Sleep and Sleep Disorders in Depression

  • Seung-Gul Kang
  • Heon-Jeong Lee
  • Leen Kim
  • John Weyl Winkelman
Chapter

Abstract

Disturbances of the sleep-wake cycle are very common in depression and serve as a sensitive biological marker of brain function. Insomnia and hypersomnia not only are some of the main symptoms of depression but also are diagnostic criteria of depression in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. These symptoms also influence the quality of life and long-term prognosis of patients with depression. In addition to sleep disturbance as symptoms of depression, primary sleep disorders are frequently comorbid with depression. Therefore, differential diagnosis and management of these conditions are important in the clinic. Sleep disturbances might be used as a biological marker for the occurrence, treatment response, and relapse of depression. The most typical sleep architecture changes in depression are an increase in rapid eye movement (REM) density and a decrease in slow-wave sleep. This REM sleep disinhibition in depression may be related to a predominance of cholinergic activity relative to monoaminergic activity. For patients with depression who experience insomnia, antidepressants, hypnotics, and cognitive behavioral therapy can be used effectively to relieve insomnia. However, since pharmacotherapy for depression and insomnia might degrade sleep quality and/or cause (or aggravate) obstructive sleep apnea, restless legs syndrome, and REM sleep behavior disorder, medication should be used cautiously.

Keywords

Sleep Insomnia Hypersomnia Depression REM sleep CBT-I Pharmacotherapy 

Notes

Acknowledgment

This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (NRF-2017R1D1A1B03032431).

