret that sleep is essential for a number of our body’s functions—from cellular repair to muscle growth and, of course, brain health. And one study published in the journal Nature Communications just put forward some new evidence on the link between sleep duration and dementia risk in middle-aged adults. Here’s what it found.
Studying the connection between dementia and sleep.
This research analyzed existing data from a long-term study on nearly 8,000 British people since 1985, conducted by University College London. As part of the research project, participants reported how long they slept multiple times over 25 years. Some of them also wore sleep-tracking devices to make sure they were giving accurate numbers on their sleep duration.
A team of researchers then looked for any correlation between poor sleep and a greater risk for dementia down the line.
Researchers have long suspected that there is a link between sleep and dementia risk, but they’ve been unsure where that link begins. That is, we don’t know if a lack of sleep can predispose people to dementia or if dementia throws off people’s sleep.
The important thing about this study is that it started following the sleep patterns of people who were in their 50s, presumably before dementia had set in.
What they found.
Sure enough, a correlation was found—though the study authors are careful to note their research still can’t prove a direct cause-and-effect relationship between sleep and dementia.
That said, within the group of almost 8,000 participants, researchers found that middle-aged adults who consistently clocked low sleep durations were 30% more likely to develop dementia—regardless of sociodemographic, behavioral, cardiometabolic, and mental health factors.
The study authors considered seven hours to be a normal sleep duration, compared to six hours or less, which was considered short.
The takeaway:
While the jury is still out on whether this connection is a direct cause-and-effect, it’s certainly a good reason to consider getting at least seven hours of sleep per night, particularly if you’re in your 50s or 60s and/or have a history of dementia in your family.
The study authors note that more research is needed to better understand the relationship between sleep and dementia risk, but given how important sleep is for so many bodily functions, there’s really no reason not to aim for a full night of quality sleep, every night.
Insomnia, disrupted sleep, and daily burnout are linked to a heightened risk of not only becoming infected with coronavirus, but also having more severe disease and a longer recovery period, suggests an international study of healthcare workers, published in the online journal BMJ Nutrition Prevention & Health.
Every 1-hour increase in the amount of time spent asleep at night was associated with 12% lower odds of becoming infected with COVID-19, the findings indicate.
Disrupted/insufficient sleep and work burnout have been linked to a heightened risk of viral and bacterial infections, but it’s not clear if these are also risk factors for COVID-19, say the researchers.
To explore this further, they drew on the responses to an online survey for healthcare workers repeatedly exposed to patients with COVID-19 infection, such as those working in emergency or intensive care, and so at heightened risk of becoming infected themselves.
The survey ran from 17 July to 25 September 2020, and was open to healthcare workers in France, Germany, Italy, Spain, the UK, and the USA.
Respondents provided personal details on lifestyle, health, and use of prescription meds and dietary supplements plus information on the amount of sleep they got at night and in daytime naps over the preceding year; any sleep problems; burnout from work; and workplace exposure to COVID-19 infection.
Some 2884 healthcare workers responded, 568 of whom had COVID-19, ascertained either by self-reported diagnostic symptoms and/or a positive swab test result.
Infection severity was defined as: very mild – no or hardly any symptoms; mild – fever with or without cough, requiring no treatment; moderate – fever, respiratory symptoms and/or pneumonia; severe – breathing difficulties and low oxygen saturation; and critical – respiratory failure requiring mechanical assistance and intensive care.
The amount of reported nightly sleep averaged under 7 hours, but more than 6. After accounting for potentially influential factors, every extra hour of sleep at night was associated with 12% lower odds of COVID-19 infection.
But an extra hour acquired in daytime napping was associated with 6% higher odds, although this association varied by country.
Around 1 in 4 (137;24%) of those with COVID-19 reported difficulties sleeping at night compared with around 1 in 5 (21%;495) of those without the infection.
And 1 in 20 (5%;28) of those with COVID-19 said they had 3 or more sleep problems, including difficulties falling asleep, staying asleep, or needing to use sleeping pills on 3 or more nights of the week, compared with 65 (3%) of those without the infection.
Compared with those who had no sleep problems, those with three had 88% greater odds of COVID-19 infection.
Proportionally more of those with COVID-19 reported daily burnout than did those without the infection: 31 (5.5%) compared with 71 (3%).
Compared with those who didn’t report any burnout, those for whom this was a daily occurrence were more than twice as likely to have COVID-19. Similarly, these respondents were also around 3 times as likely to say that their infection was severe and that they needed a longer recovery period.
These findings held true, irrespective of the frequency of COVID-19 workplace exposure.
This is an observational study, and as such, can’t establish cause. And the researchers acknowledge several limitations to their study.
These include subjective assessment of exposure levels, sleep issues, and infection severity, all of which may have been incorrectly remembered. And the sample included only cases of very mild to moderately severe COVID-19.
By way of an explanation for their findings, the researchers note: “The mechanism underlying these associations remains unclear, but it has been hypothesized that lack of sleep and sleep disorders may adversely influence the immune system by increasing proinflammatory cytokines and histamines.”
And they point to studies linking burnout to a heightened risk of colds and flu as well as long term conditions, such as diabetes, cardiovascular disease, musculoskeletal disease and death from all causes.
“These studies have suggested that burnout may directly or indirectly predict illnesses by occupational stress impairing the immune system and changing cortisol levels,” they write.
And they conclude:”We found that lack of sleep at night, severe sleep problems and high level of burnout may be risk factors for COVID-19 in frontline [healthcare workers]. Our results highlight the importance of healthcare professionals’ well-being during the pandemic.”