References

  1. Abad VC, Guilleminault C. Sleep and psychiatry. Dialogues Clin Neurosci. 2005;7:291–303.PubMedPubMedCentralGoogle Scholar
  2. Achermann P, Borbely AA. Dynamics of EEG slow wave activity during physiological sleep and after administration of benzodiazepine hypnotics. Hum Neurobiol. 1987;6:203–10.PubMedGoogle Scholar
  3. Aizawa H, Cui W, Tanaka K, Okamoto H. Hyperactivation of the habenula as a link between depression and sleep disturbance. Front Hum Neurosci. 2013;7:826.CrossRefGoogle Scholar
  4. American Psychiatric Association. Diagnostic criteria from DSM-IV-TR. Washington: American Psychiatric Association; 2000.Google Scholar
  5. Baglioni C, Battagliese G, Feige B, Spiegelhalder K, Nissen C, Voderholzer U, et al. Insomnia as a predictor of depression: a meta-analytic evaluation of longitudinal epidemiological studies. J Affect Disord. 2011;135:10–9.CrossRefGoogle Scholar
  6. Benca RM, Peterson MJ. Insomnia and depression. Sleep Med. 2008;9(Suppl 1):S3–9.CrossRefGoogle Scholar
  7. Benedetti F, Colombo C. Sleep deprivation in mood disorders. Neuropsychobiology. 2011;64:141–51.CrossRefGoogle Scholar
  8. Benedetti F, Colombo C, Serretti A, Lorenzi C, Pontiggia A, Barbini B, et al. Antidepressant effects of light therapy combined with sleep deprivation are influenced by a functional polymorphism within the promoter of the serotonin transporter gene. Biol Psychiatry. 2003;54:687–92.CrossRefGoogle Scholar
  9. Bootzin RR, Smith LJ, Franzen PL, Shapiro SL. Stimulus control therapy. In: Sateia DJ, Buysse DJ, editors. Insomnia: diagnosis and treatment. London: Informa Healthcare; 2010. p. 268–76.CrossRefGoogle Scholar
  10. Borbely AA. The S-deficiency hypothesis of depression and the two-process model of sleep regulation. Pharmacopsychiatry. 1987;20:23–9.CrossRefGoogle Scholar
  11. Bunney JN, Potkin SG. Circadian abnormalities, molecular clock genes and chronobiological treatments in depression. Br Med Bull. 2008;86:23–32.CrossRefGoogle Scholar
  12. Buysse DJ, Frank E, Lowe KK, Cherry CR, Kupfer DJ. Electroencephalographic sleep correlates of episode and vulnerability to recurrence in depression. Biol Psychiatry. 1997;41:406–18.CrossRefGoogle Scholar
  13. Buysse DJ, Hall M, Begley A, Cherry CR, Houck PR, Land S, et al. Sleep and treatment response in depression: new findings using power spectral analysis. Psychiatry Res. 2001;103:51–67.CrossRefGoogle Scholar
  14. Carney CE, Edinger JD, Manber R, Garson C, Segal ZV. Beliefs about sleep in disorders characterized by sleep and mood disturbance. J Psychosom Res. 2007;62:179–88.CrossRefGoogle Scholar
  15. Clark CP, Gillin JC, Golshan S, Demodena A, Smith TL, Danowski S, et al. Increased REM sleep density at admission predicts relapse by three months in primary alcoholics with a lifetime diagnosis of secondary depression. Biol Psychiatry. 1998;43:601–7.CrossRefGoogle Scholar
  16. Dauvilliers Y, Lopez R, Ohayon M, Bayard S. Hypersomnia and depressive symptoms: methodological and clinical aspects. BMC Med. 2013;11:78.CrossRefGoogle Scholar
  17. Edinger JD, Olsen MK, Stechuchak KM, Means MK, Lineberger MD, Kirby A, et al. Cognitive behavioral therapy for patients with primary insomnia or insomnia associated predominantly with mixed psychiatric disorders: a randomized clinical trial. Sleep. 2009;32:499–510.CrossRefGoogle Scholar
  18. Espie CA. Cognitive behaviour therapy as the treatment of choice for primary insomnia. Philadelphia: WB Saunders; 1999.Google Scholar
  19. Ferrari AJ, Somerville AJ, Baxter AJ, Norman R, Patten SB, Vos T, et al. Global variation in the prevalence and incidence of major depressive disorder: a systematic review of the epidemiological literature. Psychol Med. 2013;43:471–81.CrossRefGoogle Scholar
  20. Foley D, Ancoli-Israel S, Britz P, Walsh J. Sleep disturbances and chronic disease in older adults: results of the 2003 National Sleep Foundation Sleep in America Survey. J Psychosom Res. 2004;56:497–502.CrossRefGoogle Scholar
  21. Franzen PL, Buysse DJ. Sleep disturbances and depression: risk relationships for subsequent depression and therapeutic implications. Dialogues Clin Neurosci. 2008;10:473.PubMedPubMedCentralGoogle Scholar
  22. Gelenberg AJ. The prevalence and impact of depression. J Clin Psychiatry. 2010;71:e06.PubMedGoogle Scholar
  23. Giedke H, Schwarzler F. Therapeutic use of sleep deprivation in depression. Sleep Med Rev. 2002;6:361–77.CrossRefGoogle Scholar
  24. Gillin JC, Sutton L, Ruiz C, Kelsoe J, Dupont RM, Darko D, et al. The cholinergic rapid eye movement induction test with arecoline in depression. Arch Gen Psychiatry. 1991;48:264–70.CrossRefGoogle Scholar
  25. Hajak G, Landgrebe M. Time and depression: when the internal clock does not work. Medicographia. 2010;32:146–51.Google Scholar
  26. Hamoen AB, Redlich EM, de Weerd AW. Effectiveness of cognitive behavioral therapy for insomnia: influence of slight-to-moderate depressive symptom severity and worrying. Depress Anxiety. 2014;31:662–8.CrossRefGoogle Scholar
  27. Haynes P. Application of cognitive behavioral therapies for comorbid insomnia and depression. Sleep Med Clin. 2015;10:77–84.CrossRefGoogle Scholar
  28. Haynes PL, Kelly M, Warner L, Quan SF, Krakow B, Bootzin RR. Cognitive behavioral social rhythm group therapy for veterans with posttraumatic stress disorder, depression, and sleep disturbance: results from an open trial. J Affect Disord. 2016;192:234–43.CrossRefGoogle Scholar
  29. Holsboer F. The corticosteroid receptor hypothesis of depression. Neuropsychopharmacology. 2000;23:477–501.CrossRefGoogle Scholar
  30. Hu XZ, Rush AJ, Charney D, Wilson AF, Sorant AJ, Papanicolaou GJ, et al. Association between a functional serotonin transporter promoter polymorphism and citalopram treatment in adult outpatients with major depression. Arch Gen Psychiatry. 2007;64:783–92.CrossRefGoogle Scholar
  31. Iovieno N, van Nieuwenhuizen A, Clain A, Baer L, Nierenberg AA. Residual symptoms after remission of major depressive disorder with fluoxetine and risk of relapse. Depress Anxiety. 2011;28:137–44.CrossRefGoogle Scholar
  32. Janowsky DS, el-Yousef MK, Davis JM, Sekerke HJ. A cholinergic-adrenergic hypothesis of mania and depression. Lancet. 1972;2:632–5.CrossRefGoogle Scholar
  33. Jindal RD, Thase ME. Treatment of insomnia associated with clinical depression. Sleep Med Rev. 2004;8:19–30.CrossRefGoogle Scholar
  34. Jindal RD, Fasiczka AL, Himmelhoch JM, Mallinger AG, Thase ME. Effects of tranylcypromine on the sleep of patients with anergic bipolar depression. Psychopharmacol Bull. 2003;37:118–26.PubMedGoogle Scholar
  35. Johnson EO, Roth T, Breslau N. The association of insomnia with anxiety disorders and depression: exploration of the direction of risk. J Psychiatr Res. 2006;40:700–8.CrossRefGoogle Scholar
  36. Jouvet M. The role of monoamines and acetylcholine-containing neurons in the regulation of the sleep-waking cycle. In: Neurophysiology and neurochemistry of sleep and wakefulness. Berlin: Springer; 1972. p. 166–307.Google Scholar
  37. Ju YE, Larson-Prior L, Duntley S. Changing demographics in REM sleep behavior disorder: possible effect of autoimmunity and antidepressants. Sleep Med. 2011;12:278–83.CrossRefGoogle Scholar
  38. Kamba M, Suto Y, Ohta Y, Inoue Y, Matsuda E. Cerebral metabolism in sleep apnea. Evaluation by magnetic resonance spectroscopy. Am J Respir Crit Care Med. 1997;156:296–8.CrossRefGoogle Scholar
  39. Kaplan KA, Harvey AG. Hypersomnia across mood disorders: a review and synthesis. Sleep Med Rev. 2009;13:275–85.CrossRefGoogle Scholar
  40. Kupfer DJ, Ehlers CL, Pollock BG, Nathan RS, Perel JM. Clomipramine and EEG sleep in depression. Psychiatry Res. 1989;30:165–80.CrossRefGoogle Scholar
  41. Kupfer DJ, Frank E, McEachran AB, Grochocinski VJ. Delta sleep ratio. A biological correlate of early recurrence in unipolar affective disorder. Arch Gen Psychiatry. 1990;47:1100–5.CrossRefGoogle Scholar
  42. Kurian BT, Greer TL, Trivedi MH. Strategies to enhance the therapeutic efficacy of antidepressants: targeting residual symptoms. Expert Rev Neurother. 2009;9:975–84.CrossRefGoogle Scholar
  43. Landolt HP, Finelli LA, Roth C, Buck A, Achermann P, Borbely AA. Zolpidem and sleep deprivation: different effect on EEG power spectra. J Sleep Res. 2000;9:175–83.CrossRefGoogle Scholar
  44. Lauer CJ, Schreiber W, Holsboer F, Krieg JC. In quest of identifying vulnerability markers for psychiatric disorders by all-night polysomnography. Arch Gen Psychiatry. 1995;52:145–53.CrossRefGoogle Scholar
  45. Lipford MC, Ramar K, Liang YJ, Lin CW, Chao YT, An J, et al. Serotnin as a possible biomarker in obstructive sleep apnea. Sleep Med Rev. 2016;28:125–32.CrossRefGoogle Scholar
  46. Mahlknecht P, Seppi K, Frauscher B, Kiechl S, Willeit J, Stockner H, et al. Probable RBD and association with neurodegenerative disease markers: a population-based study. Mov Disord. 2015;30:1417–21.CrossRefGoogle Scholar
  47. Manber R, Edinger JD, Gress JL, San Pedro-Salcedo MG, Kuo TF, Kalista T. Cognitive behavioral therapy for insomnia enhances depression outcome in patients with comorbid major depressive disorder and insomnia. Sleep. 2008;31:489–95.CrossRefGoogle Scholar
  48. McCarley RW. REM sleep and depression: common neurobiological control mechanisms. Am J Psychiatry. 1982;139:565–70.CrossRefGoogle Scholar
  49. Murck H, Nickel T, Kunzel H, Antonijevic IA, Schill J, Zobel A, et al. State markers of depression in sleep EEG: dependency on drug and gender in patients treated with tianeptine or paroxetine. Neuropsychopharmacology. 2003;28:348–58.CrossRefGoogle Scholar
  50. Murphy MJ, Peterson MJ. Sleep disturbances in depression. Sleep Med Clin. 2015;10:17–23.CrossRefGoogle Scholar
  51. Nowell PD, Reynolds CF 3rd, Buysse DJ, Dew MA, Kupfer DJ. Paroxetine in the treatment of primary insomnia: preliminary clinical and electroencephalogram sleep data. J Clin Psychiatry. 1999;60:89–95.CrossRefGoogle Scholar
  52. Ohayon MM. Narcolepsy is complicated by high medical and psychiatric comorbidities: a comparison with the general population. Sleep Med. 2013;14:488–92.CrossRefGoogle Scholar
  53. Pace-Schott EF, Hobson JA. The neurobiology of sleep: genetics, cellular physiology and subcortical networks. Nat Rev Neurosci. 2002;3:591–605.CrossRefGoogle Scholar
  54. Palagini L, Baglioni C, Ciapparelli A, Gemignani A, Riemann D. REM sleep dysregulation in depression: state of the art. Sleep Med Rev. 2013;17:377–90.CrossRefGoogle Scholar
  55. Perlis ML, Smith MT, Jungquist C, Nowakowski H, Orff H, Soeffing J. Cognitive-behavioral therapy for insomnia. In: Attarian HP, Schuman C, editors. Clinical handbook of insomnia. New York: Humana Press; 2010.Google Scholar
  56. Peterson MJ, Benca RM. Sleep in mood disorders. Sleep Med Clin. 2008;3:231–49.CrossRefGoogle Scholar
  57. Picchietti D, Winkelman JW. Restless legs syndrome, periodic limb movements in sleep, and depression. Sleep. 2005;28:891–8.PubMedGoogle Scholar
  58. Quera-Salva MA, Lemoine P, Guilleminault C. Impact of the novel antidepressant agomelatine on disturbed sleep-wake cycles in depressed patients. Hum Psychopharmacol. 2010;25:222–9.CrossRefGoogle Scholar
  59. Reynolds CF 3rd, Kupfer DJ, Taska LS, Hoch CC, Sewitch DE, Restifo K, et al. Sleep apnea in Alzheimer’s dementia: correlation with mental deterioration. J Clin Psychiatry. 1985;46:257–61.PubMedGoogle Scholar
  60. Riemann D, Berger M. Sleep, age, depression and the cholinergic REM induction test with RS 86. Prog Neuro-Psychopharmacol Biol Psychiatry. 1992;16:311–6.CrossRefGoogle Scholar
  61. Schroder CM, O'Hara R. Depression and obstructive sleep apnea (OSA). Ann General Psychiatry. 2005;4:13.CrossRefGoogle Scholar
  62. Serretti A, Cusin C, Benedetti F, Mandelli L, Pirovano A, Zanardi R, et al. Insomnia improvement during antidepressant treatment and CLOCK gene polymorphism. Am J Med Genet B Neuropsychiatr Genet. 2005;137B:36–9.CrossRefGoogle Scholar
  63. Steiger A, Kimura M. Wake and sleep EEG provide biomarkers in depression. J Psychiatr Res. 2010;44:242–52.CrossRefGoogle Scholar
  64. Teman PT, Tippmann-Peikert M, Silber MH, Slocumb NL, Auger RR. Idiopathic rapid-eye-movement sleep disorder: associations with antidepressants, psychiatric diagnoses, and other factors, in relation to age of onset. Sleep Med. 2009;10:60–5.CrossRefGoogle Scholar
  65. Thase ME, Buysse DJ, Frank E, Cherry CR, Cornes CL, Mallinger AG, et al. Which depressed patients will respond to interpersonal psychotherapy? The role of abnormal EEG sleep profiles. Am J Psychiatry. 1997;154:502–9.CrossRefGoogle Scholar
  66. Vgontzas AN, Chrousos GP. Sleep, the hypothalamic-pituitary-adrenal axis, and cytokines: multiple interactions and disturbances in sleep disorders. Endocrinol Metab Clin N Am. 2002;31:15–36.CrossRefGoogle Scholar
  67. Vogel GW, Buffenstein A, Minter K, Hennessey A. Drug effects on REM sleep and on endogenous depression. Neurosci Biobehav Rev. 1990;14:49–63.CrossRefGoogle Scholar
  68. Watanabe N, Furukawa TA, Shimodera S, Morokuma I, Katsuki F, Fujita H, et al. Brief behavioral therapy for refractory insomnia in residual depression: an assessor-blind, randomized controlled trial. J Clin Psychiatry. 2011;72:1651–8.CrossRefGoogle Scholar
  69. Wheaton AG, Perry GS, Chapman DP, Croft JB. Sleep disordered breathing and depression among U.S. adults: National Health and Nutrition Examination Survey, 2005-2008. Sleep. 2012;35:461–7.CrossRefGoogle Scholar
  70. Wichniak A, Riemann D, Kiemen A, Voderholzer U, Jernajczyk W. Comparison between eye movement latency and REM sleep parameters in major depression. Eur Arch Psychiatry Clin Neurosci. 2000;250:48–52.CrossRefGoogle Scholar
  71. Wichniak A, Wierzbicka A, Jernajczyk W. Sleep and antidepressant treatment. Curr Pharm Des. 2012;18:5802–17.CrossRefGoogle Scholar
  72. Wichniak A, Wierzbicka A, Jernajczyk W. Sleep as a biomarker for depression. Int Rev Psychiatry. 2013;25:632–45.CrossRefGoogle Scholar
  73. Wilson S, Argyropoulos S. Antidepressants and sleep: a qualitative review of the literature. Drugs. 2005;65:927–47.CrossRefGoogle Scholar
  74. Winkelman JW, James L. Serotonergic antidepressants are associated with REM sleep without atonia. Sleep. 2004;27:317–21.CrossRefGoogle Scholar
  75. Wu JC, Bunney WE. The biological basis of an antidepressant response to sleep deprivation and relapse: review and hypothesis. Am J Psychiatry. 1990;147:14–21.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  • Seung-Gul Kang
    • 1
  • Heon-Jeong Lee
    • 2
  • Leen Kim
    • 2
  • John Weyl Winkelman
    • 3
  1. 1.Department of Psychiatry, Gil Medical Center, College of MedicineGachon UniversityIncheonSouth Korea
  2. 2.Department of PsychiatryKorea University Medical Center, Korean University College of MedicineSeoulSouth Korea
  3. 3.Departments of Psychiatry and NeurologyMassachusetts General Hospital, Harvard Medical SchoolBostonUSA

Personalised recommendations